Oklahoma health care providers targeted in federal fraud investigations can face recoupments, fines, treble damages, program exclusion, and even federal imprisonment. If you have been contacted by federal agents or received a target letter, subpoena, or civil investigative demand, it is important that you speak with an attorney as soon as possible.
Federal health care fraud investigations can be triggered by a variety of different factors, and they can start in a variety of different ways. But, regardless of whether the government identified an “anomaly” in your program billing data or received a whistleblower complaint, and regardless of whether you received a subpoena or federal agents showed up at your facility, the risks and defense tactics are the same. Health care fraud investigations can lead to fines, recoupments, and other penalties, and avoiding these penalties requires a proactive and strategic defense.
If your Oklahoma health care practice or medical business is under investigation, Oberheiden, P.C.’s federal defense team can help you avoid unnecessary consequences. Our team is comprised of senior defense attorneys and former federal prosecutors, many of whom spent decades with the Department of Justice (DOJ) prior to entering private practice. Our team also includes the only former federal trial judge currently in private practice; and, together, our attorneys bring centuries of combined experience to protecting health care providers against civil and criminal penalties.
Oberheiden, P.C.’s federal defense attorneys are available to represent health care providers in Oklahoma who are being targeted in Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other federal agency investigations. For a confidential initial case assessment, call 888-519-4897 now.
About Our Federal Health Care Fraud Defense Practice
Clients We Represent
Our federal health care fraud defense practice is national in scope, and our team has an extensive track record of representing all types of providers in high-stakes federal investigations. We represent the following types of clients throughout Oklahoma and nationwide:
- Compounding pharmacists
- Physician groups
- Hospitals, clinics, and other medical facilities
- Testing laboratories
- Durable medical equipment (DME) companies
- Company owners, board members, and executives
Cases We Handle
Our practice is similarly broad with respect to the types of federal health care fraud cases we handle. We represent clients at all stages of the investigative and prosecutorial processes in cases involving allegations of:
- Billing and coding errors
- Kickbacks, bribes, and rebates
- Physician self-referrals
- False and fraudulent claims
- Billing for medically-unnecessary services, supplies, or equipment
- Billing for services, supplies, or equipment not provided
- Prescription drug fraud
- Falsifying patient records and inaccurately reporting test results
- Fraudulent physician certifications and election statements
- Attempt and conspiracy to commit health care fraud
- Tax evasion and other related federal offenses
Examples of Our Success
We have a greater than 90% success rate in protecting our clients against criminal charges in federal health care fraud investigations; and, to date, not one of our clients has been forced to cease operations due to an investigation in which our attorneys have been involved. Some examples of our success stories include:
- No civil or criminal liability for a client facing a Medicare fraud investigation conducted by the U.S. Attorney’s Office and the Federal Bureau of Investigation (FBI).
- No civil or criminal liability for a client facing multiple fraud allegations from the FBI and the DOJ.
- No civil or criminal liability for a client targeted for prosecution by the OIG for allegations of various federal health care law violations.
- No civil or criminal liability for a client targeted in a joint DOJ-OIG investigation in which we were able to demonstrate the applicability of specific Medicare law exceptions.
- No civil or criminal liability for a client targeted in a criminal health care fraud investigation involving multiple federal law enforcement agencies.
5 Key Facts about Federal Health Care Fraud Investigations
1. All Health Care Providers are at Risk for Being Targeted in Federal Health Care Fraud Investigations.
Combatting Medicare, Medicaid, Tricare, and Department of Labor (DOL) are top federal law enforcement priorities, and the DOJ and other agencies are devoting substantial resources to investigating and prosecuting health care providers suspected of improperly billing these government benefit programs. As a result, if a health care provider’s billing records appear to be anomalous when compared to those of other similarly-situated providers, this alone can be enough to trigger government scrutiny. Whistleblower claims and contractor audits can trigger investigations as well; and, in today’s world, no provider is immune from being investigated.
