Oakland Health Care Fraud

Proven Oakland Health Care Fraud Defense Lawyers

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

As a health care 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 health care providers can also face long-term imprisonment.

Oberheiden, P.C.’s federal health care 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 health care 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 health care 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 health care 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 Health Care Fraud?

What does it mean to be accused of “health care fraud”? In its broadest sense, health care fraud involves any unlawful attempt to obtain payment in connection with the delivery (or purported delivery) of health care services, equipment, or supplies. But, the list of individual practices constituting health care 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 health care 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 health care fraud investigation.

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

1. Anti-Kickback Statute

The Anti-Kickback Statute (AKS) applies to all health care providers and other businesses in the health care 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 health care 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 health care program fraud, and most health care 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. Health Care Fraud Statute

The health care 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 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.” 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 health care 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 health care benefit program funds.

6. Program Billing Regulations

One of the most important steps health care 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 health care 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 health care and non-health care cases. For example, our federal defense lawyers have represented health care 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 Health Care Fraud Defense Lawyers

As a health care 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 health care providers in high-stakes investigations. When you choose Oberheiden, P.C.’s health care 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 health care 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 health care 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. Health care providers in Oakland, throughout California, and nationwide have trusted our federal health care fraud lawyers to represent them. With us, you can feel confident that your case is in good hands.

Contact Us about Your Oakland Health Care Fraud Investigation

If your health care practice or business in Oakland, CA, is under investigation, it is important that you speak with our Oakland health care 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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