Long Island Healthcare Fraud Defense Attorney
The federal government has recently increased healthcare fraud enforcement efforts targeting healthcare providers in New York, with a heightened focus on Long Island practitioners. If federal authorities reached out to you about an investigation into your practice, our Long Island, New York healthcare fraud defense lawyers can get to work immediately developing an effective defense strategy. Call 888-680-1745 to schedule a free consultation with an attorney today.
Healthcare providers face tremendous risks when under investigation for healthcare fraud. Government investigations into healthcare fraud are incredibly burdensome, which can take your focus off of your business. Not only that, but healthcare fraud charges can result in astronomical civil penalties and, in some cases, criminal consequences. However, prompt action can make a difference in how these investigations proceed and the outcomes providers can expect.
If federal agents have informed you that you or your organization is under investigation for healthcare fraud, it is critical to obtain the assistance of a Long Island federal healthcare fraud defense attorney as soon as possible. Even if you doubt the government’s accusations or its ability to prove them in court, the realities of a healthcare fraud investigation make it necessary to take every claim seriously. At Oberheiden P.C., our team of veteran Long Island federal healthcare fraud defense lawyers have helped thousands of clients defend their practices, their reputations, their financial standing and their future. We have centuries of experience handling some of the most complex and high-stakes healthcare fraud investigations in the United States and know what it takes to secure favorable results in an efficient and cost-effective manner.
What Is Healthcare Fraud?
Healthcare fraud is a term that refers to any false, misleading, or otherwise illegal conduct that negatively affects the party responsible for paying a patient’s healthcare expenses. In most Long Island federal healthcare fraud cases, the government is looking into allegations that a provider sought personal gain at the expense of Medicare, Medicaid, or another federally funded healthcare program.
While most assume that “fraud” involves the conscious objective to deprive a government program of resources, that isn’t necessarily the case. Civil healthcare fraud laws punish even inadvertent errors. And given the federal government’s aggressive prosecution of these offenses, there is no guarantee that investigators won’t come to the wrong conclusion about a well-intentioned provider’s motives. In this case, a provider may end up facing criminal liability. The result is that many honest, hardworking providers who make innocent mistakes have found themselves at the center of a healthcare fraud investigation at some point in their careers.
At Oberheiden P.C., our respected Long Island federal criminal defense attorneys defend providers accused of engaging in all types of fraudulent activity, including:
One of the federal government’s recent areas of focus is on referral relationships between healthcare providers. While referrals are an important and legitimate part of the healthcare industry, federal laws place strict rules on these relationships. There are three major federal statutes that limit referrals.
The Stark Law
The Stark Law precludes a provider from referring a patient to another practice when the referring provider has a financial stake in the organization receiving the referral. For example, a physician could not legally receive a referral fee if she sent a patient sample to a lab that she had an ownership interest in. A violation of the Stark Law is civil in nature and can carry significant economic penalties, including $15,000 per violation. Those found in violation of the Stark Law may also face program exclusions, meaning they can no longer participate in federal programs such as Medicare and Medicaid.
The Anti-Kickback Statute
The Anti-Kickback Statute prevents any party from paying or receiving anything of value when referring a patient whose medical bills are paid by a federally funded program. Unlike the Stark Law, the Anti-Kickback Statute applies to physicians, healthcare providers, and anyone else who makes or solicits a referral. The Anti-Kickback Statute is a criminal law, which carries penalties of up to $25,000 and five years in prison per offense. The government may also pursue civil claims under the False Claims Act.
The Eliminating Kickback in Recovery Act
In passing the Eliminating Kickbacks in Recovery Act (EKRA), lawmakers wanted to limit the situations in which anyone could profit from the opioid epidemic. Thus, EKRA makes it illegal to receive any sort of remuneration for the referral of patients who are suffering from addiction. EKRA is very broad in scope and applies not only to healthcare providers but anyone who makes, receives, or solicits a referral. EKRA can both result in criminal sanctions in addition to civil liability under the False Claims Act.
At Oberheiden P.C., we have extensive experience defending healthcare providers, laboratories, and others from allegations of an illegal referral relationship. We take a proactive approach to these cases, preferring to get involved as early as possible so we can effectively advocate on your behalf well before charges have been filed.
