Indianapolis, Indiana Health Care Fraud Defense
Aggressive Health Care Fraud Defense Attorneys for Indianapolis, Indiana
Medical providers in Indianapolis and surrounding communities must expect dramatically increased scrutiny and prosecutions from federal law enforcement agencies. Since late 2017, when the Attorney General of the United States, Jeff Sessions, announced a national combat against health care fraud and abuse and instructed federal prosecutors to aggressively pursue Medicare Fraud, Medicaid Fraud, and violations of the Controlled Substances Act, it is no longer a secret that Indianapolis is one of the epicenters of this new wave of prosecution. FBI, DEA, and Department of Justice prosecutors throughout Indiana have noticeable expanded their investigations to arrest and prosecute health care providers and business owners. In this climate of investigations, experienced and reliable legal advice becomes a fundamental decision that may decide between criminal immunity and incarceration.
About Oberheiden, P.C.
Oberheiden, P.C. is a team of health care fraud defense attorneys and former federal prosecutors who represent Indianapolis medical providers in federal health audits, fraud investigations, and federal criminal defense cases. As former Department of Justice officials and former federal health fraud prosecutors, our attorneys offer clients decades of real life experience when it comes to audits, investigations, and criminal defense in health care cases.
This is who we are:
- Former Department of Justice Trial Attorneys
- Former Assistant United States Attorneys
- Former Federal Health Care Fraud Prosecutors
- Experience of More than 1,000 Federal Health Care Fraud Cases
- Dismissed Federal Indictments
- Avoided Criminal Charges in the Majority of Cases
- Handled More than 1,000 Grand Jury Subpoenas
- Unmatched Trial Record Exceeding 500 Criminal Trials
- 70 Years of Department of Justice Experience
We have successfully represented physicians, pain management specialists, pharmacies, toxicology laboratories, DME companies, home health and hospice agencies, and many more against alleged violations of the Controlled Substances Act, Medicare Fraud, Medicaid Fraud, the Anti-Kickback Statute, and fraud of private insurance plans. Do not hesitate to call right away if you want a former lead prosecutor to assess your case—free of charge and absolutely confidential.
“Our companies have worked with firms all over the country within various specialties and now use [Oberheiden, P.C.] almost exclusively. Nick represented our companies in some federal law investigations. His guidance and expertise allowed us to continue to concentrate on our core business as he dealt with the complex legal issues.” – Satisfied Client“The very best!”
“I hired Nick Oberheiden and Oberheiden, P.C. to defend me in a criminal health care matter. From the first moment I met with Nick[,] my wife and I knew that he [would provide] the help I need[ed]. And yes, Nick got me out of trouble. No charges. Case Dismissed.” – Satisfied Client
Indianapolis, and Indiana Health Care Companies are Being Targeted in Federal Fraud Investigations
Various federal agencies such as the U.S. Department of Health & Human Services’ (HHS), the Office of Inspector General (OIG), the Drug Enforcement Administration (DEA), and the Federal Bureau of Investigation (FBI) have elevated Indianapolis to one of the centers of Medicare fraud enforcement. Local providers and health care entities must remain very vigilant to make sure they don’t get on the government’s radar.
Here is the real news. In previous years, government agents would investigate companies and practices when they have fairly concrete information that something was not right, or at least suspicious enough to look into it.
Today, computers do that work. Health care investigations have become data games. If your practice bills more than the practice next door, you may find yourself on the target list. Data analysts compare billing records and reimbursement reports of different doctors (often of different specialties and different geographical regions) to then conclude that the cardiologist or the pain management physician that bills Medicare the most is likely committing fraud somehow.
This so-called “outlier” approach routinely fails in practice. Experienced attorneys are often able to demonstrate to the government that there are important and compelling reasons why one provider sees more patients (and bills insurance plans more) than others. In particular, the lump sum approach of comparing, for example, surgeons with different specialties (and under complete ignorance of applicable subspecialties) leads to uneven negotiations. Nonetheless, while this data approach still exists, providers must take necessary precautions. Hiring lawyers to conduct a professional compliance review is one of several options. Fighting already brought charges is another.
