Jacksonville, Florida Health Care Fraud Defense Attorneys
Oberheiden, P.C.’s defense attorneys represent physicians, pharmacists, company executives and other clients in federal health care fraud investigations in Jacksonville, FL. If your health care business or medical practice is under investigation, call our proven (214) 692-2171 for a free and confidential case assessment.
What is at stake if your Jacksonville health care business or medical practice is under investigation by the federal government? While providers who have nothing to hide often assume that these investigations will go away quietly on their own, the reality is often quite the opposite. If you are aware that federal authorities are looking into your business or practice, there is a good chance that the investigating agency or task force has already uncovered evidence against you. To avoid civil or criminal charges, you will need to mount a swift, proactive, and strategic defense.
At Oberheiden, P.C., our Jacksonville health care fraud defense attorneys represent health care providers in Jacksonville and nationwide in high-stakes federal matters. The attorneys on our federal health care fraud defense team (including several former federal health care fraud prosecutors) have handled thousands of federal investigations, and we have helped the majority of our clients avoid charges entirely. This involves a greater than 90% success rate in avoiding criminal indictments. To date, not a single client of ours has been forced to cease operations due to an investigation in which we have been involved.
If you are being targeted by the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Office of Inspector General (OIG), Opioid Fraud and Abuse Detection Unit, Prescription Interdiction & Litigation Task Force, or any other federal law enforcement authority, you need to take your situation very seriously. If you are under investigation for health care fraud, this means that you are at risk for being charged and this means that business-threatening consequences are on the table. Our team of highly experienced federal health care fraud defense lawyers can help you. To start executing a strategic defense immediately, we encourage you to call our Jacksonville health care fraud defense attorneys at (214) 692-2171 for a free and confidential case assessment.
What Is Health Care Fraud?
As a physician, pharmacist, clinic operator, executive of a durable medical equipment (DME) company, or other individual in the health care industry, facing a federal investigation typically involves facing allegations of health care fraud. So, what is “health care fraud”?
The term “health care fraud” can mean different things under different circumstances. There is not one single act or omission that constitutes health care fraud. Rather, broadly defined, “health care fraud” involves any activity which results in the submission of an invalid claim for payment from Medicare, Medicaid, Tricare, or another federal health care benefit program.
As a result, in a federal health care fraud investigation, the specific allegations could include any or all of the following:
- Intentional or unintentional billing and coding errors
- Billing for medically-unnecessary services or for services that were not actually rendered
- Offering, soliciting, paying, or accepting any illegal “kickback” or referral fee
- Diverting prescription opioid medications
- Engaging in other forms of prescription drug fraud
- Falsifying patient records, physician certifications, or election statements
- Using any other “scheme or artifice” to obtain payment from Medicare, Medicaid, Tricare, or the Department of Labor (DOL)
In order to determine the specific allegations against you, it is necessary to intervene in the government’s investigation, make contact with the agents and prosecutors involved, and quickly discern the scope and nature of the government’s inquiry. Which agency or task force initiated the investigation? What other agencies or task forces are now involved? Is the DOJ considering civil or criminal charges? These are just some of the questions you need to have answered as soon as possible.
Sources of Authority in Federal Health Care Fraud Investigations
1. False Claims Act (FCA)
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by a federal health care benefit program. Depending upon whether an investigation reveals evidence of intent, FCA charges can either be civil or criminal in nature. And potential penalties include civil monetary penalties, criminal fines, and federal imprisonment.
2. Anti-Kickback Statute (AKS)
The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, and receiving referral fees or other forms of “remuneration” in connection with referrals for Medicare, Medicaid, Tricare, and DOL-reimbursed medical services and equipment. Like the False Claims Act, the AKS includes both civil and criminal enforcement provisions. However, the AKS’s broad prohibitions are subject to a laundry list of statutory safe harbors, and these safe harbors will provide complete defenses to liability in many cases.
