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Irvine Health Care Fraud

Federal authorities are aggressively targeting health care providers in Irvine for a variety of federal offenses. If your business or practice is under investigation, you need the experienced federal defense team at Oberheiden, P.C.

Health care providers in Irvine, CA, are in the federal government’s crosshairs. Law enforcement agencies (including the Drug Enforcement Administration (DEA) and Department of Health and Human Services (DHHS), among others) are aggressively targeting providers throughout the industry for a broad range of federal health care law violations. These range from opioid diversion to the payment of unlawful referral fees (or “kickbacks”).

Oberheiden, P.C., is a federal health care fraud defense law firm that represents providers and other industry players in both civil and criminal investigations in California. Our attorneys bring well over a century of combined legal experience to the table – including decades of experience as senior federal prosecutors – to help clients make smart decisions and avoid unnecessary consequences due to federal health care fraud investigations.

Are you being targeted for submitting “false or fraudulent” claims to Medicare, Medicaid, or TRICARE? Have you been targeted as part of the national opioid crackdown? Are you, like many providers, at a loss as to why you are suddenly under so much government scrutiny?

Let us put our extensive experience to work for you. We will deal with the government on your behalf so that you can get back to managing your business or caring for your patients, as it should be.

What Is Health Care Fraud?

“Health care fraud” is a broad term that encompasses a number of federal offenses, many of which can be prosecuted using a bevy of federal statutes. Over the years, the United States Congress has acted again and again (usually for political expediency) to arm the country’s criminal code against health care providers, specifically. Few industries are as repeatedly and explicitly targeted by our country’s criminal laws.

If you are under federal investigation for health care fraud, you will want to know what that means in the context of your practice or business operations. But the target letter, notice, or indictment might not make that immediately clear. “Fraud” can mean many things.

As health care fraud defense lawyers, there are two critical pieces of information we want to immediately find out from the government:

  • The nature of the investigation (civil or criminal?)
  • The specific agencies and/or task forces involved

Different federal agencies have different priorities when it comes to health care fraud enforcement though they often combine forces (in a federal task force, for example). The DEA, DOJ, and the Office of the Inspector General of the Department of the Health and Human Services (DHSS – OIG) are among the chief investigators of health care fraud.

Additionally, a health care fraud case often also means that the practice or provider gets charged with additional, non-medical-specific forms of fraud, too – mail fraud, for example, or money laundering. Conspiracy charges are common as well. The list of federal offenses on any health care fraud indictment can be very long, indeed. For that reason, you should consult with a defense team that is well versed in the whole gamut of federal offenses that might ultimately apply to your case.

Who We Represent in Irvine

At Oberheiden, P.C., we represent Irvine health care providers in federal investigations pertaining to any health care criminal allegation. For example, we routinely represent medical practitioners and health organizations accused of:

  • Billing fraud (Medicare, Medicaid, Tricare, etc.)
  • Department of Labor (DOL) fraud
  • Anti-Kickback Statute violations
  • Stark Law violations (physician self-referral)
  • Controlled Substances Act / DEA registration violations (including prescription drug fraud)
  • Providing / Billing for medically unnecessary services
  • Billing for services not actually rendered to patients
  • Falsifying patient records, prescriptions, physician certifications, or election statements

Whether you know why you are under investigation or not, you should seek out experienced legal representation, right away.

Sources of Authority in Federal Health Care Fraud Investigations

While we are available to get involved in any stage of the criminal justice process, we urge you to contact us as soon as possible. Generally speaking, the earlier we are involved, the more options we have.

1. The False Claims Act

Under the False Claims Act (FCA), it is illegal for a health care provider to submit any “false or fraudulent” claims for payment to the federal government. The False Claims Act also applies to any health care provider or company that bills Medicare, Medicaid, Tricare, or other health care benefit programs – and even to organizations that don’t otherwise contract with the government. The False Claims Act includes both civil and criminal penalties that apply on a “per-claim basis,” meaning that those accused often face exorbitant financial liability. Additional consequences may include exclusion from CMS or other benefits programs as well as imprisonment.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) makes it a crime to offer, solicit, pay for, or receive a referral fee or any other form of “remuneration” in exchange for referrals for Medicare, Medicaid, Tricare, and DOL beneficiaries. Like the False Claims Act, the Anti-Kickback Statute provides for both civil and criminal prosecution of health care providers. The reality of the health care industry in Irvine is that businesses often enter into good-faith business or marketing arrangements that do not strike anyone as being unethical or unlawful. But federal agents are currently making a concerted effort to crack down on AKS violations, so providers and businesses must be very careful not to arouse suspicion.

