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AVOIDING CRIMINAL CHARGES

Dr. Nick Oberheiden
Founder

Aaron Wiley
Former State &
Federal Prosecutor

S. Amanda Marshall
Former U.S. Attorney

Bill McMurrey
Former DOJ-Trial Attorney

Lynette Byrd
Former Assistant
U.S. Attorney

  • Federal Criminal Defense
  • Federal Trial Lawyers
  • Search Warrant Defense
  • Grand Jury Subpoenas
  • OIG Subpoenas
  • Whistleblower Cases
  • FBI, DEA, IRS, OIG, HHS Cases
Los Angeles False Claims Act & Whistleblower Defense

Categories: False Claims Act

whistleblower
Los Angeles Office
12400 Wilshire Blvd #1180
Los Angeles, CA 90025
310-873-8140
(Meeting location by appointment only)

Oberheiden, P.C. is a health care fraud defense firm with extensive experience with all aspects of whistleblower lawsuits. Several of our attorneys previously reviewed and prosecuted whistleblower cases at the Department of Justice and understand how important it is early on to present a compelling defense strategy to avoid criminal prosecution. We have served clients in a variety of industries and handled whistleblower lawsuits on behalf of our clients in the health care, environmental, tax, and other sectors. We recognize the importance of each matter and we dedicate our fullest attention to each client. All Oberheiden, P.C. clients are represented by senior attorneys only. We are available for a free and confidential consultation.

False Claims Act Explained

The False Claims Act applies to anyone – whether a business or an individual – who contracts with the United States and is paid for their services or products by the United States, whether directly or indirectly.  Thus, all types of persons and entities may be subject to the False Claims Act, including medical providers, administrative personnel, billing companies, medical service organizations, contractors, and corporations.  Liability under the Act accrues when a person knowingly submits, or knowingly causes another person to submit, a false or fraudulent claim in order to obtain approval or payment from the government.  Under the False Claims Act, knowingly means either actual knowledge of the claim’s falsity or the failure to complete an adequate investigation to determine whether or not the claim is false.  In other words, a person will be liable for a False Claims Act violation if they actually knew or should have known that a submission to the federal government was inaccurate.  A common example of such a scenario is submitting a claim under a billing code that is no longer in use.

Civil & Criminal Liability

Any potential defendant must take False Claims Act charges seriously because both civil and criminal penalties are possible under federal law.  Often, at the beginning of the investigation, the government will not specify whether its investigation is civil or criminal in nature.  The penalties a defendant may be subject to vary accordingly.

  • Civil Penalties: Under the False Claims Act, any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the federal government can be required to pay a fine of up to $ $21,916 per claim as well as treble damages and attorney’s fees.
  • Criminal charges: (18 U.S.C. § 287): Anyone who knowingly submits or causes submission of a false or fraudulent claim to the United States government is subject to up to a five-year term in prison plus a fine of up to $250,000 for individuals or $500,000 for corporations for felony convictions or $100,000 (individuals) or $200,000 (corporations) for misdemeanor convictions. These separate penalties may be applied to each false claim submitted to the government.

What Is a Whistleblower Lawsuit?

As noted above, the federal government is enforcing health care False Claims Act violations through the Los Angeles HEAT task force.  Still, many False Claims Act investigations are initiated when a private citizen files a lawsuit.  Such lawsuits, which are authorized the False Claims Act, are known as qui tam or whistleblower cases.  Qui Tam means “for the king and himself” in Latin; in the United States, a qui tam case is one in which the person filing the suit is seeking to recover money that is owed to the government.  If a relator is successful, he or she will receive a portion of the monetary judgment for himself.  Many individuals who file qui tam lawsuits are disgruntled current or former employees or competitors looking to harm your business.  The process of a qui tam suit is as follows:

Complaint.  The person filing the qui tam case is known as the relator.  He or she will file the case in a federal court against defendants, who may include individuals, businesses, or both.  The relator’s identity is initially protected because all qui tam lawsuits are filed under seal. The initial seal affords the government time to analyze the allegations in the lawsuit.  During the duration of the seal, only the assigned judge and certain government officials receive copies of the complaint.  As a result, the defendant or defendants may not even know that they are under investigation.  The qui tam case is automatically sealed for six months, but this period can be extended if the investigation is not finished and the government requests more time.

Evidence.  Once the court informs the government that a qui tam lawsuit has been filed, federal investigators will review the complaint and reject any claims that are implausible or unsubstantiated on their face.  However, if the complaint seems persuasive and cites to credible evidence, the government will proceed to investigate the claims alleged therein through one or more of the FBI, the DEA, the OIG, the DOJ, or other agencies, correlated by the type of allegations made in the complaint.  Usually, this investigation is handled through subpoenas issued both to the defendants named in the complaint and to third parties. These subpoenas seek corporate, financial, business, billing, and communications records.

