“Opioids, Compounds, and Kickbacks”: Expect More Health Care Fraud Crackdowns
Former DOJ-Health Care Prosecutors & Experienced Criminal Trial Attorneys
Physicians and owners of health care companies must remain vigilant. In light of increased federal scrutiny and new waves of indictments, it is imperative to make the right choice when it comes to trusting a lawyer with your license, livelihood, and liberty.
Attorney Nick Oberheiden stated: “Our team offers effective defense strategies and a proven track record based on decades of federal trial and health care experience.”
Oberheiden, P.C. has successfully defended clients against federal agencies and entities that include the Department of Justice (DOJ), the Office of Inspector General, the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG), the Drug Enforcement Administration (DEA), the Department of Health and Human Services (HHS), and others.
Why Clients Choose Oberheiden, P.C.
Clients of Oberheiden, P.C. are represented by former Department of Justice officials, former federal prosecutors, and senior trial attorneys with a proven track record of effectively defending physicians and health care business owners across the United States. Our attorneys have successfully resolved government investigations involving criminal conspiracies, health care fraud, Anti-Kickback Statute allegations, Tricare Fraud, Medicare Fraud, Medicaid Fraud, mail fraud, wire fraud, money laundering, and tax fraud.
The extensive nature of our experience and proven success includes the following:
- Experience of over 1,000 health care fraud cases
- Experience of over 500 criminal trials (and supervising far more)
- Dismissal of state and federal indictments
- Avoiding criminal indictment of our clients in majority of federal investigations
- Negotiating millions of dollars in fines against our clients to nominal amounts
- Client representations in cases relating to Arizona, Colorado, Alabama, Kentucky, Arkansas, Illinois, Alaska, Florida, Washington, New York, Oregon, Michigan, Louisiana, New Mexico, Texas, Missouri, Oklahoma, Utah, Virginia, New Jersey, Ohio, New Mexico, and Nevada.
This list of accomplishments is merely illustrative of the advantages our national health care fraud attorneys and criminal defense lawyers offer to clients. When health care professionals and entities retain Oberheiden, P.C., they benefit from the experience of working with former DOJ-prosecutors who offer clients decades of government insights.
1. DEA Controlled Substances Investigations
Because Oberheiden, P.C. has successfully represented a significant number of physicians, pharmacists, and health care entrepreneurs, our criminal defense attorneys have extensive insight into the way federal agencies investigate and prosecute cases involving the alleged over-prescription of opioids. Our law firm has a track record of success assisting medical professionals, pharmacies, and health care businesses with compliance issues to avoid government allegations of operating a “pill mill.” We also offer tenacious defense of doctors and other health care professionals facing investigations and charges of overprescribing medication.
Aggressive Prosecution of Medical Providers in Wake of Opioid Epidemic
State and federal law enforcement agencies across the U.S. are investing an increasing amount of drug enforcement and judicial resources toward the prosecution of offenses and recovery of funds related to the opioid epidemic. Accidental drug overdose was the leading cause of accidental death in the U.S. according to the Morbidity & Mortality Weekly Report. Overdoses involving prescription painkillers accounted for more than 20,000 of these deaths. Another 12,990 people suffered a heroin overdose, and 80 percent of new heroin users report their addiction started with abusing prescription pain medications.
While these statistics are enough to explain the increasingly aggressive posture of federal and state prosecutors toward health care professionals for atypical opioid prescription practices, economics also plays a role. States, counties, and municipalities have pursued civil and criminal proceedings seeking to recover hundreds of billions of dollars. Government entities claim opioid addiction and overdoses have increased the costs related to public health expenditures, law enforcement and justice system proceedings, lost productivity, drug treatment facilities, and more. Given the enormous expense associated with the opioid epidemic, as well as the human cost, government authorities at both the state and federal level see an incentive to aggressively pursue the prosecution of suspected “pill mills” and other health-related businesses alleged to contribute to the opioid crisis.