Current Fraud Investigations in Indianapolis, Indiana
Our Indianapolis health care fraud defense attorneys are prepared to represent physicians and executives in cases involving allegations of Medicare Fraud (18 U.S.C. 1347), Medicaid Fraud, as well as violations of the Controlled Substances Act (21 U.S.C. 841), the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law Statute (42 U.S.C. 1395nn), and the federal False Claims Act (31 U.S.C. 3729-3733).
- Prescription Drug Fraud.Any pain management physician in Indiana and any doctor that routinely prescribes Schedule I, Schedule II, Schedule III medications needs to make a conscious decision: do I gamble and see if the government chooses me to be a target (although I think that I did nothing wrong), or do I accept the reality that in the war against opioids, I am one of the declared (potential) targets? Undisputedly, following Justice Department’s orders, the Drug Enforcement Administration (DEA) has massively intensified its investigations in the metropolitan Indianapolis area. Oberheiden, P.C. offers competent help to those that are already targets as well as to those physicians that have concerns and are seeking a compliance advice.
- Medicare Fraud, Medicaid Fraud. Medicare Fraud and Medicaid Fraud have always been top enforcement priorities in Indianapolis. New, however, is that prosecutors in Indiana can request more support and resources from Washington D.C.. In terms of terminology, Medicare Fraud represents any intentional violation of federal health laws, in particular 18 U.S.C. 1347 and 18 USC 1349 (conspiracy to commit health care fraud). Fraud so understood encompasses billing and coding fraud (e.g. upcoding, getting paid for services not actually provided), home health and hospice certifications, and many more. Oberheiden, P.C. has handled Medicare and Medicaid cases across the country with surrounding success. Key in each of our defense cases is to understand the nuances of the Medicare rules to derive exceptions and render allegedly illegal conduct into lawful behavior. If you or your business are under Medicare Fraud suspicion, you should speak to a former Medicare Fraud prosecutor, someone that understands the process and hidden exit avenues.
- ZPIC Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments though a process of reviewing and analyzing claims data in addition to medical documentation that is obtained from the member/provider. Many times this involves a statistical sampling of files in order to establish an error rate. Another type of Medicare audit is conducted by the Zone Program Integrity Contractors (ZPICs). ZPIC audits identify and stop potential fraud and refer these cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that a mishandled audit can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice health care prosecutors with first-hand knowledge safely navigate our clients through the audit and make sure that they can continue their business and don’t need be worried about their license or a government investigation.
- Kickbacks & Bribery Accusations. The Anti-Kickback Statute prohibits the offering, solicitation, payment, or receipt of any form of compensation for a patient referral. Often overlooked, the Statute applies to anyone, not just physicians. Indiana doctors, health marketers, pharmacies, and toxicology laboratories have become subject to intense scrutiny since the government takes the position that illegal kickbacks are behind many Indiana business arrangements and joint ventures between physicians and business owners. Whether you are seeking compliance advice or need help defending an existing arrangement, contact Oberheiden, P.C. to discuss your best options. Calls are free and confidential and will be answered by senior attorneys.
- The False Claims Act. Why is the False Claims Act (FCA) the most heavily enforced health care fraud statute? Well, the False Claims Act does not require intent, does not require actual knowledge. Government prosecutors only need to show that a business or a provider should have known that the submission of a certain claim was false and thereby fraudulent. This “should-have-known” standard means that there is less room to defend an FCA case because, for example, the argument that the client did not know that a certain code was wrong, does not matter too much. Nonetheless, Oberheiden, P.C. has over and over resolved False Claims Act cases against toxicology laboratories, hospitals, pharmacies, health care billing providers, medical offices, and many more with no civil and no criminal liability for our clients. If you want to find out how, call our attorneys today for a free and confidential consultation.
- Stark Law. Most health care entities are confronted with Stark Law questions for the first time when they receive a subpoena from the Office of Inspector General or the Department of Health and Human Services informing them about a pending investigation. If that happens to you, or if you are just trying to structure physician and business joint ventures in a compliant way, you should contact Oberheiden, P.C.. Proactively as compliance advisors as well as in form of efficient negotiators at OIG offices across the country, have we demonstrated that many Stark Law matters can be addressed and resolved by applying one of the many (but admittedly complicated) exceptions. Call us today to get free and confidential advice!
