Jefferson City, Missouri Health Care Fraud Defense
Passionate Attorneys for Health Care Providers Facing Fraud Investigations in Jefferson City
Has your health care business or practice been contacted by agents from the U.S. Department of Justice (DOJ), the Drug Enforcement Administration (DEA), the Office of Inspector General (OIG), or the Medicare Fraud Strike Force? If so, you are not alone. Health providers in Jefferson City, Missouri are increasingly being targeted in fraud investigations, and those that do not take adequate steps to protect themselves are frequently facing federal prosecution – often in criminal court.
Federal Prosecutors are Targeting Jefferson City, Missouri Health Care Providers
Health fraud is a top federal law enforcement priority. From Medicare fraud to prescription drug fraud contributing to the nation’s opioid crisis, federal investigators and prosecutors are under strict mandates to aggressively pursue cases against providers suspected of engaging in all types of health care fraud. Federal agencies are relying on sophisticated data analytics to comb through millions of federal benefit program billings, and they are calling on “whistleblowers” to report suspected instances of fraud. However, while some of these inquiries are resulting in substantial recoupments from fraudulent providers, far more end up targeting legitimate health businesses and practices that, at most, have committed minor billing violations due to simple human error.
If your Jefferson City, Missouri health care business or practice is under investigation, we encourage you to contact our Jefferson City health care fraud defense lawyers promptly for a free case assessment. Oberheiden, P.C. is a team of proven health care fraud lawyers and former federal prosecutors who have decades of experience on both sides of federal health fraud investigations. We can quickly assess your case, intervene in the investigation, and implement a comprehensive defense strategy. In most cases, we have been able to resolve our clients’ investigations without federal prosecutors filing civil or criminal charges.
“Dr. Oberheiden has successfully represented our company in various federal health matters involving the OIG, the Department of Labor, and the Department of Health and Human Services. Dr. Oberheiden quickly understands all issues and is able to convincingly present the client’s side of the story. From my experience with other lawyers, I consider Dr. Oberheiden to be among the best attorneys we have ever used. Should we ever need legal help, the first thing our company will do is to call Dr. Oberheiden.” – Satisfied Client“Impeccable Service”
“Our experience with [Oberheiden, P.C.] was overwhelmingly positive! We recently brought a range of complex legal issues to the table, which they responded to with a systematic, prudent approach. Throughout our work together, Oberheiden, P.C. served as an invaluable source of practical guidance and legal leadership. We would recommend them highly and without reservation to anyone.” – Satisfied Client
Our Scope of Practice
Our experience includes representing providers such as physicians, pharmacists, other licensed practitioners, hospitals and other medical facilities, hospices and home health agencies, toxicology laboratories, durable medical equipment (DME) companies, and others in health care fraud audits, investigations and prosecutions. We routinely represent clients in Jefferson City, Missouri and other major cities around the country in cases involving allegations of:
- Billing and Coding Violations. Many health fraud investigations focus on providers’ billing practices, including specific violations of the applicable program billing guidelines. If your business or practice is being accused of upcoding, unbundling, double-billing, billing for medically-unnecessary services, or billing for services not actually rendered, we can use the available evidence to disprove the allegations or, if necessary, to mitigate your exposure.
- Illegal Kickbacks. Under the federal Anti-Kickback Statute, it is unlawful for any health care provider to offer or pay any form of compensation for a patient referral involving a Medicare, Medicaid, Tricare, or other program beneficiary (subject to numerous “safe harbors” and exemptions). The law prohibits the solicitation and receipt of these illegal “kickbacks” as well, and providers on both sides of kickback transactions can face civil and criminal penalties.
- Physician “Self-Referrals.” The federal Stark Law imposes civil penalties for what are commonly known as physician “self-referrals.” Physicians are prohibited from referring federal health benefit program beneficiaries to entities with which they have financial ties; and, in a Stark Law investigation, both the referring physician and the treating entity can face substantial civil liability. Similar to the Anti-Kickback Statute, the Stark Law includes various exceptions, and we have frequently been able to use these exceptions to protect our clients.