Government Intervention.  Once the government receives and reviews the records it requested, and possibly once it has negotiated with attorneys for the defendants, it will decide whether to formally intervene in the lawsuit and prosecute the case through government attorneys or to let the relator pursue the case on his or her own.  In order for the government to choose intervention, it must obtain approval from DOJ headquarters in Washington, D.C.  If the government does intervene, it will typically amend the complaint to add the facts it learned during the investigation as well as additional causes of action against the defendants that it thinks may create further liability.

Case Settlement. During the course of their preliminary investigation, the government attorneys may try to reach an agreement with the defendant or defendants that would settle the case.  Once subpoenas have been served, the defendants are aware of the case and that they are being investigated by the federal government.  The prosecutors and defense attorneys may spend weeks or even months trying to negotiate an agreement that will satisfy both sides.  Investigation and settlement negotiations may move slowly, as it takes time for the government to fully investigate and analyze its options, particularly in a complicated case.

Liability and Rewards.  As noted above, the civil penalty for False Claims Act cases includes treble damages and a fine of up to $21,916 per fraudulent claim. The relator is rewarded with up to 25 percent of these damages if the government intervened in the case, and up to 30 percent if the government did not intervene.  Such incentives are a common reason why qui tam cases are initiated.

How to Defend Against an Investigation?

At Oberheiden, P.C., our attorneys have successfully resolved many False Claims Act investigations and qui tam lawsuits throughout the country. We appreciate the fine distinction between human error and intentional fraud, and we understand that keeping our clients in compliance with health care regulation — and out of the government’s crosshairs — requires an emphasis on details, superb negotiating skills, and years of experience in the health care industry.  These principles guide us in every case.

  • No Criminal Charges. Our number one goal in every False Claims Act case is preventing the imposition of federal criminal charges against our clients.  Our years of experience in federal health care cases – both as prosecutors and defense attorneys – allow us to quickly determine the prosecutors’ intent.  What results are they seeking?  Is it a civil or criminal investigation?  How can we achieve a fast, fair, and favorable resolution for our client?  In most cases, we can answer many of these questions within hours of being retained.
  • No Government Intervention. Anytime we are defending a qui tam action, we try to persuade the government not to intervene. Most cases filed under the False Claims Act are initiated by current or former employees with an axe to grind or by competitors hoping to usurp business.  Our attorneys strive to expose the relators’ self-motivated agendas to the government, to challenge the relators’ evidence, and to ultimately destroy the relators’ credibility.  In this way, we have successfully persuaded the government not to waste the taxpayers’ money and its attorneys’ limited time by intervening.  After all, it is easier to defeat one or two private citizens than to take on the full power of the United States government.
  • Favorable Settlement. We always seek the most favorable resolution for our clients, including through pre-trial settlement of cases.  We take pride in negotiating low figure settlements for our clients.  To date, none of our False Claims Act clients have been forced to resign their professional license, cease operations, or close their business.

Call us at Oberheiden, P.C. today to discuss your situation with one of our senior attorneys.  Initial consultations are free and confidential. You may call us directly, complete our contact form, or contact us by email.

Oberheiden, P.C.

At Oberheiden, P.C., our attorneys have successfully defended companies, business owners, medical providers and many others from various industries against False Claims Act investigations. Our recent outcomes include:

  • False Claims Act Investigation (Pharmacy)
    Result: No Liability.
  • False Claims Act Investigation (Pharmacy)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Physician)
    Result: No Liability.
  • False Claims Act Investigation (Physician)
    Result: No Liability.
  • False Claims Act Investigation (DME Company)
    Result: No Liability.
  • False Claims Act Investigation (MSO)
    Result: No Liability.
  • False Claims Act Investigation (MSO)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Device Company)
    Result: No Liability.
  • False Claims Act Investigation (Health Care Service Provider)
    Result: No Liability.

Contact Oberheiden, P.C. today and speak with former federal prosecutors and established defense counsel about your case. All initial consultations are free and confidential.

1-800-810-0259
Including Weekends 
 
Oberheiden, P.C.
Serving Los Angeles, CA and Surrounding Areas
310-873-8140
Federal-Lawyer.com

Who Will Handle Your Case

When you hire us, you will not work with paralegals or junior lawyers. Each lawyer in our Healthcare Practice Group has handled at least one hundred (100) matters in the healthcare industry. So, when you call, you can expect a lawyer that immediately connects with your concerns and who brings in a wealth of experience and competence. For example, you need someone like Lynette S. Byrd, a former federal prosecutor in healthcare matters, who recently left the government and who is now sharing the valuable insights she gained as a healthcare prosecutor with our clients.

Bill C. McMurrey

Bill C.
McMURREY

Dr. Nick Oberheiden

Dr. Nick
OBERHEIDEN

Lynette S. Byrd

Lynette S.
BYRD

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