Louisville, Kentucky Health Care Fraud Defense Lawyers
Representing Louisville, Kentucky Providers in Audits, Investigations, and Prosecutions
Medical providers in Louisville and surrounding Kentucky communities must expect significantly increased monitoring and scrutiny from government authorities. In late 2017, the Attorney General of the United States, Jeff Sessions, reinforced the federal government’s war against narcotic drug diversion and violations of the Controlled Substances Act, making Kentucky one the strategic operational centers of DEA and FBI health care fraud enforcement. According to Mr. Session’s announcement, almost 100 federal agents will be transferred to a newly created DEA Field Office in Louisville to criminally prosecute physicians and business owners contributing to prescription drug and drug diversion fraud.
About Oberheiden, P.C.
Oberheiden, P.C. is a team of Louisville health care fraud defense attorneys and former federal prosecutors who represent medical providers in federal health care fraud matters. As former Department of Justice officials and former federal health care fraud prosecutors, our attorneys offer clients decades of specific experience when it comes to health care audits, investigations, and criminal defense. If your office is under the government’s radar, immediate intervention is without alternative. With the experience of more than 1,000 health care audits and investigations, we know how to protect you and your business. Our team of attorneys will develop a defense strategy that is based on a proven track record, not on experiments.
Our experience includes:
- More than 1,000 health care fraud investigations
- More than 1,000 grand jury investigations
- Dismissal of state and federal indictments
- More than 500 criminal trials
- More than 70 years of Department of Justice experience
Our attorneys have successfully represented physicians, pharmacies, toxicology laboratories, DME companies, home health and hospice agencies, and many more against alleged violations of the Controlled Substances Act, Medicare Fraud, Medicaid Fraud, the Anti-Kickback Statute, and fraud of private insurance plans. Call us immediately if you are concerned about your role or if you are under investigation. As we have for others, we will find a way to help you.
Louisville, Kentucky Health Care Companies are Being Targeted in Federal Fraud Investigations
Kentucky has become a key focus of the federal government’s fight against health care fraud. The U.S. Department of Health & Human Services’ (HHS), the Office of Inspector General (OIG), the Drug Enforcement Administration (DEA), and local U.S. Attorneys’ Offices in Louisville, Bowling Green, Owensboro, and Paducah Kentucky as well as in Wheeling, Clarksburg, Elkins and Martinsburg, West Virginia, have joined forces to take down physicians and businesses accused of health care fraud and drug diversion.
This is what is really new. In the past, it was understood that every human and every company make mistakes. Human error was part of every business, big and small. When that happened, the government would seek a recoupment, often accompanied with a fine, and the case would be resolved. Today, even simple human errors, for example in the context of coding and billing, may result in referrals to prosecutors. The climate has radically changed and anyone in health care must be on alert.
Further, investigations have become a mathematical fraud analysis. Today, so-called hot spots for fraud and abuse in the health care industry are identified based on numerical analysis. If you prescribe more or if you bill Medicare in higher volumes than your peers in your geographical area, you are automatically a potential target. The fact you may simply offer better medicine or are more trusted by patients comes second in that analysis, if at all. Physicians and health care practices must understand that it is part of today’s enforcement reality to be criminally investigated for being an “outlier.”
Current Fraud Investigations in Louisville, Kentucky
Recent developments indicate that Kentucky health care providers have become the focus of federal law enforcement agencies, in particular of the DEA. Our attorneys are prepared to represent Louisville physicians and health care executives in cases involving allegations of:
- Prescription Drug Fraud. Kentucky pain management physicians and those doctors regularly prescribing Schedules II or III are prime targets of the Drug Enforcement Administration (DEA) and other federal agencies tasked to investigate opioid abuse. Medical practices should contact experienced attorneys to obtain advice of how to avoid becoming a federal target relating to the dispensing or the administration of illegal prescriptions. Those that are already targets, it is critical to immediately establish a comprehensive defense plan to save your license and to protect your future.
- Medicare Fraud, Medicaid Fraud. Medicare Fraud and Medicaid Fraud are among the most charged offenses in health care investigations. In this context, Medicare Fraud is a generic term that summarizes any intentional violation of federal health care laws, in particular 18 U.S.C. 1347. Medicare Fraud includes coding and billing fraud, fraudulent certifications for home health and hospice eligibility, billing for services not provided, DME fraud, and many more. Our team has a track record of concluding Medicare Fraud and Medicaid Fraud investigations with no civil and no criminal liability for our clients. Call us today and find out how to protect yourself in Medicare cases.
- Medicare Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments though a process of reviewing and analyzing claims data in addition to medical documentation that is obtained from the member/provider. Many times this involves a statistical sampling of files in order to establish an error rate. Another type of Medicare audit is conducted by the Zone Program Integrity Contractors (ZPICs). ZPIC audits identify and stop potential fraud and refer these cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that a mishandled audit can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice health care prosecutors with first-hand knowledge safely navigate our clients through the audit and make sure that they can continue their business and don’t need be worried about their license or a government investigation.
- Illegal Kickbacks, Bribes, and Referral Fees. The Anti-Kickback Statute prohibits the offering, solicitation, payment, or receipt of any form of compensation for a patient referral. Often overlooked, the Statute applies to anyone, not just physicians. Kentucky doctors, health care marketers, pharmacies, and toxicology laboratories have become subject to intense scrutiny since the government takes the position that illegal kickbacks are behind many Kentucky business arrangements and joint ventures between physicians and business owners. Experienced attorneys will be able to advise that the Anti-Kickback Statute knows many exceptions. A forceful defense can render many kickback allegations into acceptable practices of medicine.
