North Dakota Health Care Fraud Defense
Oberheiden, P.C.’s federal defense attorneys represent North Dakota health care providers in False Claims Act, Stark Law, Anti-Kickback Statute, and other federal health care fraud investigations. If you have received a subpoena or been contacted by federal agents, call 214-692-2171 for a free consultation.
For health care providers targeted by the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other federal agencies and task forces, avoiding the potential for severe penalties requires prompt action and experienced legal representation. These authorities have a mandate to aggressively pursue health care providers suspected of improperly dispensing opioid medications and overbilling Medicare, Medicaid, Tricare, and the Department of Labor (DOL), and providers accused of fraud can face recoupments, fines, program exclusion, prison time, and other costly consequences.
Federal Health Care Fraud Defense Attorneys Representing Providers in North Dakota
Our federal defense attorneys have extensive experience representing health care providers in federal fraud investigations. We have secured favorable results for clients being targeted for prosecution by the DEA, DOJ, OIG, and other agencies, often with the result that our client is never formally charged. Many of our attorneys served as health care fraud prosecutors with the DOJ prior to joining Oberheiden, P.C., and our team also includes the Honorable Joe Kendall – the only former federal trial judge in private practice.
If your health care business or medical practice is under investigation for prescription drug fraud or for overbilling Medicare, Medicaid, Tricare, or the DOL, this is the type of experience you need on your side. When you engage Oberheiden, P.C. to represent you, our attorneys will use their experience to quickly intervene in the government’s investigation and gather the information necessary to execute a strategic defense. We will work to keep your case civil in nature (which will keep prison time off of the table), and we will use the available evidence (or lack thereof) to seek to obtain a favorable result as efficiently and cost-effectively as possible.
Meet the federal health care defense lawyers at Oberheiden, P.C.
Cases We Handle
Our attorneys represent health care providers charged with fraud and related offenses under the False Claims Act, Stark Law, Anti-Kickback Statute, health care fraud statute (18 U.S.C. § 1347) and all other federal laws. We have successfully represented numerous providers in civil and criminal cases, securing favorable results during our clients’ investigations, following grand jury indictments, and during trial. This includes protecting health care providers against financial penalties, prison time, and other potential penalties in cases involving allegations of:
1. Billing and Coding Errors
Billing and coding errors include submission of improper billing codes, upcoding, unbundling, and double-billing the federal government and/or a private insurer. Health care providers can face prosecution for both intentional and unintentional billing and coding errors, with intentional billing fraud carrying the potential for criminal penalties under the False Claims Act and the federal health care fraud statute.
2. Kickbacks, Bribes, and Rebates
Kickbacks, bribes, and rebates are prohibited under the Anti-Kickback Statute. This federal statute prohibits the offer, payment, solicitation, or receipt of any form of “remuneration” in exchange for referrals for program-reimbursed services, equipment, or supplies. Similar to billing and coding errors, health care providers can face civil penalties for unintentional violations, and they can face criminal prosecution if federal agents find evidence of intent. In many cases, one of the strongest defenses to an alleged Anti-Kickback Statute violation will be to demonstrate that one of the statute’s many “safe harbor” provisions applies.
3. Physician Self-Referrals
The concept of “physician self-referrals” is established in the federal statute commonly known as the Stark Law. Under this law, physicians and their related entities can face civil penalties for paying or receiving compensation for Medicare or Medicaid-reimbursed “designated health services.” These services include:
- Clinical laboratory service
- Physical therapy services
- Occupational therapy services
- Outpatient speech-language pathology services
- Radiology and certain other imaging services
- Radiation therapy services and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
Similar to the Anti-Kickback Statute, the Stark Law contains a number of safe harbors and exceptions as well.
4. False and Fraudulent Claims
The False Claims Act prohibits the submission of any “false or fraudulent” claim for Medicare, Medicaid, Tricare, or DOL reimbursement. This includes all types of billing and coding errors (both intentional and unintentional), program billings related to unlawful referral relationships, and billings that violate other laws or program billing regulations. False Claims Act violations are among the most-common allegations in federal health care fraud investigations, and our federal defense lawyers have successfully defended numerous providers against accusations of submitting “false or fraudulent” claims.
