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Indiana Healthcare Fraud Defense Lawyers

For healthcare providers in Indianapolis, Bloomington, South Bend, and other parts of Indiana, federal healthcare fraud investigations can lead to fines, program exclusion, prison time, and other penalties. To protect yourself and your business or practice, call Oberheiden, P.C. at 888-680-1745 today.

Federal authorities are targeting Indiana healthcare providers in civil and criminal fraud investigations. Often alleging offenses such as double-billing, improperly dispensing opioid medications, and offering or accepting illegal kickbacks or referral fees, agents and prosecutors from the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other agencies are contacting providers with target letters, civil investigative demands, and subpoenas, and they are looking for any justification to file civil or criminal charges.

As a healthcare provider in Indiana, what does this mean for you? Most immediately, it means that you need to be aware of the risk of a federal investigation. You need to understand that federal agents may come knocking at your door (literally or figuratively); and, when they do, you need to be prepared to defend yourself by all means available.

Federal Defense Lawyers for Medical Practitioners, Business Owners, and Others Accused of Healthcare Fraud

At Oberheiden, P.C., our Indiana healthcare fraud defense attorneys are committed to defending physicians, pharmacists, clinic and laboratory owners, healthcare company executives, and other clients in federal healthcare fraud investigations. While Medicare and Medicaid fraud are undoubtedly serious issues that cost the federal government billions of dollars each year, not all allegations of Medicare and Medicaid fraud are justified. Frequently, the government’s reliance on data analysis and whistleblower allegations leads to misguided enforcement efforts, and the providers targeted in these efforts must justify their billing practices in order to avoid prosecution.

With our attorneys’ extensive experience as defense attorneys and former federal healthcare fraud prosecutors with the DOJ, we have amassed a substantial track record of defending providers in DEA, DOJ, and OIG investigations. We have successfully represented clients in numerous investigations involving the Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), and other agencies as well, and we have also secured numerous favorable verdicts at trial. Regardless of the current status of your case, and regardless of whether you have a clear understanding of why you are being targeted (initially, many of our clients do not), we can help, and we encourage you to contact us promptly for a free and confidential case assessment.

Are you facing a healthcare fraud audit or investigation in Indiana? Call 888-519-4897 now to speak with our Indiana healthcare fraud defense lawyer in confidence.

Trusted Attorneys for Federal Healthcare Fraud Investigations in Indiana

While every case involves unique aspects, the DEA, DOJ, FBI, IRS, and OIG commonly target healthcare providers with similar allegations. For example, we routinely represent clients accused of improper and illegal practices including:

1. Billing and Coding Errors

Billing and coding errors include submitting the wrong billing code, “upcoding” services and supplies, “unbundling” services and supplies, and double-billing the federal government and/or a private insurer. Alleged billing and coding errors are at the center of many healthcare fraud investigations, and our attorneys are intimately familiar with the rules and regulations that govern providers’ participation in Medicare, Medicaid, Tricare, and the Department of Labor’s (DOL) healthcare benefit program.

2. Kickbacks, Bribes, and Rebates

In certain circumstances, healthcare providers may unknowingly enter into commercial transactions and business relationships that facially violate the federal Anti-Kickback Statute. This statute makes it a federal offense to accept any kickback, bribe, rebate, or other form of “remuneration” in exchange for a referral for program-reimbursed services.

However, in many cases, these providers will also qualify for protection under one of the Anti-Kickback Statute’s “safe harbor” provisions. These provisions permit certain specified transactions and relationships that would otherwise violate the statute’s broad prohibitory language. We have successfully defended numerous clients in Anti-Kickback Statute investigations, in many cases by demonstrating that one of the statute’s safe harbors applies.

3. Physician Self-Referrals

Physicians and their related entities can also face investigations as a result of alleged “physician self-referrals.” These transactions are prohibited under the federal Stark Law with respect to certain “designated health services” that are reimbursable under Medicare or Medicaid. Designated health services under the Stark Law include:

  • Clinical laboratory service
  • Physical therapy services
  • Occupational therapy services
  • Outpatient speech-language pathology services
  • Radiology and certain other imaging services
  • Radiation therapy services and supplies
  • Durable medical equipment and supplies
  • Parenteral and enteral nutrients, equipment, and supplies
  • Prosthetics, orthotics, and prosthetic devices and supplies
  • Home health services
  • Outpatient prescription drugs
  • Inpatient and outpatient hospital services

4. False and Fraudulent Claims

The broadest category of healthcare-related offenses consists of the submission of “false and fraudulent” claims for federal program reimbursement. The False Claims Act prohibits all improper reimbursement requests, and it imposes criminal penalties for intentional billing fraud. Even providers who unintentionally overbill Medicare, Medicaid, Tricare, or the DOL can face civil penalties, including fines, recoupment, treble damages, pre-payment review, and program exclusion.

5. Billing for Medically-Unnecessary Services, Supplies, or Equipment

Billing for services, supplies, or equipment deemed not medically-necessary under the applicable program guidelines can result in investigation and prosecution under the False Claims Act and/or the federal healthcare fraud statute. If federal authorities are questioning the soundness of your independent medical judgment, our Indiana healthcare fraud defense lawyers can use their vast experience in similar matters to help demonstrate the validity of your program billings.

