Our attorneys provide strategic defense representation for physicians, pharmacists, and other health care providers facing federal fraud investigations in Nebraska. To speak with a member of our federal health care fraud defense team in confidence, call 888-519-4897 now.
Health care providers in Omaha, Lincoln, and other parts of Nebraska are being targeted in federal health care fraud investigations. In these investigations, agents from the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other federal agencies and task forces are using aggressive tactics to collect the evidence prosecutors need to press charges, and providers are at risk for both civil and criminal penalties.
What are the Possible Consequences of a Federal Health Care Fraud Investigation?
The possible consequences of a federal health care fraud investigation range from termination of the investigation without charges being filed to a criminal conviction and sentencing in federal district court. Two of the key facts to understand about a federal health care fraud investigation are: (i) being investigated is not the same as being charged, and (ii) an investigation can be either civil or criminal in nature.
If are under investigation, this means the federal government does not yet have the evidence it needs to file charges against you. This means it is possible that the investigation could potentially be resolved without charges being filed. Our attorneys have significant experience helping clients avoid charges in health care fraud investigations, and early intervention is a key aspect of a pre-indictment defense strategy.
The False Claims Act, the Anti-Kickback Statute, and other federal health care laws include provisions for both civil and criminal prosecution. Various other federal criminal statutes can come into play as well, and some laws (such as the Stark Law) only include provisions for civil enforcement. Understanding whether your investigation is civil or criminal in nature is critical to determining what penalties are on the table. In civil health care fraud cases, potential penalties include:
- Civil fines
- Treble (triple) damages
- Costs and fees
- Denial of pending claims and pre-payment review
- Loss of program eligibility
- Loss of DEA registration and other privileges
In criminal health care fraud cases, potential penalties include:
- Criminal fines
- Program-related penalties (i.e. Medicare, Medicaid, Tricare, or Department of Labor (DOL) exclusion)
- Federal incarceration
Within each of these categories of penalties, health care providers can face a broad range of potential consequences. Certain financial penalties apply on a per-claim basis, which means that providers’ exposure will depend on the scope of the allegations against them. Fines and prison sentences can also vary widely, and mitigating the consequences of a civil or criminal health care fraud charge requires a skilled and strategic defense.
Why is My Health Care Practice of Medical Business Being Targeted?
In today’s world, there are a number of reasons why health care providers may be targeted in federal fraud investigations. With increasing frequency, we are seeing investigations being triggered by the federal government’s automated review of providers’ billing data. The government’s software analyzes providers’ aggregate billing data for apparent outliers or anomalies, and simply being different can be enough to trigger closer scrutiny. As a result, in many cases, defending against a federal health care fraud investigation is a matter of demonstrating why a particular provider’s “anomalous” program billings are fully justified.
Other potential triggers include whistleblower claims, audit reports, and regularly-scheduled examinations (for example, the DEA reviews registrants’ eligibility every three years). When you engage our firm to represent you, one of our first steps will be to determine why your business or practice is under investigation.
What are My Obligations if I Received a Target Letter, Subpoena, or Civil Investigative Demand?
Target letters, subpoenas, and civil investigative demands are very different investigative tools that trigger very different obligations. If you have received any sort of formal request for documents or information from the DEA, DOJ, OIG, or another federal agency or task force, you should discuss your obligations with an attorney immediately.
What Should I Tell My Staff about the Investigation?
At this point, you should not tell your staff any more than they absolutely need to know. You do not want to unnecessarily turn your staff members into witnesses, and you need to make sure that you control the narrative of your case.
That said, your staff should be provided with certain instructions. For example, they should be instructed to refer any inquiries from federal agents to you or your legal counsel, and they will need to be aware of your business’s or practice’s obligation to retain potentially-relevant documentation. Our attorneys can assist with this process, and we can meet with you and your staff on-premises in Nebraska if desired.
What are the Federal Agents Conducting the Investigation Looking For?
