Nebraska Healthcare Fraud Defense Lawyers
Our Nebraska healthcare fraud defense attorneys provide strategic defense representation for physicians, pharmacists, and other healthcare providers facing federal fraud investigations. To speak with a member of our federal healthcare fraud defense team in confidence, call 888-680-1745 now.
Healthcare providers in Omaha, Lincoln, and other parts of Nebraska are being targeted in federal healthcare 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 Healthcare Fraud Investigation?
The possible consequences of a federal healthcare 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 healthcare 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 Nebraska healthcare fraud defense lawyers have significant experience helping clients avoid charges in healthcare 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 healthcare 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 healthcare 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 healthcare 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, healthcare 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 healthcare fraud charge requires a skilled and strategic defense.
Why is My Healthcare Practice of Medical Business Being Targeted?
In today’s world, there are a number of reasons why healthcare 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 healthcare 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 a Nebraska healthcare fraud defense 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 healthcare 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 Healthcare 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 Nebraska healthcare fraud defense attorneys to quickly convince the government to drop its investigation into your business or practice.
How Can Oberheiden, P.C.’s Federal Healthcare Fraud Defense Team Assist with My Investigation?
When you engage our firm to represent you during your federal healthcare 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 healthcare 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 healthcare fraud prosecutors with the DOJ
- Attorneys who offer centuries of combined experience in high-stakes federal healthcare fraud cases
Where Can I Learn More about Defending Against a Federal Healthcare Fraud Investigation in Nebraska?
Our blog contains a wealth of information for healthcare 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 Healthcare Fraud Investigation
- Q&A with Federal Healthcare 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 Healthcare 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 healthcare fraud defense attorney. To discuss your investigation with a member of our defense team in confidence, please contact us today.
What is the Anti-Kickback Statute?
The Anti-Kickback Statute (AKS) is a federal government law that limits anyone’s ability to pay or receive a referral incentive for referring a patient whose medical bills are covered by a federally funded program. In the context of healthcare, the AKS most often involves patients receiving Medicare or Medicaid benefits. The Anti-Kickback statute is codified in 42 U.S.C. §1320a–7b and is a criminal law statute. Therefore, unlike many other healthcare fraud statutes, a violation of the AKS can result in incarceration, with each offense carrying a maximum of five years in federal prison and a fine of up to $25,000 per violation. To prove a violation of the AKS, federal prosecutors must show that you knowingly and willfully participated in the referral arrangement. Many defenses to AKS violations are based on a provider’s lack of “guilty knowledge.” If you are under investigation for a violation of the Anti-Kickback Statute, protect yourself by contacting a Nebraska federal healthcare defense attorney as soon as possible.
Why does the DEA target doctors in nebraska?
The DEA investigates physicians who have prescribed controlled substances, in particular pain medications, to chronic pain patients or cash paying patients, between 2014 and the present. The Department of Justice and the DEA take the position that pill mill operations caused drug diversion and addiction in large areas of Nebraska. The Justice Department’s announcement to prosecute physicians of all specialties and pharmacies should put healthcare providers on high alert as many doctors nationwide have already been arrested and jailed for alleged opioid fraud.
What penalties could nebraskan physicians face in opioid investigations?
Doctors or pharmacists found guilty for dispensing medically unnecessary opioids are subject to 21 U.S.C. 841, 846 (drug dealing) and 18 U.S.C. 1347 (healthcare fraud). Both statutes contain significant fines, including federal imprisonment of up to 10 years per count. Avoid these consequences, call for help today!
When should I contact a Nebraska federal healthcare defense attorney?
As soon as possible. If you are fortunate enough to learn of the investigation before any charges have been filed, reaching out to an attorney immediately may grant the possibility of avoiding charges altogether. If charges have been filed, however, there is no doubt that you need to reach out to an attorney immediately. By the time you learn of an investigation, the federal government has usually already put a case against you together, meaning you are playing catch-up. Although there are many defenses to healthcare fraud allegations, the more time your Nebraska federal healthcare defense attorney has to develop an effective defense, the greater the likelihood of success.
What are the potential outcomes of a federal healthcare fraud investigation?
The possible outcomes of a federal healthcare fraud investigation range from termination of the investigation without formal charges to a felony conviction on multiple counts of healthcare fraud, mail fraud, wire fraud, conspiracy, money laundering, and other related offenses. In order to determine your potential exposure as a result of the government’s investigation, you will need to know:
- The specific allegations against you; and
- whether the investigation is civil or criminal in nature.
Do You Have More Questions? Contact Us Now for a Confidential Initial Case Assessment
If you have more questions and would like to speak with a Nebraska healthcare fraud defense lawyer about your Nebraska healthcare fraud investigation, please call 888-680-1745 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.