Northern Florida Health Care Fraud

If you are being investigated for health care fraud in Northern Florida, you need the experienced Northern Florida Health Care Fraud Defense Lawyers at Oberheiden, P.C.

Oberheiden, P.C., is a federal health care fraud defense firm that represents health care professionals, corporate officers, owners, and business entities in both civil and criminal investigations in Northern Florida.

It is more important now than ever that health care providers in North Florida be able to access aggressive and experienced defense – not only because relatively few criminal defense law firms focus almost exclusively on white-collar federal criminal defense, but also because federal agents are currently targeting the health care industry as never before.

The Northern Florida health care fraud defense lawyers at Oberheiden, P.C., offer more than 100 years of cumulative legal experience, as well as a long track record of persuading federal agents and prosecutors not to file charges against the majority of our clients or to drop them if charges were already filed.

Several of our lawyers are former federal prosecutors. We also have extensive experience in negotiating directly with agencies like the Drug Enforcement Administration (DEA) and the Department of Health and Human Services Office of the Inspector General (DHSS – OIG).

What Is Health Care Fraud?

There are many ways to commit health care fraud under federal law. Congress has enacted numerous criminal statutes aimed at the problem of fraud, waste, and abuse in health care. Many of these laws carry severe penalties. Prosecutors are notorious for pursuing the largest number of counts and charges possible and for seeking the harshest possible sentences. That’s why an aggressive criminal defense against any accusation of health care fraud is so important.

Some of the health care fraud allegations that our team has defended against include:

  • Billing fraud (Medicare, Medicaid, Tricare, etc.)
  • Department of Labor (DOL) fraud
  • Anti-Kickback Statute violations
  • Stark Law violations (physician self-referral)
  • Controlled Substances Act / DEA registration violations (including prescription drug fraud)
  • Providing / Billing for medically unnecessary services
  • Billing for services not actually rendered to patients
  • Falsifying patient records, prescriptions, physician certifications, or election statements

Details matter. The specific circumstances of your investigation dictate which defense strategies will serve you best. To determine which kind of health care fraud matter we’re really dealing with, we try to learn two key pieces of information right away:

  • Is the investigation currently oriented toward a civil enforcement proceeding or a criminal prosecution?
  • Which federal law enforcement agencies and/or task forces are involved?

By answering those questions, we can determine where your investigation currently stands and, accordingly, your best opportunity for avoiding and defeating prosecution (or devastating civil fines).

The Most Commonly Invoked Health Care Fraud Laws

Below, we review just a handful of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of health care professionals in Northern Florida.

1. The False Claims Act

The False Claims Act (FCA) is also known as “The Lincoln Law,” so called because it was enacted in 1863 under the presidency of Abraham Lincoln. The law has been modified many times since then and has only given the government more power with time. Among other things, the FCA makes it a crime to submit “false or fraudulent” payment claims to a federal benefits program such as Medicaid or Medicare. The FCA also contains qui tam provisions, incentivizing private whistleblowers whose civil claims on the government’s behalf can trigger criminal investigations as well. FCA penalties are applied per claim, so they can add up to a very large dollar amount, very quickly. Additional consequences may include exclusion from federal benefits programs under the CMS or other agencies, not to mention a potential prison sentence.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) applies civil and/or criminal penalties to health care providers who offer, solicit, pay for, or receive remuneration (for example, a referral fee) in exchange for referring a government health program beneficiary. While the term “kickback” might seem self-explanatory, the government has brought AKS charges against numerous providers whose conduct did not readily appear to be a “kickback” so much as a common-sense and good-faith business arrangement. If you have been accused of violating the AKS, you should contact our office right away.

3. The Stark Law

The Stark Law makes it unlawful for a physician to make “self-referrals.” With the Stark Law, the government hopes to preclude doctors from gaming the system by profiting from their own referrals. But while that might sound sensible in theory, in practice, the government has used the statute aggressively, often resulting in unfair and excessive financial penalties for health care providers who were only trying to get their patients the best care they could. Our Northern Florida health care fraud defense attorneys are available to assist any physicians or health care businesses accused of Stark Law violations in Northern FL.

