Lincoln, Nebraska Health Care Fraud Defense
Facing A Federal Health Care Fraud Investigation In Lincoln? You Need Aggressive Legal Representation
Federal agents and prosecutors with the Drug Enforcement Administration (DEA), the U.S. Department of Justice (DOJ), and other law enforcement authorities have recently ramped up their efforts to target health providers suspected of defrauding Medicare and other government programs in select cities around the country, including Lincoln, Nebraska. For local providers, this means that it is important not only to carefully reassess their compliance efforts but also to be prepared to respond proactively in the event of a federal investigation.
At Oberheiden, P.C., we represent health care providers in Lincoln and throughout Nebraska in fraud investigations and prosecutions. Our attorneys have decades of experience – both in private practice and as former federal fraud prosecutors – and we take a strategic approach that is focused on resolving our client’s case prior to trial. In fact, most of our clients are able to avoid charges entirely, and not one of our clients has been forced to close its business or practice as a result of an investigation during which our Lincoln health care fraud defense lawyers provided legal representation.
Experienced Defense Attorneys for Health Care Entities in Lincoln, Nebraska
If your business or practice is being targeted in a federal investigation, what do you need to know? First and foremost, being investigated does not mean that you are guilty. The DEA, DOJ, and other agencies rely heavily on data analytics and “whistleblowers” to identify potential targets for health fraud investigations, and it is not unusual for fully-compliant providers to face invasive government inquiries.
However, even if you believe that your billing practices are fully-compliant, you cannot afford to take your investigation lightly. The potential consequences are severe, and you will need to present a successful defense in order to avoid liability. While most health care fraud investigations involving legitimate providers are civil in nature, there is the potential that you could face criminal charges for health fraud, and these carry the potential for hundreds of thousands of dollars in fines and decades behind bars.
“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“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 . . . .” – Satisfied Client
Strategic Legal Defense for All Health Care Fraud Matters
With our experience on both sides of federal health fraud investigations, we offer unique insights and an unparalleled breadth of knowledge for physicians, pharmacists, hospitals, hospices, and other providers facing civil and criminal inquiries. We routinely advise and represent clients in matters involving allegations of:
- Illegal Kickbacks and Referral Fees. Under the Anti-Kickback Statute and the Stark Law, it is illegal to offer, solicit, pay, or receive any form of remuneration for a Medicare, Medicaid, Tricare, or other health benefit program beneficiary. The Anti-Kickback Statute includes both civil and criminal provisions, while the Stark Law imposes substantial civil liability for physicians and related entities that engage in unlawful “self-referrals.” Despite these statutes’ sweeping language, physicians and other providers are often able to avoid liability by demonstrating that their compensation arrangements are covered by a statutory or regulatory safe harbor.
- Billing and Coding Violations. Billing and coding violations are among the most-common allegations in health fraud investigations targeting legitimate providers. This includes violations such as upcoding, unbundling, billing for medically-unnecessary services, and billing for services that were not actually provided. Unintentional violations can lead to recoupments and other financial penalties, while intentional overbilling of Medicare, Medicaid, or Tricare can lead to a criminal indictment and prosecution.
- Prescription Drug Fraud. With the fight against opioid fraud and abuse gaining renewed national attention, the DOJ and DEA are aggressively pursuing cases against health care providers suspected of involvement with prescription drug fraud. Physicians, pharmacists, medical facilities, and other providers in Lincoln, NE are currently facing close scrutiny for prescription drug diversion, medically-unnecessary prescriptions, violating electronic prescription rules, prescribing narcotic medications to drug-dependent patients, and other forms of prescription drug fraud.
- Physician Certification Fraud. Home health and hospice service providers are subject to a bevy of unique rules and regulations. This includes the requirement to obtain a valid physician certification for all patients within their care. With increasing frequency, federal authorities are challenging physician certifications in Lincoln, NE and other cities throughout the Midwest, and both providers and certifying physicians must be prepared to defend their certifications in the event of a civil or criminal investigation.