- False and Fraudulent Claims. The False Claims Act (FCA) is among the most widely enforced health care law statutes. The FCA is a hybrid statute, which means violations can be sanctioned through civil penalties but also through criminal prosecution. The FCA sanctions the submission of “false and fraudulent” claims to Medicare, Medicaid, Tricare, and other government benefit programs. Any “false” submission for reimbursement, even those without any intent or knowledge, subject providers and entities to draconian recoupments and fines. Our Firm has handled FCA investigations across the United States by offering clients proven defense strategies and compelling negotiation skills. Call us today if you received an OIG subpoena or other notice of a False Claims Act investigation against you or your business.
- Illegal Physician “Self-Referrals”. Under the federal Stark Law, it is illegal for physicians to refer patients to “related” health care entities for financial benefit. The entities that receive illegal “self-referrals” can face penalties under the Stark Law as well. Oberheiden, P.C. has extensive experience in Stark Law matters, and we can use our experience to protect your business or practice from fines and recoupments.
The attorneys at Oberheiden, P.C. are available to discuss your concerns or situation in a free and confidential consultation. Think about it. You have nothing to lose. Speak to one of our former Department of Justice health care prosecutors today and find out how we assess your case. Get reliable guidance from experienced attorneys with a proven track record.
Important FAQs Regarding Health Care Fraud Investigations in Louisville, Kentucky
Q&A with Health Care Fraud Defense Attorney Nick Oberheiden, PhD
Q: What do I need to know if my practice is under investigation?
If your practice is under investigation, you should consult with seasoned counsel to carefully analyze the reason for the investigation. Experienced lawyers can quickly determine the potential exposure, the nature of the investigation, and the potential outcome. From the initial assessment a decision will derive whether and how to contact the government to inquire more about the status and the goal of the investigation. I encourage you to contact Oberheiden, P.C. so that our health care fraud defense team can start working on your case immediately.
Q: What are the penalties for federal health care fraud?
The penalties for federal health care fraud depend on the specific statute (or statutes) at issue. In civil cases, the government is likely to demand a recoupment and fines. In criminal cases, the penalties can include:
- Hundreds of thousands of dollars in criminal fines
- Asset forfeiture and seizure
- Up to 10 years of federal imprisonment for each count of health care fraud
- Up to 20 years of federal imprisonment for each count involving serious bodily injury to a patient
- A life sentence for health care fraud resulting in a patient fatality
Q: How do I know what statutes I am accused of violating and whether my case is civil or criminal?
At the beginning of a case, it is not always clear whether the investigation is civil or criminal. Experienced attorneys will be able to make a reliable determination when they hear the full story from you and when they analyze how the government proceeds in the investigation. Is it an OIG subpoena or a grand jury subpoena? Are federal agents involved? Is the case assigned to a prosecutor? Is the prosecutor in the civil or in the criminal enforcement section? To get you quick peace of mind, one of the first things our attorneys will do is to make contact with the investigators and prosecutors involved in order to obtain the specifics of the allegations against you.
Strategic Defense for Health Care Providers in Louisville, Kentucky
When it comes to protecting and defending your license, livelihood, and your freedom, you simply cannot experiment. If you are under investigation or have important questions about health care fraud, Medicare fraud, Medicaid fraud, prescription policies, drug investigations, or the Anti-Kickback Statute, advice from the best DUI defense attorney may not be what you need.
Oberheiden, P.C. represents clients across the country in health care cases. Decades of experience from health care enforcement positions at the Department of Justice and from establishing a track record in private practice allow us to competently and efficiently advise and guide individual and corporate clients through all and any health care law related audit, investigation, prosecution, or trial.
While the approach varies from case to case based on the specific circumstances and the stage the investigation is in, in general, we apply a proactive approach where we challenge the government rather than allowing them time to build a case against our clients. Our strategic approach to defending health care providers in Louisville and throughout Kentucky includes:
- Making immediate contact with the investigators and prosecutors involved in your case in order to intervene in the investigation and collect the key information we need to formulate a tailored defense strategy.
- Evaluating the legal standards that apply based on the nature of the government’s investigation and the unique aspects of your business or practice.
- Exploring all possible defenses to the government’s allegations, including statutory exceptions and safe harbors, factual arguments, and constitutional protections.
- Doing everything possible to preserve your professional reputation and resolve the investigation without your business or practice being put in jeopardy.
- Trial expertise. Where needed, we are ready to challenge the government in court. With more than 500 criminal cases handled, Oberheiden, P.C. is highly capable of bringing in former Department of Justice Trial Attorneys, former state and federal prosecutors with significant court room expertise.
Schedule a Confidential Case Evaluation
Our team of Louisville health care fraud defense lawyers is available to begin working on your case immediately. To speak with our attorneys in confidence, please call (888) 519-4897 or request a free case evaluation online now.
Areas We Serve in Louisville, Kentucky
Subject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel.
Louisville, Shively, Saint Matthews, Newburg, Lyndon, Okolona, Highview, Jeffersontown, Fern Creek, Valley Station, Shelbyville, Radcliff, Bardstown, Lexington, Cincinnati, Cave City, Cumberland Falls State Park, Ashland, Bowling Green, Campbellsville, Corbin, Danville, Edgewood, Erlanger, Florence, Georgetown, Frankfort, Hopkinsville, Independence, Jeffersontown, Owensboro, Paducah, Richmond, Anchorage, Indian Hills, Hurstbourne, Crestwood, Windy Hills, Barbourmeade.
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