Newark Healthcare Fraud Defense Attorneys
Oberheiden P.C. is a team of highly experienced federal healthcare fraud defense attorneys representing physicians, pharmacists, executives, and others in the healthcare industry in audits, investigations, and trials. If your New Jersey healthcare business or medical practice is being targeted for fraud, call 888-680-1745 for a confidential consultation.
The most considerable risk facing many Newark healthcare providers and businesses is a federal healthcare fraud investigation. While most assume that, absent an intent to defraud the government, they cannot be prosecuted for healthcare fraud, that isn’t the case. The federal government routinely targets healthcare providers based on reckless or even negligent mistakes. Given the ease with which federal investigators and prosecutors can establish liability in a Newark healthcare fraud claim, even well-intentioned providers are not immune from federal scrutiny.
If agents and prosecutors with the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG) or any other federal agency announced their intention of investigating your healthcare business or practice, you should immediately contact the respected Newark healthcare fraud defense lawyers at Oberheiden P.C. Our dedicated team of attorneys consists of many former high-ranking federal prosecutors, giving us a unique insight into these cases and how the government approaches them. Oberheiden P.C. has centuries of combined experience defending healthcare providers from all types of healthcare fraud claims, including those involving civil and criminal liability.
Types of Newark Healthcare Fraud Cases Oberheiden P.C. Handles
At Oberheiden P.C., we are a comprehensive healthcare fraud defense law firm representing clients in a wide range of fraud allegations. We handle claims of Medicare and Medicaid fraud, as well as fraud related to private payers. Due to our vast experience, unlike many other Newark healthcare fraud defense law firms, we command a remarkably deep knowledge of both the substantive laws that govern these cases as well as a nuanced understanding of the healthcare industry. Some of the types of cases we regularly handle include the following:
Illegal Kickbacks, Bribes and Rebates
While there is nothing wrong with certain types of referral relationships or other forms of kickbacks, these agreements can easily run afoul of the federal healthcare fraud laws. Three major federal statutes govern referral relationships:
The Stark Law
The Stark Law prohibits physician self-referrals. More specifically, the Stark Law makes it illegal for a physician to refer a patient for “designated health services” payable by Medicare or Medicaid to another healthcare provider in which the referring physician has a financial interest. In this context, “designated health services” refer to any of the following:
- Clinical laboratory services;
- Durable medical equipment and supplies;
- Home health services;
- Inpatient and outpatient hospital services;
- Outpatient prescription drugs;
- Parenteral and enteral nutrients, equipment, and supplies;
- Physical therapy, occupational therapy, and outpatient speech-language pathology services;
- Prosthetics, orthotics, and prosthetic devices and supplies;
- Radiation therapy services and supplies; and
- Radiology and certain other imaging services.
The Stark Law is a strict liability law, meaning the federal government does not need to prove you intended to violate the law. Penalties for a Stark Law violation can include significant fines as well as exclusion from Medicare and Medicaid.
The Anti-Kickback Statute (AKS)
The Anti-Kickback Statute (AKS) is a criminal statute focused on preventing the payment of referrals for services or equipment payable by Medicare or Medicaid. The AKS makes it illegal to provide any sort of “remuneration” for a referral. Remuneration includes cash and anything of value, such as free rent, expensive hotel stays or meals, and excessive compensation for medical directorships or consultancies. Unlike the Stark Law, the AKS applies to physicians, other healthcare providers and anyone else who makes or receives a referral.
Because the AKS is a criminal statute, prosecutors must prove that you knowingly or willingly entered into the illegal referral relationship. However, if federal prosecutors meet this burden, you will face harsh criminal consequences, including jail time, fines, and exclusion from federal programs. For example, a physician who violated the AKS will face up to a $50,000 fine plus an additional fine of up to three times the amount of remuneration received. There are, however, safe harbors that protect referral relationships that would otherwise fall within the AKS.
The Eliminating Kickbacks in Recovery Act (EKRA)
The Eliminating Kickbacks in Recovery Act (EKRA) prohibits anyone from paying, receiving, or soliciting, any remuneration in return for referrals to recovery homes, clinical treatment facilities, or laboratories. Congress’s intent on passing EKRA was to reduce patient brokering and recovery profiteering that became rampant during the early years of the opioid epidemic. While the focus of EKRA is on preventing any recovery-based business from paying a referral, a healthcare provider who makes a referral can also be prosecuted under the law. While there are safe harbors under EKRA, they are narrower in scope than those available through the AKS. EKRA also prohibits referrals to privately paid services, making it broader than the AKS in that regard. The penalties for an EKRA violation are incredibly harsh, carrying up to 20 years in jail and a $200,000 fine per violation.
Billing and Coding Violations
Healthcare providers who serve patients on Medicare or Medicaid must comply with these programs’ strict billing and coding procedures. However, these procedures are complex, and it is rare for a provider to submit claims with 100% accuracy. Nonetheless, the federal government is constantly on the lookout for billing and coding violations, including:
- Billing for medically unnecessary services and equipment;
- Billing for non-allowable costs;
- Billing for kickbacks or referral fees;
- Billing for services or equipment not provided;
- Billing for unlicensed or excluded services;
- Submitting duplicate claims;
- Failure to comply with secondary-payer rules;
- Unbundling of services;
- Upcoding; and
- Use of the wrong billing code.