6. Billing for Services, Supplies, or Equipment Not Provided

Billing for services, supplies, or equipment not provided can be prosecuted as a False Claims Act and/or healthcare fraud statute violation as well. While some providers may intentionally engage in such “phantom billing” practices, it is far more common for these allegations to result from administrative errors or federal authorities’ misinterpretation of providers’ patient and billing records.

7. Prescription Drug Fraud

Prescription drug fraud investigations often involve multiple federal law enforcement agencies, and they can lead to drastic consequences for prescribing physicians, pharmacy owners, and other healthcare providers. We have extensive experience in prescription drug fraud cases involving opioids and other medications; and, if your practice is under investigation, we can help you avoid dangerous and unnecessary consequences.

8. Falsifying Patient Records and Inaccurately Reporting Test Results

Allegations of falsifying patient records and inaccurately reporting test results are commonly the result of misguided assumptions and oversights during the investigative process as well. We can review the totality of your practice’s patient and billing records to set the record straight; and, if there are mistakes that need to be addressed, we can help you demonstrate good-faith efforts at compliance.

9. Fraudulent Physician Certifications and Election Statements

For hospices and physicians who certify patients for hospice care, allegations of forging and preparing fraudulent physician certifications and election statements can lead to severe penalties. We have successfully defended numerous hospices and physicians in these types of cases, and we can use this experience to your advantage.

10. Tax Evasion and Other Related Federal Offenses

In many cases, in addition to targeting providers with healthcare-specific allegations, federal agents and prosecutors will seek to charge providers with various other offenses as well. In addition to defending providers against charges of healthcare fraud, we also provide aggressive representation for defense of tax evasion, mail fraud, wire fraud, money laundering, conspiracy, and other related allegations.

Indiana Healthcare Fraud Defense Lawyers

Frequently Asked Questions

What is the Anti-Kickback Statute?


The Anti-Kickback Statute is a federal government law that places limits on anyone’s ability to pay or receive a referral incentive for referring a patient whose medical bills are covered by a federally funded program. In the healthcare context, most often, the Anti-Kickback Statute involves patients receiving Medicare or Medicaid benefits. The Anti-Kickback statute is codified in 42 U.S.C. §1320a–7b and is a criminal law statute. Thus, unlike many other healthcare fraud statutes, a violation of the Anti-Kickback Statute can result in a prison sentence, with each offense carrying a maximum of five years in federal prison and a fine of up to $25,000 per violation. However, to prove a violation of the Anti-Kickback Statute, federal prosecutors must show that you knowingly and willfully participated in the referral arrangement. Many defenses to AKS violations are based on a provider’s lack of “guilty knowledge.” If you are under investigation for a violation of the Anti-Kickback Statute, protect yourself by immediately reaching out to an Indiana federal healthcare defense attorney.

When should I contact an Indiana federal healthcare defense attorney?


As soon as possible. If you are fortunate enough to learn of the investigation before any charges have been filed, reaching out to an attorney immediately may give your attorney the possibility of avoiding charges altogether. However, if charges have been filed, there is no question that you need to immediately contact an attorney. Often, by the time you learn of an investigation, the federal government has already put a case against you together, meaning you are playing catch-up. While there are many defenses to healthcare fraud allegations, the more time your Indiana federal healthcare defense attorney has to develop a compelling defense, the better the likelihood of success.

What is the difference between the Anti-Kickback Statute and the Stark Law?


Both the Anti-Kickback Statute and the Stark Law limit a provider’s ability to receive referral payments. However, the two laws are very different in several respects. The Anti-Kickback Statute is a criminal law that prohibits providers from receiving or paying anything of value for referring a patient whose medical bills are covered under a federal program, such as Medicaid or Medicare. The Stark Law, on the other hand, applies to all patients—even those who do not receive government benefits. Additionally, the Stark Law limits the situations in which a provider refers patients to another practice in which the referring party has a financial interest. Both statutes can result in significant civil liability, however, only the Anti-Kickback Statute carries the possibility of criminal sanctions. If you are under investigation for healthcare fraud, contact an experienced Indiana federal healthcare fraud defense attorney immediately to protect your interests.

Additional Resources for Indiana Healthcare Providers Facing DEA, DOJ, FBI, IRS, and OIG Investigations

For healthcare providers targeted in audits and investigations, understanding the substantive and procedural issues involved in these proceedings is critical to making informed decisions. To learn more about what you need to know, we encourage you to read these articles written by our Indiana healthcare fraud defense attorneys:

Schedule a Confidential Initial Case Assessment at Oberheiden, P.C.

If your Indiana healthcare practice or medical business is under investigation by the DEA, DOJ, FBI, IRS, OIG, or another federal agency, it is important that you seek legal representation immediately. To discuss your case, contact an Indiana healthcare fraud defense attorney at Oberheiden, P.C., call 888-680-1745 or request an appointment online now.

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  • Former Federal Prosecutors, U.S. Attorney’s Office
  • Former Agents from FBI, OIG, DEA
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