Oklahoma City, Oklahoma Health Care Fraud Defense
Trusted Representation for Oklahoma City Health Care Providers Targeted in Federal Investigations
What should you do if your business or practice is being targeted in a federal investigation? What are your legal rights? What are your legal obligations? Could you really guilty of health care fraud? Recently, health providers in Oklahoma City, Oklahoma have been facing these questions with increasing frequency. Federal authorities are aggressively pursuing cases against providers suspected of obtaining improper payments from Medicare, Medicaid, Tricare, and other government benefit programs, and they are conducting a record number of investigations that are leading to both civil and criminal charges.
For health providers in Oklahoma City, Oklahoma, this means that becoming the target of a federal investigation is a very real possibility. All types of providers are being investigated; and, in most cases, the providers being targeted do not realize that they are at risk for federal prosecution. Most investigations of legitimate providers are triggered by mistakes resulting from a simple human error. However, these mistakes are enough to establish liability under statutes including the False Claims Act, and avoiding substantial liability requires experienced legal representation.
National Health Care Fraud Defense Attorneys Serving Oklahoma City, Oklahoma
Our health care fraud defense attorneys represent clients in federal fraud investigations in Oklahoma City, Oklahoma and nationwide. With a team that includes several former high-level federal health care fraud prosecutors, we offer unparalleled insights into the investigative and prosecutorial processes, and our defense lawyers are intimately familiar with the complexities of the federal health system. When your business or practice is under investigation by the federal government, you cannot risk taking chances, and you cannot afford any unnecessary delays. Our experienced team of Oklahoma City health care fraud defense lawyers can take prompt action to intervene in your investigation and mitigate the consequences of the investigation as much as possible.
With a long record of successful representation in federal health care fraud investigations (the vast majority of our clients have been able to avoid facing civil and criminal charges), our firm is a trusted ally for hospitals, laboratories, pharmacies, physician-owned practices, licensed practitioners, and medical company executives across the country.
“It is very clear to me that Nick Oberheiden has a deep understanding of health law issues. Nick has been instrumental in managing and resolving many difficult legal matters. He is always relentlessly focused on the critical issues that matter most. Nick is very dedicated and available and always displays a high degree of professionalism. I would not hesitate in recommending Nick for the most important of legal matters.” – Satisfied Client“The very best!”
“I hired Nick Oberheiden and Oberheiden, P.C. to defend me in a criminal health care matter. From the first moment I met with Nick . . . I knew that he [would provide] the help I need[ed]. And yes, Nick got me out of trouble. No charges. Case Dismissed.” – Satisfied Client
Federal Defense Attorneys for All Health Care Fraud Investigations
Our Oklahoma City health care fraud attorneys have decades of experience on both sides of federal health fraud investigations. We routinely represent providers in Oklahoma City, Oklahoma and other major cities around the country in cases involving:
- Anti-Kickback Statute. The Anti-Kickback Statute applies to all health providers and does not require actual knowledge or intent to commit a violation in order for a provider to be subject to penalties. Violations include both (i) referring a patient for a service or item covered by a federal health care program, and (ii) purchasing, leasing, ordering, or arranging for any good, facility, service, or item reimbursable under a federal health program. Critically, parties on both sides of unlawful referral transactions can face liability under the Anti-Kickback Statute.
- Stark Law. The Stark Law prohibits physicians from referring physicians to related entities for the provision of “designated health services” for which payment is to be made under Medicare. Similar to the Anti-Kickback Statute, the Stark Law has a number of safe harbors and exceptions; however, in a health fraud investigation, it is up to the physician or related entity to establish that a safe harbor applies.
- False Claims Act. The False Claims Act imposes severe penalties for the submission of any “false or fraudulent” claim for Medicare, Medicaid, Tricare, or other federal health enefit program reimbursement. The False Claims Act applies to all providers that bill these programs, and it includes penalty provisions for both intentional and unintentional billing violations.
- Prescription Fraud. Fraudulent practices involving the prescription, administration, or dispensing of controlled substances is a serious federal offense that can implicate a variety of civil and criminal statutes. Physicians, nurses, pharmacists, hospice and home health caregivers, billing administrators and others must be extremely careful to avoid prescription drug practices that have the potential to trigger federal health care fraud investigations.
