Oakland Healthcare Fraud

Proven Oakland Healthcare Fraud Defense Lawyers

A federal healthcare fraud investigation can lead to financial liability, program exclusion, licensing action, and even prison time. If your Oakland, CA, healthcare practice or business is under investigation, our Oakland healthcare fraud defense lawyers can protect your career, your reputation, and your future.

As a healthcare provider, facing a federal investigation is one of the biggest risks to your business or practice. Federal agencies including the U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and Office of Inspector General (OIG) routinely conduct investigations in Oakland and throughout California, and the providers targeted in these investigations can face fines, assessments, recoupments, denial of payment, program exclusion, and other penalties. In criminal investigations, Oakland healthcare providers can also face long-term imprisonment.

Oberheiden, P.C.’s federal healthcare fraud defense team is comprised exclusively of senior defense lawyers, several of whom served for years or decades with the DOJ. Working together to defend clients facing allegations ranging from billing and coding violations to payment of unlawful referral fees (or “kickbacks”), our team has resolved countless complex and high-stakes investigations in California and nationwide. Our seasoned Oakland healthcare fraud defense lawyers utilize an aggressive and strategic approach that emphasizes early intervention and pre-indictment resolution, and we do so while remaining carefully attuned to the unique facts and circumstances of each client’s case.

If your healthcare business or medical practice is under investigation by the DOJ, DEA, FBI, OIG, or any other federal agency in Oakland, you need experienced legal representation. The agents, prosecutors, and task forces that handle healthcare fraud investigations are very good at what they do. They are devoted to securing recoupments, kicking unscrupulous providers out of Medicare and Medicaid, and obtaining criminal convictions in federal district court. Regardless of the circumstances involved, you have defenses available. And protecting yourself starts with knowing how to assert these defenses effectively.

What Is Healthcare Fraud?

What does it mean to be accused of “healthcare fraud”? In its broadest sense, healthcare fraud involves any unlawful attempt to obtain payment in connection with the delivery (or purported delivery) of healthcare services, equipment, or supplies. But, the list of individual practices constituting healthcare fraud is practically endless. For example, we routinely represent physicians, clinic operators, home health agencies, hospices, testing laboratories, pharmacies, and business executives facing allegations of:

  • Submitting improper billing codes to Medicare, Medicaid, Tricare, and the Department of Labor (DOL);
  • Billing for services, supplies, or equipment at a higher rate than the one prescribed by the applicable billing regulations (known as “upcoding”);
  • Billing for services, supplies, and equipment at individual billing rates rather than the bundled rates prescribed in the regulations (known as “unbundling”);
  • Billing for services that are deemed medically-unnecessary under the applicable program billing regulations;
  • Billing for services that are not actually rendered to patients (known as “phantom billing”);
  • Offering or accepting unlawful “kickbacks” or making unlawful “self-referrals” in connection with program-reimbursed medical services, supplies, or equipment;
  • Forging and falsifying prescriptions, diverting medications to drug-dependent individuals, and other forms of pharmaceutical fraud; and
  • Falsifying patient records, prescriptions, physician certifications, and election statements.

Do you know why your healthcare practice or business is under investigation? Most likely not. Federal agents and prosecutors play their cards close to the vest, and determining what you need to defend yourself against is one of the first steps avoiding civil and criminal charges in a federal healthcare fraud investigation.

What Are the Federal Healthcare Laws and Regulations Involved in DOJ, DEA, FBI, and OIG Investigations?

1. Anti-Kickback Statute

The Anti-Kickback Statute (AKS) applies to all healthcare providers and other businesses in the healthcare industry that bill Medicare, Medicaid, Tricare, or the DOL. It prohibits practitioners, business owners, and others from offering, paying, soliciting, or receiving referral fees and all other forms of “remuneration” in connection with referrals for program-reimbursed services, equipment, or supplies. The Anti-Kickback Statute includes provisions for civil and criminal penalties. And while most AKS investigations are civil in nature, providers targeted in AKS investigations cannot rule out the possibility of criminal prosecution.

2. Controlled Substances Act

The Controlled Substances Act is one of the primary federal statutes used to prosecute healthcare providers suspected of pharmaceutical fraud and related prescription drug offenses. It is enforced by the DEA, which monitors and investigates both registered and unregistered providers.