Think about it. If you have concerns about health care fraud or are seeking advice regarding a defense matter, what do you have to lose by calling former Justice Department prosecutors for a free and confidential case assessment?
Important FAQs Regarding Health Care Fraud Investigations in Indianapolis, Indiana
Q: What Should I Do If Our Practice Is Accused of Fraud?
If your practice is under investigation, you should consult with lawyers that understand all pertinent health care law rules. Further, the lawyer of your choice should have a history of resolving health fraud allegations. Health care fraud defense is not the time for experiments. The government’s lawyers are sophisticated and trained and you cannot prevail in negotiations about misconduct if your counsel needs to research the rules first. Instead, experienced counsel will strategically analyze the allegation, present defenses, and then contact the auditors, agents, or prosecutors to open a dialogue to resolve the matter. Oberheiden, P.C. is known for getting clients out of trouble before they are actually in trouble. If you call our Firm, you will speak to senior attorneys right away and not be walled off by paralegals or secretaries. We immediately start working on each new case because we know that time is on the government’s side, not on your side.
Q: What Are the Penalties for Health Care Fraud?
The penalties for federal fraud depend on the underlying statute (or statutes). In civil cases (e.g. Stark Law), the government may ask for a repayment. In criminal cases, the penalties can include:
- Asset forfeiture and seizure
- Up to 10 years of federal imprisonment for each count of health care fraud
- Up to 20 years of federal imprisonment for each count involving serious bodily injury to a patient
- A life sentence for fraud resulting in a patient fatality
Q: How Do I Know Whether My Case Is Civil or Criminal?
At the beginning of a case, it is not always clear whether the investigation is civil or criminal. Experienced attorneys will be able to make a reliable determination when they hear the full story from you and when they analyze how the government proceeds in the investigation. Is it an OIG subpoena or a target letter? Is the FBI or the OIG involved? Is the prosecutor assigned a so-called criminal AUSA? Oberheiden, P.C. knows how pressing the question civil v. criminal can be. In order for you to get the fastest relief possible, call our senior attorneys today, share your story, and see how we evaluate your case.
Compelling Defenses and Creative Ideas for Health Care Practices in Indianapolis, Indiana
When your license, your business, and potentially your freedom are at stake, nothing replaces a proven defense plan. Health care fraud defense is not a hobby. There is a reason why Oberheiden, P.C. almost exclusively focuses its practice on federal health fraud, ZPIC audits, civil and criminal health investigations, and federal criminal trials in the health care industry. Just like our attorneys would not advise you what to do if you get pulled over for drunk driving, the best DUI attorney probably should not advise you how to defend your practice in a health care fraud investigation or a Medicare audit.
- Criminal Defense
- Federal Trials
Our strategic approach to defending health care providers in Indianapolis and throughout Indiana includes:
- Making immediate contact with the investigators and prosecutors involved in your case in order to intervene in the investigation and collect the key information we need to formulate a tailored defense strategy.
- Evaluating the legal standards that apply based on the nature of the government’s investigation and the unique aspects of your business or practice.
- Exploring all possible defenses to the government’s allegations, including statutory exceptions and safe harbors, factual arguments, and constitutional protections.
- Doing everything possible to preserve your professional reputation and resolve the investigation without your business or practice being put in jeopardy.
- Trial expertise. Where needed, we are ready to challenge the government in court. With more than 500 criminal cases handled, Oberheiden, P.C. is highly capable of bringing in former Department of Justice Trial Attorneys, former state and federal prosecutors with significant courtroom expertise.
Find Out Why So Many Clients Trust The Dedicated Lawyers of Oberheiden, P.C. with Their Business and Their Livelihoods
Our Indianapolis health care fraud defense lawyers are available to begin working on your case immediately. To speak with our attorneys in confidence, please call (888) 519-4897 or request a free case evaluation online now.
Compliance – Litigation – Defense