Experienced Attorneys for Healthcare Providers and Business Owners Facing Fraud Investigations in Cleveland, Ohio
Has your healthcare business or practice been contacted by the Centers for Medicare and Medicaid Services (CMS), agents from the Drug Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG), or the Medicare Fraud Strike Force? If so, you are not alone. Healthcare providers in Cleveland, Ohio and surrounding communities are heavily targeted in waves of audits, investigations, and criminal prosecutions. Taking adequate steps to protect your license, livelihood, and freedom then becomes a critical business decision.
Who Will Handle My Case At Oberheiden, P.C.?When you hire Cleveland Healthcare Fraud Defense Lawyers from Oberheiden, P.C., you will be represented by former Department of Justice officials and seasoned attorneys with significant experience in healthcare law matters. The attorneys at Oberheiden, P.C. represent clients in Cleveland and surrounding communities who are under audit, investigation, or subject to prosecution for alleged healthcare fraud. Our experience includes:
- More than 1,000 healthcare fraud investigations
- Dismissal of state and federal indictments
- More than 500 criminal trials
- More than 70 years of Department of Justice experience
Federal Prosecutors are Targeting Cleveland, Ohio Healthcare Providers and BusinessesNo day goes by without new horror scenarios of hard-working doctors being arrested and prosecuted. Healthcare fraud enforcement is at a new height and the declared war against the country’s opioid crisis by the Department of Justice and Attorney General Jeff Sessions has led to a dramatically increased scrutiny in Cleveland and throughout Ohio. The fraud accusations against Cleveland providers and healthcare entities include Medicare Fraud (18 U.S.C. 1347), Medicaid Fraud, as well as violations of the Controlled Substances Act (21 U.S.C. 841), the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law Statute (42 U.S.C. 1395nn), and the federal False Claims Act (31 U.S.C. 3729-3733). Two things have changed in recent times. First, human errors are more and more construed as intentional fraud. Due to the complexity and the constantly changing rules of the healthcare industry, every healthcare practice, big and small, is prone to errors and mistakes. However, Cleveland healthcare providers must realize that even non-systematic, non-deliberate, and non-intentional errors are now being audited and often referred to civil or criminal prosecution. Second, investigations that used to be civil in nature, are now pursued as criminal prosecutions. Raids, arrests, and search warrant executions against providers in Ohio reflect the overall trend visible across the country. Combatting healthcare fraud has become a top priority by the Department of Justice and new resources and more prosecutors are tasked to criminally investigate physicians, psychologists, pharmacies, laboratories, home health agencies, and hospitals. If your Cleveland, Ohio healthcare business or practice is under investigation, we encourage you to contact us promptly for a free case evaluation. Oberheiden, P.C. can quickly assess your case, intervene in the investigation, and implement a comprehensive defense strategy. Ask us about our track record!
We Are Ready to Fight Healthcare Fraud Allegations in Cleveland, OhioOberheiden, P.C.’s attorneys have successfully represented physicians, pharmacies, toxicology laboratories, DME companies, home health and hospice agencies, and many more against alleged violations of the Controlled Substances Act and the Anti-Kickback Statute and we routinely appear before all relevant agencies such as the Office of Inspector General, the Drug Enforcement Administration, the Federal Bureau of Investigation, and U.S. Attorney’s Offices around the country to resolve Medicare Fraud, Medicaid Fraud, Stark Law, Anti-Kickback claims, False Claims Act, prescription fraud, and similar investigations on behalf of our clients.
- Medicare Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments though a process of reviewing and analyzing claims data in addition to medical documentation that is obtained from the member/provider. Many times this involves a statistical sampling of files in order to establish an error rate. Another type of Medicare audit is conducted by the Zone Program Integrity Contractors (ZPICs). ZPIC audits identify and stop potential fraud and refer these cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that a mishandled audit can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice healthcare prosecutors with first-hand knowledge of the process navigate our clients through the audit and make sure that they can continue their business and don’t need to be worried about their license or a government investigation.
- Medicare Fraud, Medicaid Fraud. Due to the high number of Medicare beneficiaries in Ohio, Cleveland healthcare providers, business owners, and healthcare entities are frequently accused of Medicare Fraud or Medicaid Fraud. Both offenses can have serious consequences and caution is in order. If this happens, experienced attorneys must carefully analyze the nature of the allegation to determine your exposure. In general, Medicare Fraud stands for a variety of conduct (e.g. coding and billing fraud, fraudulent physician certifications for home health and hospice care, billing for services not provided, DME fraud). Oberheiden, P.C. has a track record of resolving Medicare Fraud and Medicaid Fraud investigations with no civil and no criminal liability for many of our clients. The sooner experienced attorneys can oppose the government’s case and develop efficient and proven defense strategies, the higher the chance of a favorable outcome. Call us today and speak to an experienced healthcare fraud attorney on how we can protect your license, livelihood, and your freedom in Medicare and Medicaid cases.