False and Fraudulent Claims
The False Claims Act prohibits providers from submitting any “false or fraudulent” to Medicare, Medicaid or any other federally funded program. Intentional violations of the False Claims Act can result in criminal liability; however, even inadvertent violations can still put you at risk of significant civil liability. Those found in violation of the False Claims Act may also face program exclusion, meaning they can no longer receive reimbursement from Medicare or Medicaid. At Oberheiden P.C., our Long Island federal healthcare fraud defense lawyers have successfully defended hundreds of clients facing charges under the False Claims Act, including those stemming from the following:
Billing and Coding Errors
Healthcare providers are expected to submit accurate bills when seeking reimbursement from a federally funded program. However, the billing and coding requirements of these programs are onerous, to say the least. Even well-intentioned providers can find themselves making honest mistakes that can raise the suspicion of federal investigators. For example, the government is on the lookout for any of the following:
- Failure to provide sufficient information
- Providing false information
- Using the incorrect codes
- Unbundling procedures into multiple codes
Billing Medicare or Medicaid for Unnecessary Supplies, Services or Equipment
Healthcare providers can only bill Medicare and Medicaid for supplies, services or equipment that are medically necessary. However, the determination of what is medically necessary doesn’t rest solely with a provider; the federal government has the final say. Thus, what makes something medically necessary can come down to the subjective opinion of a federal investigator who is essentially tasked with second-guessing a provider’s assessment.
Falsifying Patient Records
The federal government often raises allegations that a provider falsified patient records or test results to support a claim of intentional billing and coding violations. If left unaddressed, these allegations can turn a minor pattern of errors turning into something much more serious.
Who Does Oberheiden P.C. Represent?
At Oberheiden P.C., we have a comprehensive Long Island federal healthcare fraud defense practice that represents providers across the healthcare industry. We represent the following types of clients throughout Long Island and nationwide:
- Company owners, board members, and executives
- Compounding pharmacists
- Durable medical equipment (DME) companies
- Hospice providers
- Hospitals, clinics, and other medical facilities
- Clinical laboratories
- Physician groups
- Testing laboratories
Regardless of the type of practice you operate or the nature of the investigation, our veteran Long lsland healthcare fraud defense lawyers have very likely handled similar cases in the past.
What You Need to Know About Long Island Healthcare Fraud Investigations
Understandably, when you find yourself at the center of a fraud investigation, you may have many questions. This is not a situation you ever expected to find yourself in, and you may not yet have come up with a plan to address the allegations or have any idea how to start putting one together. Oberheiden P.C. is here to help. To begin, below are a few things to keep in mind about healthcare fraud investigations.
Any Provider is at Risk of Becoming the Subject of a Federal Fraud Investigation
Regardless of a provider’s practice area, level of experience, or good intentions, no one is immune from a healthcare fraud investigation. Uncovering Medicare and Medicare fraud are one of the government’s top priorities, and it has devoted significant resources to that end. As a result, any question into an inconsistent billing pattern, an allegation made by a whistleblower, or a concern raised over a referral relationship must be taken seriously.
Healthcare Fraud Investigations Can Carry Criminal Liability
Several healthcare fraud statutes can result in criminal liability. Even if you believe that your actions were above-board, there is no guarantee that’s how the federal government will see them. And once the government decides criminal sanctions may be appropriate, it opens the door to a host of other potential issues, such as mail fraud, wire fraud, conspiracy and tax evasion. At Oberheiden P.C., our primary focus is always on taking the possibility of criminal sanctions off the table as early as possible. From there, we can develop a comprehensive strategy to address any remaining civil claims.
Even Civil Healthcare Fraud Penalties Can Be Severe
Just because the federal government has agreed not to pursue criminal charges does not mean the case loses its urgency. The civil penalties that come along with a Long Island healthcare fraud violation can be life-changing. Some of these include:
- Denial of pending claims
- Fees and costs
- Loss of DEA registration
- Medicare, Medicaid, Tricare, and DOL exclusion
- Pre-payment review (which can delay payment by up to six months)
- State board licensing action
- Treble damages
There Are Defenses to Healthcare Fraud Allegations
The fact that the government has identified your practice as having engaged in fraud does not mean that you will be found civilly or criminally liable. Depending on the circumstances, there is a wide range of defenses that may either reduce your exposure or result in the withdrawal of charges. At Oberheiden P.C., our senior Long Island healthcare fraud defense attorneys will work closely with you to identify the defenses that best fit your situation.
