Los Angeles Health Care Fraud
Proven Los Angeles Health Care Fraud Lawyers
12400 Wilshire Blvd #1180
Los Angeles, CA 90025
(Meeting location by appointment only)
The Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and other federal authorities are actively targeting physicians, pharmacists, and other providers in Los Angeles in health care fraud investigations. To avoid civil or criminal charges, providers must engage experienced defense representation immediately. Contact our respected and winning Los Angeles health care fraud lawyers today.
Allegations of health care fraud can have devastating consequences. As a physician, pharmacist, clinician, facility operator, or company executive in Los Angeles, being accused of over-billing Medicare, Medicaid, Tricare, or the Department of Labor (DOL) can ruin your reputation; it can also do so much more. Providers who are charged with civil health care fraud can face crippling financial penalties, loss of program eligibility, loss of professional licensure, and loss of DEA registration. Those charged with criminal health care fraud can face these consequences plus long-term federal imprisonment.
If your business or practice is being targeted in a federal health care fraud investigation, you cannot assume that everything will be okay. Regardless of how confident you are in your business’s or practice’s billing compliance program, you need to understand what it means to come under government scrutiny. If you are being targeted in a fraud investigation, this means that the DOJ, DEA, OIG, or another federal agency or task force already has reason to believe that you (or someone else within your business or practice) has committed fraud. At this point, avoiding charges needs to be your top priority. You need to engage a team of highly experienced Los Angeles health care fraud lawyers who can protect you against life-altering consequences.
Fighting program fraud (i.e., Medicare, Medicaid, and Tricare fraud) and opioid fraud are top federal law enforcement priorities. In major cities like Los Angeles, federal agents and prosecutors are aggressively targeting health care providers suspected of engaging in fraudulent billing practices, offering or accepting “kickbacks,” and diverting opioid medications. At Oberheiden, P.C., our highly skilled and respected health care fraud lawyers are actively representing providers in federal health care fraud investigations nationwide and we can use our vast experience in these matters to protect you.
Why Am I Under Investigation for Health Care Fraud?
For most health care providers, their first question after learning that they are being targeted in a federal investigation is, “Why?” Most health care providers do their best to comply with the applicable health care benefit program regulations and the conditions of DEA registration, and they assume that the federal government reserves its resources for going after large-scale fraudulent operations.
But, in today’s world, Medicare enforcement is not what it used to be. With the government paying thousands of providers in the Los Angeles area alone, fraud at the individual provider level has become a top concern for the Centers for Medicare and Medicaid Services (CMS) and the other agencies responsible for enforcing the nation’s health care laws. And, with the growth of Big Data, it is now easier than ever for these agencies to identify “anomalies” that appear to be indicative of fraudulent billing practices.
As a result, individual health care providers in Los Angeles are increasingly being targeted in federal billing fraud investigations. In most cases, these investigations focus on a number of common mistakes – all of which carry the potential for civil enforcement, and some of which carry the potential for criminal prosecution:
- Submitting incorrect billing codes (including “upcoding,” or billing for services at a higher rate than the one prescribed)
- Billing for individual services rather than “bundling” as required under the applicable program guidelines
- Billing for medically-unnecessary services or for services not actually provided (referred to as “phantom billing”)
- Offering, soliciting, paying, or accepting illegal “kickbacks” or referral fees
- Prescribing opioid medications without medical necessity, selling medications to drug-dependent patients, improperly filling prescriptions, and other forms of prescription drug fraud
- Falsifying patient records, prescriptions, physician certifications, and election statements
- Submitting other false or misleading information to CMS, the DEA, or any other federal government agency
When facing a federal health care fraud investigation, one of the first steps toward protecting yourself is to identify the specific allegations against you. With our extensive experience on both sides of these investigations (many of our attorneys are former senior federal health care fraud prosecutors), out Los Angeles health care fraud lawyers can aggressively intervene in the government’s investigation and determine both (i) what you need to defend against, and (ii) the scope of your potential exposure.