Depending on the nature of the alleged violation, a practitioner may face civil or criminal liability if they are found to have committed billing or coding violations. At Oberheiden P.C., our Newark healthcare fraud defense lawyers have a successful track record of resolving these claims before charges are filed.
Five Reasons Why Oberheiden P.C. Is Qualified to Defend You Against Newark Healthcare Fraud Charges
If you face healthcare fraud charges in Newark, the attorney you select to represent you is one of the most important decisions you will make related to your case. While there are many federal defense attorneys who can competently handle your case, when have you settled for mere competence? You deserve an attorney who is steadfastly dedicated to your defense and will do everything possible to resolve your case as quickly and efficiently as possible. Below are five reasons you should contact Oberheiden P.C. to represent you in your Newark healthcare fraud case.
We Have Vast Experience
Given the complexity of healthcare fraud cases, experience is one of the most important traits you can seek in an attorney. At Oberheiden P.C., we have centuries of combined experience handling every type of healthcare fraud case. We also offer a valuable perspective in that many of our senior Newark healthcare fraud defense attorneys formerly worked as federal prosecutors and investigators, bringing healthcare fraud cases on behalf of the government.
We Have a Successful Track Record
When you are looking for a Newark healthcare fraud defense lawyer, you want an attorney who has not only handled similar cases in the past, but successfully handled them. At Oberheiden P.C., we have a 90% success rate among the thousands of cases we’ve handled. In many cases, we are able to intervene early in the process to avoid the filing of charges.
We Maintain a Unique Focus on Healthcare Fraud
At Oberheiden P.C., we are not a jack-of-all-trades law firm; we focus exclusively on providing an exceptional level of representation to healthcare providers in healthcare fraud cases. This provides us with an unrivaled depth of understanding, both as to the substantive federal healthcare fraud laws as well as the healthcare industry as a whole.
We Are Respected Advocates
Oberheiden P.C., consists of highly skilled attorneys who have dedicated their careers to the enforcement and defense of healthcare fraud laws. As a result, many or our senior attorneys are nationally recognized for their efforts.
We Offer Client-Centered Representation
No two healthcare fraud cases are the same, and no two defense strategies should be the same. At Oberheiden P.C., our deep and diverse experiences provide us with a keen ability to develop custom-tailored solutions that fit the needs of each of our clients.
Frequently Asked Questions
What is a whistleblower lawsuit?
The False Claims Act contains what is referred to as the “qui tam” provision, which allows private citizens to initiate a healthcare fraud lawsuit on behalf of the government. Often, these lawsuits are filed by people who have some inside knowledge of a healthcare practice, such as a former employee or business partner, a patient, or another service provider. When a whistleblower comes across evidence they believe indicates a practitioner is engaging in healthcare fraud, they typically bring that evidence to the attention of federal authorities. This triggers a duty on the part of the federal government to conduct its own independent investigation into the allegations. If the government finds the whistleblower’s claims compelling and determines that the case is significant, it will intervene. Government interventions are extremely burdensome and decrease the likelihood that a case will be resolved early in the process. Thus, if you received word that a whistleblower identified you or your practice in healthcare fraud allegations, it is imperative to speak with a Newark healthcare fraud defense lawyer at Oberheiden P.C. as soon as possible.
How can I find out if I am facing criminal healthcare fraud charges?
The short answer is that it is not always easy to determine if the government is seeking to hold you civilly or criminally liable. On occasion, you can glean information from the information provided by the government. For example, if you receive a target letter, the government is likely to pursue criminal charges against you. Similarly, if federal agents inform you in writing that you are under investigation for a violation of the Anti-Kickback Statute, this too is an indication you face criminal liability. However, in the majority of cases, it is unclear what exactly is at stake until much later in the process. For example, allegations involving the False Claims Act may be either civil or criminal in nature. At Oberheiden P.C., we can help healthcare practitioners defend against both civil and criminal healthcare fraud charges. We are skilled at quickly identifying the government’s theory of liability, and will act promptly, focusing our efforts on eliminating the possibility of any criminal charges.
What is the False Claims Act?
In the healthcare context, the False Claims Act is a federal law focusing on preventing medical providers from overcharging federally funded healthcare programs. Essentially, the False Claims Act is the mechanism used by the government to prosecute providers who submit false, fraudulent, or exaggerated bills for the services or supplies provided to the patient. The False Claims Act imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government. However, depending on the specific nature of the allegations, a violation of the False Claims Act may result in criminal liability. If you are under investigation for a violation of the False Claims Act, it is essential to take the allegations seriously, even if you believe they are not based in reality. This is because there is no specific intent required to establish a violation of the False Claims Act, meaning an inadvertent error can still result in civil liability.
Contact Oberheiden. P.C. to Schedule a Free Consultation with an Experienced Newark Healthcare Fraud Defense Attorney
If you recently learned that you are under investigation for healthcare fraud, contact the Newark federal healthcare fraud defense attorneys at Oberheiden P.C. We’ve litigated more than 500 federal jury trials involving healthcare fraud and resolved 1,000 other healthcare fraud cases in federal courts around the county. You can reach our Newark healthcare fraud defense lawyers at 888-680-1745 or reach us online through our contact form. If a member of our team is not available immediately, we will respond to your inquiry as soon as possible.