An Investigation Doesn’t Always Result in Charges Being Filed
When facing a federal investigation, you cannot assume that the government has all the information it needs to prove its case against you. For various reasons, investigations targeting physicians, pharmacists, testing laboratories, hospices, and other healthcare entities are often misguided. Perhaps the whistleblower or referring agency failed to complete a full investigation or overlooked key evidence indicating a lack of intent. At Oberheiden P.C., we have successfully defended hundreds of clients who faced federal charges. Even if you believe that your business or practice may have billed a federal healthcare program improperly, you may still have defenses available. Oberheiden P.C. attorneys will work with you to quickly determine whether you have any potential exposure and come up with a comprehensive defense strategy to protect your interests.
Frequently Asked Questions
What is a qui tam lawsuit?
A qui tam lawsuit refers to a whistleblower’s case brought under the qui tam provision of the False Claims Act. While most federal healthcare fraud cases are initiated by the federal government, the False Claims Act allows for a private citizen who believes they uncovered evidence of fraud to file a case against a provider. Once the whistleblower comes forward, they will present the evidence to federal investigators, who must then conduct their own inquiry. If federal investigators believe there is sufficient evidence of fraud and that the case presents high enough stakes, they will intervene, taking over the case. However, even if the federal government chooses not to intervene, the whistleblower can bring the case on their own. Whistleblowers stand to receive up to 30 percent of any amount recovered, which is quite an incentive to bring these cases. Nonetheless, any allegation made by a whistleblower must be taken seriously in hopes of a prompt resolution to avoid a full-fledged federal investigation. To learn more about defending against a whistleblower claim, contact the Long Island federal healthcare fraud defense lawyers at Oberheiden P.C. today.
What to look for in a Long Island federal healthcare fraud defense attorney?
Healthcare fraud cases are complex. They also present very high stakes. Thus, if you face federal healthcare fraud charges in Long Island, you need an attorney who not only understands the applicable legal principles but also the healthcare industry as a whole. When looking for a Long Island federal healthcare fraud defense attorney, it is imperative you select a lawyer who has vast experience successfully handling similar healthcare fraud cases. This means experience investigating, preparing, negotiating and litigating these cases. The last thing you want is to feel compelled to take the government’s offer because you do not have confidence in your attorney’s ability to take the case to trial. At Oberheiden P.C., we’ve been involved in over 1,000 federal cases, handled more than 500 federal trials, and many of our senior attorneys used to work as federal healthcare fraud prosecutors. This gives us the insight and experience needed to successfully handle any case, no matter how complex.
Which federal agencies investigate Long Island healthcare fraud?
In most cases, the Federal Bureau of Investigation (FBI) spearheads healthcare fraud investigations. However, the FBI routinely works with other federal agencies, including:
- The Centers for Medicare and Medicaid Services (CMS)
- The Department of Defense (DOD)
- The Department of Health and Human Services (HHS)
- The Department of Justice (DOJ)
- The Department of Labor (DOL)
- The Drug Enforcement Administration (DEA)
- The Office of Inspector General (OIG)
For example, one or more of these federal agencies may come into evidence of potential fraud. The discovering agency will then initiate its own internal investigation. If the agency determines that there is compelling evidence of fraud, it will contact the FBI. FBI agents will then work with agents from the referring agency to further investigate the claim. Eventually, the FBI agents may involve federal prosecutors if the allegations are criminal in nature.
Call Oberheiden. P.C. to Set Up a Free Case Evaluation with an Experienced Long Island Healthcare Fraud Defense Attorney
If you recently learned that you are under investigation for any type of healthcare fraud, contact the Long Island federal healthcare fraud defense attorneys at Oberheiden P.C. as soon as possible. You can reach our Long Island healthcare fraud defense lawyers at 888-680-1745 or through our contact form. If a member of our team is not available immediately, we will respond as soon as possible.