2. Health Care Fraud Investigations Can Be Either Civil or Criminal in Nature.
The False Claims Act and the Anti-Kickback Statute include provisions for both civil and criminal enforcement, and federal authorities routinely pursue investigations targeting both civil and criminal violations. Physicians can face civil enforcement proceedings under the Stark Law, and the federal health care fraud statute (18 U.S.C. Section 1347) presents another risk for criminal prosecution. When facing a federal investigation, one of the first steps in building a defense is to determine the scope of the allegations and whether the allegations are civil or criminal in nature, as each type of case requires a different type of defense strategy.
3. The Penalties for Health Care Fraud are Severe.
Health care providers charged with violations of the False Claims Act and other statutes can face severe penalties. These penalties can include:
- Treble damages
- Fees and costs
- Denial of pending claims
- Pre-payment review (which can delay payment by up to six months)
- Medicare, Medicaid, Tricare, and DOL exclusion
- Loss of DEA registration
- State board licensing action
Additionally, in criminal cases, DOJ prosecutors will often file charges for conspiracy, mail fraud, wire fraud, money laundering, tax evasion, and other federal crimes as well. Each of these crimes carries the potential for substantial fines and years of federal imprisonment.
4. There are Several Potential Defenses to Allegations of Health Care Fraud.
Depending upon the specific allegations and factual circumstances involved, there are several potential defenses to allegations of health care fraud. These defenses range from asserting constitutional protections that prevent prosecutors from presenting key evidence in court to asserting statutory safe harbors and other defenses that can fully insulate providers from liability. When you engage Oberheiden, P.C. for your federal health care fraud investigation in Oklahoma, our senior attorneys will work closely with you to identify the defenses you have available.
5. Many Investigations End Without Charges Being Filed.
When facing a federal investigation, it is critical not to assume the government has information that you do not. For various reasons, investigations targeting physicians, pharmacists, testing laboratories, hospices, and other health care entities are often misguided, and at Oberheiden, P.C. we have protected numerous clients against federal charges. Even if you believe that your business or practice may have billed a federal health care program improperly, you may still have defenses available, and our attorneys can work with you to quickly determine whether you have any potential exposure.
Frequently-Asked Questions (FAQs): Defending Against Health Care Fraud Allegations in Oklahoma
Q: My practice has a strict Medicare compliance program. Do I still need to be worried?
Potentially. Having a comprehensive compliance program is crucial to mitigating the risk of billing errors that have the potential to trigger a federal investigation; but, if errors have been made, having a compliance program will not necessarily protect you against penalization. However, what it may do is convince the prosecutors handling your case that any billing violations were unintentional, and that therefore your investigation should remain civil (rather than criminal) in nature.
Q: I am worried about what federal investigators may find. What should I do?
If you are concerned that federal investigators may find evidence of improper program billings, prescription practices, referral relationships, or certification practices for hospice care, the first thing you need to do is stay calm. While you could be facing a precarious situation, it is also possible that you could avoid prosecution by presenting a strategic defense. It will be important to consult with an attorney promptly so that you can begin making informed decisions that mitigate your risk of prosecution.
Q: Can Oberheiden, P.C.’s defense attorneys represent me in Oklahoma?
Yes, our firm’s practice is national in scope, and our attorneys are available to represent health care providers in Oklahoma.
Q: Where can I learn more about protecting my business or practice during the government’s investigation?
If you would like to gain a better understanding of your situation before your initial case assessment, we encourage you to read our blog. These articles will help you get started:
- Glossary: Understanding Your Federal Health Care Fraud Investigation
- Q&A with Federal Health Care Fraud Defense Lawyer, Nick Oberheiden, PhD: What Do You Need to Know If Your Practice Is Under Investigation?
- The Obligation to Report and Refund Medicare Overpayments
- What Constitutes a “Safe Harbor” in an Anti-Kickback Statute Investigation?
- What Kinds of Billing and Coding Errors Constitute Health Care Fraud?
Schedule Your Free Initial Case Assessment at Oberheiden, P.C.
To discuss your case in confidence, please contact us to schedule a free initial case assessment. Call 888-519-4897 or tell us how to reach you online and we will arrange for you to speak with one of our federal health care fraud defense attorneys as soon as possible.