Feds Place Physicians and Pharmacies Under Increased Scrutiny in Wake of Opioid Crisis
The DEA and the Department of Justice will be putting physicians and pharmacies under more intense scrutiny for prescription fraud as part of its opioid epidemic policy. Attorney General Jeff Session recently announced the creation of the Opioid Fraud and Abuse Detection Unit as a new federal enforcement program. Session indicated the unit will focus its efforts on opioid prescription fraud. The new program will be staffed with a dozen experienced Assistant United States Attorneys to exclusively focus on the investigation and prosecution of health care fraud.
“[W]e are announcing a new effort to target our federal resources against this epidemic. If you are a doctor illegally prescribing opioids for profit or a pharmacist letting these pills walk out the door and onto our streets based on prescriptions you know were obtained under false pretenses, we are coming after you.”
This effort to intensify investigation and prosecution of health care fraud makes it prudent to seek advice on compliance practices before you fall under suspicion. If you are already the target of an investigation, we can protect your interests and guide you through the process of resolving fraud allegations.
What Tactics Do Federal Agencies Use to Target Alleged “Pill Mills”?
DEA and other federal agencies utilize an array of monitoring programs to target so-called “pill mills,” such as OARRS, PMP, PDMP, KASPER, MAPS, E-FORCE, and more. After the investigating agency receives information about an overprescribing doctor, the DEA or other investigating agency will initiate an investigation and commence a review of the practitioners PDMP records despite the fact these records provide no information about the patient’s medical condition.
Based on this review, the investigating agency will collaborate with local law enforcement to implement surveillance of the target of the investigation. In some cases, the agency might use one or more informants or undercover agents, which could include current patients approached by the government. The patients will be “wired,” and complain of pain while also dropping hints that should constitute “red flags” like trying to pay with cash, traveling from another state, doctor shopping, or referring to drugs by their street name.
While the agency might seek to conduct an “administrative inspection,” physicians with legal representation have a significant advantage in this situation. The medical professional with an existing attorney-client relationship can delay the DEA inspection, but you must permit the DEA admittance if they have a search warrant.
Our law firm has been involved in many cases brought against physicians, pharmacies, and other health care providers facing charges related to improper dispensation and prescription of narcotics. We have the experience and expertise of former federal prosecutors, which allows us to guide clients through the complex matrix of DEA regulations to confirm regulatory compliance. We also will analyze your intake procedures and paperwork, pain prescription practices, and other relevant practices. Our law firm can conduct independent compliance audits to prevent DEA entanglements. Our criminal defense attorneys also have a track-record for keeping our clients from facing an indictment when we are retained during the investigation process. If you are indicated, our experience handling hundreds of federal trials and successful appeals means that we are prepared to zealously fight for your freedom and professional practice.
2. Defense Against Fraud Charges Based on Compounding Pharmacy-Physician Relationships
Federal agencies that include the Department of Defense, the Department of Justice, the Department of Health and Human Services, and the Office of Inspector General have recently been cracking down on all forms of health care fraud schemes, which include kickbacks between compound pharmacies and physicians. The Food and Drug Administration (FDA), defines “compounding” as a practice whereby physicians, pharmacists or other authorized professionals under their supervision modify, mix, or combine the components of a drug to tailor a medication to a specific patient. These customized drugs do not need FDA approval. While the FDA retains some authority over compound pharmacies, state boards of pharmacy are primarily responsible for their regulation.
Recent investigations conducted by several states, U.S. Attorneys Offices, and an array of federal agencies have examined the rise in TRICARE (military health care expenditures) associated with compounding pharmacies from $5 million in 2004 to $514 million in 2014. These investigations have focused on alleged fraud schemes that include compound pharmacy and physician relationships that violate the federal Anti-Kickback Statute (AKS), the Federal Claims Act (FCA), and other federal and state laws. The AKS forbids anyone from soliciting, offering, paying, or receiving any form of compensation as a quid pro quo for referral of federal health care business. Because a violation of the AKS is a predicate to liability under the FCA, a violation can result in exposure to criminal liability, treble damages, program exclusion, and per claim penalties.