Sources of Authority in Federal Health Care Fraud Investigations
1. False Claims Act
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment under a federal health care benefit program. Contrary to popular belief, a billing error does not have to be intentional in order to be considered “fraudulent.” While evidence of intent is a requirement for the U.S. Attorney’s Office to successfully pursue criminal charges under the FCA, Los Angeles providers accused of unintentional violations can still face civil penalties.
2. Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, and receipt of referral fees and all other forms of “remuneration” in connection with referrals for Medicare, Medicaid, Tricare, and DOL-reimbursed health care services. Charges under the AKS can either be civil or criminal in nature (based upon evidence of intent, similar to the False Claims Act), though the statute’s “safe harbor” provisions will protect providers in many instances.
3. Stark Law
The Stark Law prohibits so-called “physician self-referrals.” Similar to the Anti-Kickback Statute, the Stark Law contains broad prohibitions that are scaled back by statutory safe harbors – although physicians must be cautious to ensure that their financial relationships with related entities meet all of the substantive and technical requirements for safe harbor protection. The Stark Law is exclusively a civil statute with financial penalties similar to those imposed under civil provisions of the FCA and AKS.
4. Controlled Substances Act
The Controlled Substances Act (CSA) is the primary federal statute used to prosecute health care providers suspected of engaging in pharmaceutical fraud. The DEA aggressively pursues criminal cases against health care providers suspected of diverting opioid medications, prescribing medications without a valid registration, forging and selling prescriptions, and engaging in other fraudulent prescription-related 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.” Providers charged under 18 U.S.C. 1347 can face exorbitant financial penalties and the potential for 10 years, 20 years, or even life in federal prison.
6. Program Billing Regulations
The Medicare, Medicaid, Tricare, and DOL health care benefit programs are all subject to complex sets of billing guidelines and regulations. Failure to adhere to these guidelines can trigger liability under the False Claims Act and potentially even criminal charges under 18 U.S.C. 1347. Maintaining a comprehensive and up-to-date compliance program is the best way to mitigate the risk of a billing fraud investigation (though mistakes by billing personnel and other factors can still lead to government scrutiny).
7. Other Federal Criminal Statutes
In criminal health care fraud investigations, health care providers and company executives in Los Angeles will often face charges under a number of non-health-care-specific statutes as well. For example, it is not uncommon for Assistant United States Attorneys to pursue charges for conspiracy, bank fraud, mail fraud, wire fraud, and money laundering in addition to pursuing criminal charges under the False Claims Act, Anti-Kickback Statute, and/or 18 U.S.C. 1347.
5 Reasons to Choose Oberheiden, P.C., for Your Federal Health Care Fraud Investigation in Los Angeles, CA
When you are being targeted by federal agents and prosecutors, you need to mount a strategic and effective defense. This starts with engaging a powerful and experienced defense team to represent you. Here are five reasons why health care providers choose our Los Angeles health care fraud lawyers at Oberheiden, P.C.:
- National Reputation – Our health care fraud defense lawyers are known nationwide for their experience and results in federal health care fraud investigations.
- Prosecutorial Insights – Several of our defense attorneys previously served as senior health care fraud prosecutors with the DOJ.
- Aggressive Intervention – When our Los Angeles health care fraud lawyers represent you, we will aggressively intervene in the government’s investigation in order to determine the scope and nature of the allegations against you.
- Pretrial Resolutions – The majority of our clients have never faced criminal charges. We focus on resolving our clients’ cases prior to trial, and prior to charges being filed, whenever possible.
- Trial–Ready Strategies – As highly experienced litigators, when a favorable pretrial resolution is not on the table, our seasoned Los Angeles health care fraud lawyers prepare meticulously to represent our clients in federal district court.
Contact the Los Angeles, CA, Office of Oberheiden, P.C.
For more information about how our Los Angeles health care fraud attorneys can help with your federal health care fraud investigation, please call 888-519-4897 or contact us online. We can conduct your free initial case assessment over the phone. And if you engage our firm, our Los Angeles health care fraud attorneys can make arrangements to meet with you in person in Los Angeles as soon as possible.