- Certification Fraud. Certification fraud is defined as providing hospice or home health services to a patient without the requisite physician certification. This can include: (i) providing services without a certification, (ii) providing services based on a deficient certification, (iii) falsifying patient information on a certification, (iv) creating fraudulent certifications, and (v) failing to discharge patients or obtain renewal certifications every 60 days.
FAQs: Facing a Health Care Fraud Investigation in Oklahoma City, Oklahoma
Q: Which federal agencies conduct health care fraud investigations in Oklahoma?
Numerous federal agencies are charged with enforcing the nation’s health laws and the Medicare, Medicaid, and Tricare billing regulations. At Oberheiden, P.C., we have represented clients in investigations involving:
- Centers for Medicare and Medicaid Services (CMS)
- Drug Enforcement Administration (DEA)
- Federal Bureau of Investigation (FBI)
- Medicaid Fraud Control Units (MFCUs)
- Medicare Fraud Strike Force
- Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (DHHS)
- S. Department of Defense (DOD)
- S. Department of Justice (DOJ)
- S. Department of Labor (DOL)
Q: What are some examples of “false or fraudulent” claims under the False Claims Act?
The False Claims Act applies to any and all claims that result in overpayment from a federal health benefit program. This includes billing and coding errors as well as violations of other statutes such as the Anti-Kickback Statute and the Stark Law. In our experience, most federal health care investigations under the False Claims Act target practices such as:
- Billing for medically-unnecessary or other non-qualifying costs or services
- Billing for services or supplies not actually provided to patients
- Double-billing Medicare, Medicaid, Tricare, and/or private health insurers
- Hospice and home health certification fraud
- Payment and receipt of illegal kickbacks and referral fees
- Prescription drug fraud
- Upcoding, unbundling, and other coding violations
Q: What forms of compensation are prohibited under the Anti-Kickback Statute?
The Anti-Kickback Statute prohibits payment of all forms of compensation in exchange for referrals for program-reimbursed services, supplies, or equipment. This includes, without limitation:
- Airplane tickets and other in-kind gifts
- Cash payments
- Disproportionate returns on investments
- Marketing commissions
- Payments to family members
Q: What is the definition of “designated health services” under the Stark Law?
Under the Stark Law, “designated health services” for which compensated referrals are prohibited include the following:
- Clinical laboratory services
- Durable medical equipment (DME) and supplies
- Home health services
- Imaging services
- Inpatient and outpatient hospital services
- Outpatient pathology services
- Outpatient prescription drugs
- Parenteral and enteral nutrients, equipment and supplies
- Physical therapy services
- Prosthetics, orthotics, and prosthetic devices and supplies
- Radiology and radiology therapy services
Q: When can a provider face criminal charges for health care fraud?
Providers can face criminal charges for numerous forms of health fraud; and, when facing a federal investigation, one of the most important early steps is to determine whether your investigation is civil or criminal in nature. The False Claims Act, the Anti-Kickback Statute, and other health fraud laws include provisions for both civil and criminal penalties (the Stark Law is an exception, including only provisions for civil penalties), and providers can often face charges under other criminal statutes as well. For example, mail fraud, wire fraud, conspiracy, identity theft, and controlled substance offenses are frequently implicated in federal health care fraud investigations.
How Can Our Zealous Oklahoma Team Help with Your Federal Health Care Fraud Investigation
If your business or practice is being targeted in a federal investigation, it is critical that you engage experienced legal representation as soon as possible. By the time you learn about the investigation, the government has already begun building its case against you, and you need a team of knowledgeable attorneys who can intervene in order to help you avoid facing federal charges. When you retain Oberheiden, P.C. for your investigation, we will:
- Make immediate contact with the investigators and prosecutors assigned to your case
- Seek answers to key questions about the investigation
- Conduct an internal assessment and help you address any potential compliance issues
- Develop and execute a customized defense strategy
- Help you and your personnel avoid mistakes that could harm your defense
- Explore all available options for resolving your investigation without charges being filed
- Provide vigorous representation through final resolution of the investigation
To discuss the specifics of your investigation, please contact us to arrange a complimentary case assessment. You can reach us seven days a week at (888) 519-4897, or send us a message online and we will respond as soon as possible.