While the facts of these cases vary depending on the alleged fraud scheme, recent settlements between two compound pharmacies and Florida provide a common example. The Assistant U.S. Attorney in Florida indicated doctors conducted sham research studies and received “speaker fees” as renumeration for prescribing drugs from the compound pharmacies. The case involved two key practices prohibited by the AKS: (1) failing to establish a sufficient patient-physician relationship (sometimes patients never even met the doctor) and (2) the drug is not tailored to the patients’ needs (lack of medical necessity).
Our federal practice attorneys understand the tactics used by federal agencies in pursuing these claims, as well as safe harbor provisions. For example, a bona fide personal services or management contract between the physician and compound pharmacy is covered by the safe harbor provision. If the physician is paid to appear at conferences and other events about the products from the compound pharmacy, this can be protected under the safe harbor provision if certain requirements are met. Our attorneys carefully review the facts to determine whether a violation of AKS has occurred and explore defenses based on lack of the requisite intent or applicability of a safe harbor.
3. Health Care Fraud and Kickback Defense
Federal and state agencies across the U.S. have committed ever-growing resources to pursuing health care fraud. In broad terms, physicians, pharmacies, and other healthcare professionals and entities engage in fraud when they make false statements or commit illegal acts for financial gain. Many people swept up in the efforts of state and federal agencies and prosecutors to recover public health care dollars have no desire to violate the law. Efforts at regulatory compliance with a broad spectrum of federal and state laws can result in inadvertent violations. Oberheiden, P.C. assists clients in navigating audits and cases involving civil and criminal charges.
Protecting Health Care Professionals and Businesses Facing Fraud Investigations
At Oberheiden, P.C., we work diligently to assist our clients in avoiding a fraud indictment for health care fraud. Whether you are the subject of an independent audit or a federal fraud investigation, we are prepared to challenge an auditor’s allegations and methodology or intervene to prevent the federal investigation from proceeding to a civil or criminal case.
Audits are undertaken by the Centers for Medicare and Medicaid Services (CMS) typically are performed by private contractors. These contractors work on a “fee-for-pay” model, so they have a motivation to reach an unfavorable outcome when conducting the audits. Whether you are facing a private audit or a federal investigation for inaccurate or false Medicaid or Medicare billings, our law firm has a perfect record for preventing such investigations and audits from proceeding to a civil or criminal case. Our results in federal court also extends to other forms of fraud or misappropriation of public funds, such as Department of Defense (DOD) fraud, Tricare fraud, wire fraud, and tax evasion.
Criminal and Civil Charges for Health Care Fraud
If you are already facing criminal or civil case for health care fraud, time is of the essence in speaking to experienced attorneys. Our primary goal is to resolve our client’s case without a determination of civil liability or a criminal conviction while safeguarding our client’s business and/or professional license. As soon as we are retained, we ascertain the status of your case and your potential exposure to penalties. Our attorneys draw on decades of experience as criminal defense attorneys, former federal prosecutors, and trial lawyers to protect your reputation, livelihood, and future. Even if a trial court has determined you are civilly or criminally liable, our appellate practice division might be able to challenge this determination.
Contact the Health Care Defense Lawyers at Oberheiden, P.C. Today
When facing the virtually unlimited resources and skilled prosecutors of the federal government, our clients seek the security of retaining a law firm of former federal prosecutors that has handled hundreds of federal trials. Because we are committed to resolving your fraud allegations before an indictment, we invite you to contact us as soon as you are aware of a federal investigation or audit.
A Track Record of Successful Federal Health Care Criminal Defense
Our track record for successfully avoiding indictments for 100s of clients, dismissed indictments, and trial success means that you might avoid civil or criminal prosecution entirely. We offer a no obligation, free consultation. Although we represent clients throughout the U.S., our corporate headquarters is in Dallas. Texas. Call Oberheiden, P.C. to talk to a health care defense attorney about your situation at (214) 692-2171 or contact us online.
We recognize the importance of each matter and we dedicate our fullest attention to each client. We are available to discuss your concerns in a free and confidential consultation, including on weekends.