Oberheiden, P.C. is a team of experienced federal health care fraud defense attorneys who represent physicians, pharmacists, health care company executives, and other clients in audits, investigations, and trials. If your Nevada health care business or medical practice is being targeted for fraud, call 888-519-4897 for a confidential consultation.
For many health care providers in Nevada, the risk of being targeted in a federal health care fraud investigation is one of the biggest threats to the long-term stability of their business or practice. Federal agents and prosecutors with the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other agencies and task forces are aggressively targeting providers in Las Vegas, Reno, and other parts of Nevada, and many providers are facing the potential for hundreds or millions of dollars in financial penalties and years or decades of federal imprisonment.
5 Key Facts about Federal Health Care Fraud Investigations
1. All Health Care Providers are at Risk for Prosecution.
Due to the methods by which federal authorities identify health care providers to target in Medicare, Medicaid, Tricare, and Department of Labor (DOL) investigations, no provider is immune from the risk of being targeted. In most cases, investigations result from automated review of providers’ billing data, with any apparent “anomalies” serving as potential triggers for further inquiry. For example, a provider who routinely bills Medicare for a particular service or supply may stand out if no other providers in the same part of Nevada have similar billing patterns. While this alone certainly is not indicative of fraud, it is enough to trigger a federal investigation.
2. Allegations of Health Care Fraud Can Take Many Forms.
Most people think of “fraud” as an intentional act. But, while intentionally overbilling Medicare or Medicaid is one form of health care fraud, various unintentional billing violations can lead to federal prosecution as well. Generally speaking, evidence of intent (or the lack of such evidence) is the distinguishing factor between a provider facing civil and criminal charges – not the distinguishing factor between prosecution and avoiding the potential for federal penalties.
Health care fraud investigations can involve allegations under the False Claims Act, the Anti-Kickback Statute, the Stark Law, the federal health care statute, and a variety of other federal laws. Some of the most-common allegations under these statutes include:
- 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
When facing a federal investigation, determining exactly why you are being targeted is the first step toward building an effective defense strategy. Once you engage our federal health care fraud defense team to represent you, our attorneys will quickly intervene in the investigation to determine the nature and extent of the allegations against you.
3. The Penalties for Health Care Fraud are Severe.
In both civil and criminal health care fraud cases, the penalties can be severe. Providers targeted for civil and criminal violations can face substantial financial penalties, and those targeted for alleged crimes can face long-term imprisonment. Along with fines and prison time, potential consequences of a federal health care fraud investigation also include:
- Treble damages
- Fees and costs
- Denial of pending claims
- Pre-payment review (which can delay payment by up to six months)
- Medicare, Medicaid, Tricare, and DOL exclusion
- Loss of DEA registration
- State board licensing action
While these are all potential penalties, the outcome of any particular investigation will depend heavily on the scope and severity of the allegations involved, whether the investigation is civil or criminal in nature, and the strength of the provider’s defense. Our attorneys have helped clients avoid charges and penalties altogether during the investigative process, we have negotiated plea deals and obtained dismissals prior to trial, and we have used strategic trial representation to substantially mitigate our clients’ sentences in court.
4. Health Care Fraud Investigations are Often Misguided.
Although Medicare, Medicaid, Tricare, and DOL fraud cost the federal government billions of dollars every year, many investigations targeting legitimate health care providers are misguided. In these cases, it is important for providers to quickly identify the source of the government’s misinformation and assemble the evidence needed to close the investigation promptly. However, due to the breadth of our nation’s health care laws, it is also essential for providers targeted in federal investigations to make sure that their billings will withstand scrutiny. With even unintentional mistakes having the potential for severe consequences, providers must conduct prompt and thorough internal assessments to determine the scope of any potential exposure.
5. An Aggressive Defense Strategy is Key to Avoiding Federal Charges.
Regardless of the veracity of the government’s allegations, presenting an aggressive defense strategy is the key to avoiding federal charges. This starts with intervening during the investigative process and using the information gathered during an internal assessment to respond appropriately. At Oberheiden, P.C., we rely on our attorneys’ centuries of combined legal experience on both sides of federal health care fraud cases to develop and execute comprehensive defense strategies that are tailored specifically to the facts and allegations involved in each individual client’s case.
Who We Represent
In our health care fraud defense practice, we represent clients throughout Nevada and nationwide in all facets of the health care industry. Our experience includes securing favorable outcomes for clients including:
- Compounding pharmacists
- Physician groups
- Hospitals, clinics, and other medical facilities
- Testing laboratories
- Durable medical equipment (DME) companies
- Company owners, board members, and executives
By their nature, many health care fraud investigations will involve allegations against multiple related or unrelated parties. For example, an Anti-Kickback Statute investigation may involve allegations against a medical practice and a referral source, or a Stark Law investigation may involve allegations against a physician and one or more “related entities.” Additionally, the federal conspiracy statute gives prosecutors broad authority to pursue cases against multiple providers – even in cases where no health care offense has been committed – and, in these cases, we work to ensure that our clients are insulated from liability to the greatest extent possible.
Q&A with Oberheiden, P.C.’s Federal Health Care Fraud Defense Lawyers
Q: Am I safe if have not intentionally overbilled Medicare, Medicaid, Tricare, or the DOL?
Unfortunately, not necessarily. While lack of intent is a defense to criminal health care fraud charges, you could still be charged civilly as a result of the government’s investigation. To try to prevent this from happening – and to position yourself to present a strong defense at trial if necessary – it is imperative that you begin working to counter the government’s evidence as soon as possible.
Q: What should I do if I am aware of improper billings being submitted to Medicare, Medicaid, Tricare, or the DOL?
If you are aware that your business or practice has previously submitted improper reimbursement requests to Medicare, Medicaid, Tricare, or the DOL, you need to proceed very cautiously. From how you respond to the investigation to the actions you take independent of the investigation, there are both key steps you need to take and critical mistakes you need to avoid. For more information, you can read:
Q: Should I cooperate with the government’s investigation?
This question does not have a straightforward answer. While it can be beneficial to cooperate (and you may have a legal obligation to cooperate) to a certain extent, being too cooperative can also unnecessarily expose you to prosecution and potential penalties. With our extensive experience in federal health care fraud investigations, we can advise you regarding the appropriate steps to take, and we can deal with the federal agents and prosecutors handling your investigation on your behalf.
Q: What do I need to know if I have received a target letter, subpoena, or civil investigative demand?
Target letters, subpoenas, and civil investigative demands are different investigative tools that require different responsive measures. If you have received a target letter or been served with a subpoena or civil investigative demand, we strongly encourage you to contact us to discuss your options as soon as possible.
Q: Can Oberheiden, P.C. handle my federal health care fraud investigation in Nevada?
Yes. Our law firm has a nationwide presence, and our attorneys are available to represent health care providers and medical businesses in Nevada. We can conduct your initial case assessment over the phone; and, if necessary, we can have attorneys from our defense team on the ground in Nevada at a moment’s notice.
Get Started with a Confidential Initial Case Assessment
To speak with a member of our federal defense team about your health care fraud investigation in Nevada, please call 888-519-4897 or contact us online. Federal health care fraud investigations require immediate action, and our attorneys can begin working on your case 24/7.