3. The Stark Law

The Stark Law prohibits so-called “physician self-referrals.” While the Stark Law is much more limited in scope than the False Claims Act and the Anti-Kickback Statute, it still carries significant civil penalties. Our federal defense attorneys are available to assist physicians or entities accused of Stark Law violations.

4. The Controlled Substances Act (CSA)

The Controlled Substances Act is a complex and multifaceted statute that establishes a regulatory system while also providing various criminal penalties. It is one of the primary statutes that prosecutors use against health professionals suspected of drug diversion and/or pharmaceutical fraud. Common CSA violations by care providers include: prescribing unnecessary medications, providing drugs to patients with addictions, misappropriating prescription drugs, selling prescriptions, and other unlawful practices.

5. The Federal Health Care Fraud Statute

Better known as simply “the health care fraud statute,” 18 U.S.C. 1347 makes it a crime to “knowingly and willfully execute, or attempt to execute, a scheme or artifice – (1) to defraud any health care benefit program; or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.” Similar to the False Claims Act, the health care fraud statute is extraordinarily broad. Prosecutors may use it in a number of ways to target health care providers in Irvine who the government suspects of perpetrating a fraud.

6. Program Billing Regulations

If you submit claims for payment to any federal benefit programs, the above-listed statutes aren’t your only concern. You and your practice are also subject to these programs’ stringent billing regulations. Whereas most fraud cases require proof of intent, when it comes to federal program billing regulations, intentional and unintentional violations can trigger criminal penalties or recoupment actions. These often come about as a result of a routine audit or an investigation. Unfortunately, these programs frequently change their billing regulations. Keeping up can be a challenge. For that reason, we recommend that providers maintain a proactive compliance program in order to mitigate their risk of prosecution.

7. DOJ Mandates

A DOJ mandate is a press release, public announcement, or internal memorandum that instructs the DOJ and its various agencies on how to direct their resources and priorities. While these mandates do not necessarily carry the force of law on their own, they nevertheless determine where the DOJ will be most active and which federal criminal laws are most likely to be enforced aggressively. Recently, the DOJ has intensified its focus on opioid fraud and abuse, launching both the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force within mere months of each other. These task forces, along with the Medicaid Fraud Strike Force in nearby Los Angeles, are now responsible for many of the health care arrests in Irvine.

5 Reasons to Choose Oberheiden, P.C., for Your Federal Health Care Fraud Case in Irvine

Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right defense attorney for health care fraud might be the most important decision you ever make.

Here are five reasons why health care providers and other Medicare, Medicaid, and Tricare participants in Irvine should hire Oberheiden, P.C.:

  1. Our Experience on Both Sides – Oberheiden, P.C., consists of a team of federal defense attorneys and former federal prosecutors who have devoted their careers to federal health care fraud matters.
  2. Our Extensive Experience in Health Care Fraud Investigations – We have handled thousands of federal health care fraud audits, investigations, and prosecutions on behalf of health care providers in Irvine and nationwide.
  3. Our Record of Avoiding Charges – We have resolved the majority of our cases without our clients facing federal charges.
  4. Our Focus on Federal Health Care Fraud Defense – Our practice focuses on federal health care fraud defense. We have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually every other type of health care provider.
  5. Our Proven Defense Strategies and Custom-Tailored Legal Representation – We take an aggressive approach to representing our clients. We have designed our firm so that we can quickly and cost-effectively develop custom-tailored defense strategies for our clients. We understand that time matters, and we are prepared to respond urgently to a legal crisis in Irvine when one arises.

Discuss Your Federal Health Care Fraud Investigation in Confidence

If your Irvine health care practice or company is being targeted in a federal health care fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with a member of our federal defense team for free, call (888) 519-4897 or inquire online, right away.

All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.

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