3. False Claims Act

The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by Medicare, Medicaid, Tricare, or the DOL. It is one of the government’s strongest weapons in the fight against healthcare program fraud, and most healthcare fraud investigations will include allegations under the FCA. In addition to the potential for a False Claims Act investigation to be initiated by federal authorities directly, the FCA also includes qui tam provisions which allow private citizens (typically dissatisfied patients and disgruntled former employees) to file “whistleblower” claims on the government’s behalf.

4. Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to, “knowingly and willfully execute[], or attempt[] to execute, a scheme or artifice—(1) to defraud any healthcare 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 healthcare benefit program.” Like the False Claims Act, 18 U.S.C. 1347 is extremely broad in scope, and it allows federal prosecutors to pursue criminal charges against healthcare providers for a wide range of alleged offenses.

5. Stark Law

The Stark Law prohibits so-called “physician self-referrals.” Unlike the other statutes discussed above, the Stark Law is exclusively civil in nature. But, this does not mean that physicians targeted under the law can breathe easy. A civil enforcement action under the Stark Law can result in enormous financial liability, and physicians targeted for unlawful self-referrals can also face prepayment review of future claims, loss of program eligibility, loss of licensure, and prosecution under the various other laws that apply to improper use of healthcare benefit program funds.

6. Program Billing Regulations

One of the most important steps healthcare practitioners can take to mitigate their risk of federal prosecution is to implement and follow a comprehensive compliance program focused on satisfying the requirements of the relevant program billing regulations. Providers who do not adhere to up-to-date compliance programs are almost certain to make mistakes, and these mistakes can lead to liability under each of the statutes discussed above.

7. Other Federal Criminal Laws

In criminal healthcare fraud investigations, federal prosecutors will routinely pursue charges for a variety of different offenses. This includes not only violations of the Anti-Kickback Statute, False Claims Act, and 18 U.S.C. 1347, but also various other criminal statutes that apply in both healthcare and non-healthcare cases. For example, our federal defense lawyers have represented healthcare providers nationwide accused of crimes including:

  • Bank fraud (18 U.S.C. 1344)
  • Criminal conspiracy (18 U.S.C. 371)
  • Distribution of controlled substances (21 U.S.C. 841)
  • Identity theft (18 U.S.C. 1028A)
  • Mail fraud (18 U.S.C. 1341)
  • Money laundering (18 U.S.C. 1357)
  • Tax fraud (26 U.S.C. 7206)
  • Wire fraud (18 U.S.C. 1343)

5 Reasons to Choose Oberheiden, P.C.’s Oakland Healthcare Fraud Defense Lawyers

As a healthcare provider in Oakland, protecting yourself against civil or criminal prosecution requires a strategic and proactive approach to fending off the government’s investigation. This requires extensive knowledge of the laws that apply and deep insights into how and why federal authorities pursue healthcare providers in high-stakes investigations. When you choose Oberheiden, P.C.’s healthcare fraud defense team to represent you:

  • We will immediately intervene in the government’s investigation. As soon as you engage our firm to represent you, we will begin taking the steps necessary to intervene in the government’s investigation. This will ensure that you do not disclose any more information than is absolutely necessary (or many other costly mistakes), and it will allow us to gather the information necessary to assert a strategic defense.
  • You will have centuries of experience on your side. The attorneys on our federal healthcare fraud defense team have centuries of combined legal experience. With our team approach, you will have the full weight of this experience on your side.
  • We will pursue every opportunity for a quick and discrete resolution. Our goal in every case is to secure a favorable outcome before charges get filed. This ensures that the investigation will cause minimal disruption and reputational harm.
  • We will fight to keep your investigation civil. Civil monetary penalties are something most providers can find a way to manage (as long as these penalties are mitigated appropriately). Federal imprisonment, on the other hand, is not. Our Oakland healthcare fraud defense attorneys will fight to keep your investigation civil in nature so that prison time is not on the table.
  • You can rest assured that you are in good hands. Healthcare providers in Oakland, throughout California, and nationwide have trusted our federal healthcare fraud lawyers to represent them. With us, you can feel confident that your case is in good hands.

Contact Us about Your Oakland Healthcare Fraud Investigation

If your healthcare practice or business in Oakland, CA, is under investigation, it is important that you speak with our Oakland healthcare fraud defense attorneys immediately. To schedule a free and confidential consultation at Oberheiden, P.C., call 888-680-1745 or inquire online now.

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