- False and Fraudulent Claims. The False Claims Act is a broad federal statute that imposes civil and criminal penalties for the submission of “false and fraudulent” claims to Medicare, Medicaid, Tricare, and other federal health care benefit programs. Illegal kickbacks and referral fees, billing and coding violations, medically-unnecessary prescriptions, fraudulent physician certifications, and various other forms of fraud can all lead to substantial False Claims Act liability.
Health Care Fraud Investigations: Answers to Frequently-Asked Questions (FAQs)
Q: What should I do if my health business or practice is under investigation?
If your Lincoln, NE business or practice is being investigated by the Medicare Fraud Strike Force, the DOJ, the DEA, the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (DHHS), or any other federal agency, your next steps need to include the following:
- Conducting an internal assessment focused on identifying any potential issues that may come to light during the government’s investigation.
- Updating your compliance program as necessary to demonstrate to the investigating authorities that you are taking proactive measures to prevent billing violations.
- Limiting disclosure of information to both (i) the investigating agency (to the extent permitted by law), and (ii) third parties not involved in the investigation.
- Engaging experienced legal counsel who can intervene in the investigation and advise you in all aspects of responding to the government’s inquiry.
- Executing a comprehensive defense strategy focused on the scope of the investigation and the relevant facts at hand.
Q: What are the requirements for a valid physician certification for home health care?
Under the pertinent federal regulations, in order to qualify for Medicare coverage, a home health patient must receive an in-person assessment from a physician who subsequently certifies that he or she is:
- Confined to the home;
- In need of skilled services;
- Under the care of a physician; and,
- Receiving services under a physician-reviewed care plan.
The in-person assessment (or “face-to-face encounter”) must occur no earlier than 90 days prior to the commencement of home health services and no later than 30 days after the commencement of services. Home health patients must also receive re-certification every 60 days.
Q: What are some examples of safe harbors under the Anti-Kickback Statute and Stark Law?
The safe harbors under the Anti-Kickback Statute and Stark Law are best summarized by the types of transactions and relationships to which they apply. For example, some of the most-commonly-used safe harbors include those that apply to:
- Bona-fide employment relationships and incidental staff benefits
- Discounts and group purchasing arrangements
- In-office ancillary services
- Office space and equipment rentals
- Passive investments and investments in group practices or publicly-traded securities
- Personal service arrangements
- Preventive tests and immunizations
- Price reductions involving eligible managed care organizations
- Sale of medical practices
- Waivers of coinsurance and deductibles
Q: What are the potential consequences of a federal health care fraud investigation?
The potential consequences of your investigation will depend on a number of factors, including: (i) how long the investigation has been ongoing, (ii) the specific statute or statutes involved, (iii) the volume of alleged illegal activity, and (iv) whether the investigation is civil or criminal in nature. In cases involving hundreds or thousands of allegedly-fraudulent reimbursement claims, providers can easily face crippling financial penalties and the potential for decades of federal incarceration. On a case-by-case basis, the penalties for federal health fraud can include:
- Recoupments and denial of future claims
- Fines imposed on a per-claim basis
- Treble (triple) damages
- Loss of Medicare, Medicaid, and Tricare eligibility (program exclusion)
- Professional licensing action
- Loss of assignment privileges
- Loss of hospital privileges
- Long-term federal imprisonment
Contact The Trusted Attorneys of Oberheiden, P.C. for a Complimentary Case Assessment
If you need to speak with a health care fraud attorney about your federal investigation in Lincoln, Nebraska, we urge you to contact us promptly. We will make arrangements for you to meet with our team of Lincoln health care fraud defense attorneys as soon as possible; and, if you retain our firm, we will make immediate contact with the investigators or prosecutors involved in your case. We offer complimentary case assessments, so call (888) 519-4897 or contact us online to schedule a risk-free appointment now.