- Prescription Drug Fraud. Federal authorities are aggressively pursuing charges against Jefferson City, Missouri providers suspected of engaging in prescription drug fraud, including specifically fraud involving opioid and narcotic medications. We have defended physicians, pharmacists, nurses, caregivers, facility executives and administrators, and others accused of having involvement in a wide range of prescription drug schemes, and we are intimately familiar with the unique and complex issues involved in prescription drug fraud investigations.
- Certification Errors. All patients who receive care from a hospice or home health agency must receive proper certification from a licensed physician. From failure to conduct an in-person exam to falsification of patient records, physicians, hospices, and home health agencies can all face a variety of allegations in certification fraud investigations.
FAQs: What Providers in Jefferson City, Missouri Need to Know about Health Care Fraud Investigations
Q: What are the potential outcomes if my business or practice is under investigation for health fraud?
If your business or practice is being targeted in a health care fraud investigation, there are a number of potential outcomes. These include:
- The investigation being closed without charges or liability
- The investigation being resolved with a negotiated settlement (or plea deal) prior to charges being filed
- Negotiating a plea deal once charges have been filed
- Going to trial on civil charges and being found either liable or not liable
- Going to trial on criminal charges and being found either guilty or not guilty
Of course, the likelihood of each of these potential outcomes depends on a variety of factors, including the scope of the investigation and the specific form (or forms) of fraud being alleged. At Oberheiden, P.C., our goal is to keep our clients’ investigations civil in nature and to resolve each case without charges being filed.
Q: How does the False Claims Act apply to health care providers?
If your business or practice bills Medicare, Medicaid, Tricare, or another health benefit program, any investigation will likely involve allegations under the False Claims Act. The False Claims Act prohibits the submission of “false and fraudulent” claims for government compensation, and this includes reimbursement requests for services and supplies. Billing and coding violations, kickbacks, self-referrals, and other forms of health fraud all have the potential to lead to False Claims Act liability. False Claims Act investigations can either be civil or criminal in nature, with potential penalties including massive financial liability, program exclusion, loss of assignment privileges, and long-term federal imprisonment.
Q: What types of practices can be charged as prescription drug fraud?
“Prescription drug fraud” is a broad term that encompasses all forms of health care fraud involving the prescription, dispensing, and administration of controlled-substance medications. Some of the most common allegations in prescription drug fraud investigations include:
- Prescribing opioid or narcotic medications to a drug-dependent patient
- Prescribing outside of acceptable medical treatment principles
- Allowing unauthorized use of your DEA registration number
- Prescribing medications that are not medically-necessary or without proper justification
- Failing to follow the rules for electronic and hard-copy prescriptions
Learn more about each of these examples of prescription drug fraud.
Q: What are some examples of the safe harbors and exemptions under the Anti-Kickback Statute and the Stark Law?
While it is government policy that health benefit program funds should not be used to compensate providers for patient referrals, the Anti-Kickback Statute and the Stark Law both recognize that there are various circumstances under which the payment of compensation is both necessary and appropriate. When we represent clients in kickback and self-referral investigations, we focus on identifying any and all safe harbors that we can assert to insulate our clients from liability. These include safe harbors that pertain to:
- Bona-fide employment relationships and incidental staff benefits
- Certain forms of non-monetary compensation
- Discounts and group purchasing arrangements
- In-office ancillary services
- Indirect compensation arrangements
- Isolated transactions
- Personal service arrangements
- Price reductions involving eligible managed care organizations
- Referral agreements for specialty services
- Waivers of coinsurance and deductibles
Why Choose Oberheiden, P.C. in Jefferson City, Missouri?
When you need legal representation for a federal health fraud investigation, you need to choose a firm that has the experience, resources, and capabilities required to present the strongest possible defense. At Oberheiden, P.C., we offer:
- A national practice devoted to health fraud defense.
- Decades of experience as defense attorneys and former federal health care prosecutors.
- Proven results in health care fraud investigations and prosecutions.
- A unique team approach that puts the full weight of our experience on each client’s side.
- Uncompromising dedication to protecting our clients as efficiently as possible.
Facing A Fraud Investigation in Jefferson City? Contact Tthe Trusted Team Of Oberheiden, P.C.
To speak with an experienced Jefferson City health care fraud defense attorneys, please call (888) 519-4897 or send us your contact information online. We are available every day of the year, and we can take immediate action to intervene in your federal investigation.