In most cases, federal authorities are looking for evidence of certain specific types of fraudulent practices involving Medicare, Medicaid, Tricare, or DOL program billings. In our experience, the most-common allegations against providers in federal health care fraud investigations are:
- Billing and coding errors
- Kickbacks, bribes, and rebates
- Physician self-referrals
- False and fraudulent claims
- Billing for medically-unnecessary services, supplies, or equipment
- Billing for services, supplies, or equipment not provided
- Prescription drug fraud
- Falsifying patient records and inaccurately reporting test results
- Fraudulent physician certifications and election statements
- Tax evasion and other related federal offenses
Do I have to Comply with the Investigators’ Requests for Documents or Staff Interviews?
Maybe, but this is not a determination you should make until you speak with an attorney. Your obligation to comply with investigators’ demands depends upon multiple factors – including the nature and legitimacy of the request – and you do not want to unnecessarily share any information that could lead federal prosecutors to press charges.
How Likely is it that the Government’s Investigation Will Lead to Federal Charges for Health Care Fraud?
It depends. In order to assess the probabilities of the various potential outcomes of your investigation, we will need to work closely with you to uncover the relevant facts while simultaneously determining what evidence is available to the DOJ. While facing charges is indeed a possibility, it may also be possible for our attorneys to quickly convince the government to drop its investigation into your business or practice.
How Can Oberheiden, P.C.’s Federal Health Care Fraud Defense Team Assist with My Investigation?
When you engage our firm to represent you during your federal health care fraud investigation in Nebraska, we will utilize a variety of different defense strategies in an effort to resolve your case as efficiently and favorably as possible. Some of the methods our attorneys use to defend clients in investigations conducted by the DEA, DOJ, OIG, and other federal agencies and task forces include:
- Promptly intervening in the government’s investigation
- Ensuring that the investigation remains civil in nature
- Challenging federal agents’ methodologies and assumptions
- Challenging the constitutionality of the government’s investigative and prosecutorial practices
- Exposing evidentiary flaws in the government’s case
- Asserting statutory safe harbors and other affirmative defenses
- Demonstrating that use of the government’s resources to prosecute the case through trial is unwarranted
If I Engage Oberheiden, P.C., Who Will Handle My Case?
Our federal health care fraud defense team is comprised entirely of senior attorneys. These senior attorneys work together to craft, test, and refine case strategies in every matter we handle. As a client of Oberheiden, P.C., your defense team will include:
- Seasoned defense attorneys who focus exclusively on federal practice
- Former federal health care fraud prosecutors with the DOJ
- Attorneys who offer centuries of combined experience in high-stakes federal health care fraud cases
Where Can I Learn More about Defending Against a Federal Health Care Fraud Investigation in Nebraska?
Our blog contains a wealth of information for health care providers facing federal fraud investigations in Nebraska. In addition to articles designed to address the unique issues involved in investigations targeting different types of providers, our blog also includes numerous general information articles such as:
- Glossary: Understanding Your Federal Health Care Fraud Investigation
- Q&A with Federal Health Care Fraud Defense Lawyer, Nick Oberheiden, PhD: What Do You Need to Know If Your Practice Is Under Investigation?
- The Obligation to Report and Refund Medicare Overpayments
- What Constitutes a “Safe Harbor” in an Anti-Kickback Statute Investigation?
- What Kinds of Billing and Coding Errors Constitute Health Care Fraud?
- What to Do About Medicare Overpayments
- What Types of Activities Are Covered Under the False Claims Act?
Ultimately, the best way to learn more about your situation is to obtain legal advice from a highly-experienced federal health care fraud defense attorney. To discuss your investigation with a member of our defense team in confidence, please contact us today.
More Questions? Contact Us Now for a Confidential Initial Case Assessment
If you have more questions and would like to speak with an attorney about your Nebraska health care fraud investigation, please call 888-519-4897 or contact us online. You can reach us 24/7; and, once you contact us, we will schedule your confidential initial case assessment as soon as possible.