3. Stark Law
The Stark Law prohibits physicians from making referrals to their related entities for “designated health services.” These physician “self-referrals” can lead to civil penalties, including fines, recoupments, and treble damages. Similar to the Anti-Kickback Statute, the Stark Law includes various safe harbor provisions and our attorneys are skilled at using these safe harbors to protect our clients.
4. Controlled Substances Act (CSA)
The Controlled Substances Act (CSA) imposes criminal penalties for various prescription drug related offenses, including various forms of pharmaceutical fraud. The CSA also provides the source of authority for the DEA’s registration enforcement program, and registered health care providers can face both routine and ad hoc investigations targeting their prescription practices.
5. Federal Health Care Fraud Statute
The health care fraud statute, 18 U.S.C. 1347, makes it a federal offense 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.” Potential prison sentences under 18 U.S.C. 1347 start at up to 10 years. However, in cases involving serious bodily injury or death, health care providers can face 20 years and life imprisonment, respectively.
6. Program Billing Regulations
In addition to the federal statutes listed above, health care providers that participate in Medicare, Medicaid, Tricare, DOL, and other health care benefit programs are also subject to a bevy of stringent billing and coding regulations. Intentional and unintentional violations can both trigger government scrutiny. And with these regulations constantly changing, providers must maintain comprehensive and proactive compliance programs in order to mitigate their risk of severe consequences.
7. Other Federal Criminal Statutes
While health care specific statutory and regulatory violations are the impetus for most federal investigations targeting physicians and other providers in Jacksonville, in criminal cases, federal prosecutors will often pursue a variety of other charges as well. Conspiracy, bank fraud, mail fraud, wire fraud, and money laundering charges are all common, and they can expose health care providers to the potential for hundreds of thousands or millions of dollars in fines and decades of incarceration.
5 Reasons to Why Health Care Providers in FL,Trust the Jacksonville Health Care Fraud Defense Attorneys at Oberheiden, P.C.
If your Jacksonville health care practice is under investigation, you need to undertake prompt and aggressive measures to defend yourself. This starts with hiring experienced legal representation. Here are five reasons why health care providers in Jacksonville, throughout Florida, and nationwide trust the federal health care fraud defense team at Oberheiden, P.C.:
- Centuries of Combined Federal Experience – Our attorneys have centuries of combined experience in federal matters. This includes decades of experience working as health care fraud prosecutors for the DOJ and defending health care providers in federal jurisdictions across the country.
- Commitment to Federal Health Care Fraud Practice – Our practice is devoted to representing health care providers and other individuals and entities in federal fraud investigations. Our health care fraud defense attorneys have handled thousands of investigations and hundreds of trials, and we have earned a national reputation for effective health care fraud defense.
- A Significant Pretrial Track Record – While we can not guarantee the outcome of any particular case, we have helped the vast majority of our clients avoid federal prosecution. When we get involved during the investigative process, we have a greater than 90% success rate helping our clients avoid criminal charges.
- Comprehensive, Strategic, and Personalized Defense – We have achieved this robust track record by providing comprehensive, strategic, and personalized defense representation in every case we handle. We focus on the details of each individual case to build case strategies designed to protect our clients as efficiently and discreetly as possible.
- Relentless Devotion to Our Clients – Above all, our Jacksonville health care fraud defense attorneys are relentlessly devoted to protecting our clients’ interests. Whether we are able to avoid charges during the government’s investigation or it becomes necessary to go to trial, our attorneys fight tirelessly to secure the best possible outcome for our clients in light of the facts and circumstances at hand.
Contact the Jacksonville Federal Health Care Fraud Defense Lawyers at Oberheiden, P.C.
To discuss your federal health care fraud investigation in Jacksonville, FL, with a member of Oberheiden, P.C.’s federal health care fraud defense team, please call (214) 692-2171 or contact us online. You can reach our Jacksonville health care fraud defense attorneys 24/7, and we will schedule your free and confidential initial case assessment as soon as possible.