- Controlled Substance Act & Prescription Drug Fraud. Federal authorities have begun to prosecute pain management physicians in Cleveland and throughout Ohio. Almost no day goes by without new arrests and investigations. All prescribers of Schedule II and Schedule III prescription must be aware that opioid fraud, prescription fraud, and taking down so-called “pill mills” is a declared priority of Attorney General Jeff Sessions and the Department of Justice. If you are in a situation of concern or investigation, you should not hesitate to reach out to those attorneys that previously led and supervised FBI and DEA healthcare fraud investigations before representing clients like you at Oberheiden, P.C.. Given the aggressiveness of the current prescription investigations, your license and your freedom may be at risk.
- Illegal Kickbacks. Current Anti-Kickback Statute investigations in Cleveland and throughout Ohio focus on physicians (pain management physicians, surgeons, psychiatrists), pharmacies, healthcare marketers, toxicology laboratories, and hospitals allegedly engaged in illegal business and compensation arrangements. Under the federal Anti-Kickback Statute, it is unlawful for any healthcare provider to offer or pay any form of compensation for a patient referral involving a Medicare, Medicaid, Tricare, or other program beneficiary. If this accusation reaches you, you must understand that Oberheiden, P.C. has repeatedly resolved Anti-Kickback fraud investigations with no civil and no criminal liability outcomes for our clients (i) by identifying important defenses and exceptions and (ii) by making compelling presentations to federal prosecutors in charge of these investigations.
- Hospital Billing and Coding Violations. Cleveland is home to many hospitals and surgery centers and the government is currently investigating board of directors, physicians, and affiliated individuals for alleged billing fraud, in particular with respect to Medicare beneficiaries. If your entity is being accused of billing for medically-unnecessary services, upcoding, unbundling, double-billing, or billing for services not actually rendered, you must immediately seek experienced lawyers to avoid civil or criminal prosecution.
- Physician “Self-Referrals.” The federal Stark Law imposes penalties for what are commonly known as physician “self-referrals.” Physicians are prohibited from referring certain federal healthcare benefit program beneficiaries to entities in which these referring physicians have a financial interest. Liability under the Stark Law statute can be astronomical. Similar to the Anti-Kickback Statute, the Stark Law includes various exceptions, and Oberheiden, P.C. has a track record of identifying these exceptions to protect our clients from liability.
FAQs: What Providers in Cleveland, Ohio Need to Know about Healthcare Fraud Investigations
Q: What Are Likely Outcomes If My Business is Under Investigation for Healthcare Fraud?
If your business or practice is being targeted in a healthcare fraud investigation, there are a number of potential outcomes. Depending on whether the investigation is civil or criminal, the moment in time experienced attorneys intervene, the underlying alleged misconduct, and many other factors, potential outcomes may include:
- The investigation being closed without charges or liability
- The investigation being resolved with a negotiated settlement prior to charges being filed
- Negotiating a plea deal once charges have been filed
- Going to trial on criminal charges and being found either guilty or not guilty
Q: What Is Prescription Fraud?
“Prescription drug fraud” is a generic term that includes the unlawful practice of dispensing and administration of controlled-substance medications. Some of the most common allegations in prescription drug fraud investigations include:
- Prescribing opioid or narcotic medications to a drug-dependent patient
- Prescribing outside of acceptable medical treatment principles
- Allowing unauthorized use of your DEA registration number
- Prescribing medications that are not medically-necessary or without proper justification
- Failing to follow the rules for electronic and hard-copy prescriptions
Q: Are There Exceptions to Violations of the Anti-Kickback Statute and the Stark Law?
Yes, federal law recognizes a number of important exceptions rendering alleged violations, including criminal offenses, moot and lawful. Identifying these exceptions and making compelling presentations as to why an exception to the Anti-Kickback Statute or the Stark Law apply, occupies a significant amount of work Oberheiden, P.C. attorneys do on a day to day basis for their clients. After all, if an exception applies, the government’s claim is dead. Common exceptions and so-called safe harbors involve:
- Personal service arrangements
- Bona-fide employment relationships and incidental staff benefits
- Certain forms of non-monetary compensation
- Discounts and group purchasing arrangements
- In-office ancillary services
- Indirect compensation arrangements
- Isolated transactions
- Price reductions involving eligible managed care organizations
- Referral agreements for specialty services
- Waivers of coinsurance and deductibles
Why Choose Oberheiden, P.C. in Cleveland, Ohio?When you need legal representation to protect you and your business, you cannot afford experiments. Oberheiden, P.C. offers you the experience, resources, and capabilities required to present the strongest possible defense. At Oberheiden, P.C., we offer:
- Commitment to client protection with many cases resulting in no civil and no criminal liability for our clients.
- A team approach in which clients benefit from decades of prosecutorial and defense experience in the specific area of healthcare investigations.
- Decades of experience as fraud defense attorneys and former federal healthcare prosecutors.
- A practice with Ohio lawyers focused on healthcare fraud defense.
Schedule a Confidential Case EvaluationOur healthcare fraud defense team is available to begin working on your case immediately. To speak with our attorneys in confidence, please call 888-680-1745 or request a free case evaluation online now.
Areas We Serve in Cleveland, OhioSubject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel. The areas include: Cleveland, Parma, Lorain, Elyria, Lakewood, Euclid, Mentor, Cleveland Heights, Akron, Ashland, Ashtabula, Carroll, Columbiana, Cuyahoga, Geauga, Lake, Lorain, Mahoning, Medina, Portage, Richland, Stark, Summit, Trumbull, Wayne.
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