5. Billing for Medically-Unnecessary Services, Supplies, or Equipment
Under all federal health care benefit programs, providers may only bill for services, supplies, and equipment that meet the applicable program guidelines regarding “medical necessity.” Billing for services that are deemed medically-unnecessary can lead to civil or criminal prosecution; and, in order to avoid steep penalties, providers targeted in these types of investigations must be prepared to justify their care-related decision-making.
6. Billing for Services, Supplies, or Equipment Not Provided
Billing for services, supplies, or equipment not provided is commonly known as “phantom billing;” and, while it may sound like one of the more-egregious forms of health care fraud, there are actually a variety of reasons why a phantom billing investigation may be misguided. We routinely handle cases involving allegations of phantom billing; and, if this is an issue in your case, we can use our experience reviewing countless billing records to assert an appropriate defense.
7. Prescription Drug Fraud
Prescription drug fraud allegations range from prescribing medically-unnecessary opioid medications to diverting medications and selling forged prescriptions. The DOJ’s Justice Prescription Interdiction & Litigation (PIL) Task Force, the DEA, and other authorities are vigorously pursuing providers in prescription drug fraud cases, and providers who are indicted for prescription-related offenses are facing substantial fines and long-term imprisonment.
8. Falsifying Patient Records and Inaccurately Reporting Test Results
Falsifying patient records and inaccurately reporting test results are additional serious allegations that often have a much more mundane explanation. From simple recordkeeping mistakes and other human errors by practice personnel to faulty assumptions made by federal agents during health care fraud investigations, our attorneys can get to the bottom of the government’s allegations and protect you from unwarranted consequences.
9. Fraudulent Physician Certifications and Election Statements for Hospice Care
With the rapid growth of the hospice care industry, federal authorities are increasingly focusing their sights on hospices and the physicians who certify patients for palliative care. We are increasingly seeing investigations in which health care providers in North Dakota and other states are facing allegations related to physician certifications and patient election statements, with both civil and criminal penalties on the table.
10. Health Care Fraud Attempt and Conspiracy
Under the federal attempt and conspiracy statutes, in order to face federal prosecution, it is not necessary to “successfully” defraud Medicare, Medicaid, Tricare, or the DOL. These statutes are some of federal prosecutors’ most-potent tools in health care fraud investigations. In order to protect themselves, providers must focus their defense strategies not only on overcoming any allegations of fraudulent billing practices, but on overcoming allegations of attempting or conspiring to engage in fraudulent practices as well.
5 Reasons to Choose Oberheiden, P.C. in North Dakota
If your business or practice is under investigation for health care fraud in North Dakota, it is important that you engage experienced legal representation as soon as possible. Here are five reasons why health care providers nationwide trust the federal defense team at Oberheiden, P.C.:
- Experience – Our attorneys have centuries of combined legal experience on both sides of health care fraud investigations. This includes civil and criminal investigations involving allegations of prescription drug fraud; illegal kickbacks and self-referrals; and Medicare, Medicaid, Tricare, and DOL billing fraud.
- Results – We have a greater than 90% success rate in helping our clients avoid criminal charges. To date, not a single client has been forced to close its business or practice as a result of an investigation in which our firm has provided representation.
- Focus – We focus our practice on federal defense, with particular emphasis on defending providers, executives, and other clients accused of health care fraud and related civil and criminal offenses.
- Reputation – Our attorneys are recognized nationwide for their experience in federal health care fraud investigations.
- Client Focus – We tailor our representation to the unique circumstances of each individual client’s case. As our client, you will have constant direct access to our senior attorneys, and we will work closely with you every step of the way.
Contact Oberheiden, P.C. Today
To discuss your North Dakota health care fraud investigation with an attorney on Oberheiden, P.C.’s nationally-recognized federal defense team, contact us to arrange your free and confidential initial case assessment. You can reach us by phone or online 24/7, so call 214-692-2171 or send us your information online now.