4. The Controlled Substances Act (CSA)

The Controlled Substances Act established the United States’ federal drug policy. It regulates the manufacture, distribution, importation, possession, and usage of a wide variety of substances, including illegal drugs and prescription medications. The DEA frequently investigates health care providers in Northern Florida in a wide variety of CSA-related matters, including:

  • Pharmaceutical fraud
  • Prescribing unnecessary medication
  • Diverting opioids or other prescription drugs
  • “Selling” prescriptions
  • Providing addictive drugs to addicted patients
  • Other unlawful prescription practices

Most “pill mill” or “pain mill” investigations in Northern Florida pertain to the Controlled Substances Act.

5. The Federal Health Care Fraud Statute

18 U.S.C. 1347 contains the country’s general  “health care fraud statute,” which makes it illegal to:

“knowingly and willfully execute, or attempt to execute, a scheme or artifice –

(1) to defraud any health care benefit program; or
(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.”

Owing to the broad nature of its plain text, 18 U.S.C. 1347 might appear on a list of charges in virtually any health care fraud case in North Florida.

6. Other Fraud Statutes

In addition to the criminal statutes described above, health care providers frequently face allegations of other charges, including:

  • Wire fraud
  • Mail fraud
  • Forgery
  • Making false statements
  • Federal conspiracy
  • Wrongful use of health information
  • Other serious charges

7. Program Billing Regulations

Federal health care benefits programs establish their own rules and regulations, the violation of which (even if unintentional) may have extremely serious consequences. These program billing regulations change with some frequency, making compliance a challenge. Care providers in Northern FL can mitigate their risk of prosecution by maintaining an active, up-to-the-minute compliance program.

8. DOJ Mandates

Mandates from the Department of Justice are public announcements or internal instructions about which kinds of cases DOJ agents should prioritize. Currently, health care fraud and opioid diversion are among the Department’s top priorities. In fact, the Department recently announced the creation of two new collaborative task forces within a matter of mere months: the Opioid Fraud and Abuse Detection Unit, and the Prescription Interdiction & Litigation (PIL) Task Force.

5 Reasons to Trust the Northern Florida Health Care Fraud Defense Lawyers at Oberheiden, P.C.

Here are five reasons why health care providers and other Medicare, Medicaid, and Tricare participants in Northern FL should choose Oberheiden, P.C., as their federal health care fraud defense lawyer:

  • Our Extensive Experience in Health Care Fraud Investigations – Our Northern Florida health care fraud defense lawyers have handled thousands of federal health care fraud audits, investigations, and prosecutions on behalf of health care providers in FL and nationwide.
  • Our Record of Avoiding Charges – In the majority of our cases, our have been able to end criminal investigations without the filing of criminal charges.
  • Our Focus on Federal Health Care Fraud Defense – Health care fraud defense is one of our principal focuses as a law firm. Our skilled Northern Florida health care fraud defense lawyers have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually every other category of health care provider.
  • Our Experience on Both Sides – Several of the senior defense attorneys on our team are also former federal prosecutors, having spent years or decades working for the other side. We believe this “dual perspective” helps us negotiate efficiently and effectively with current federal prosecutors.
  • Our Aggressive Defense Strategies – We take an aggressive approach to defending our clients in every single case. We understand that the incredibly high stakes demand that our dedicated Northern Florida health care fraud defense lawyers give all our passion and energy to every case, every day.

Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm could become the most important decision you will ever make.

Discuss Your Federal Health Care Fraud Investigation in Confidence

If your Northern FL health care practice or company is being targeted in a federal health care fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with our Northern Florida health care fraud defense attorneys for free, call (214) 692-2171 or inquire online, right away.

All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.

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