Orange County Health Care Fraud Defense
Seasoned Orange County Health Care Fraud Defense Lawyers
If you’re a health care provider in Orange County, chances are high that you are (or may soon be) the target of a federal investigation. High-stakes fraud investigations are being conducted by the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (DHHS) with increasing frequency into matters ranging from opioid diversion to payment of unlawful kickbacks and any number of alleged federal violations in between. If your business or practice is currently under such an investigation, you need the help of the experienced Orange County health care fraud defense lawyers at Oberheiden, P.C.
Oberheiden, P.C., is a federal health care fraud defense law firm that represents health care providers and other industry entities in both civil and criminal matters in Florida. Together, our proven Orange County health care fraud defense lawyers have well over a century of combined legal experience – including decades of experience as senior federal prosecutors – to contribute to the most effective defense of your case. The knowledge and skill offered by Oberheiden, P.C., is unparalleled, and our passion is helping clients to make smart decisions in order to avoid the unnecessary consequences of federal health care fraud investigations.
As you read this, you may be the subject of investigation for allegedly submitting “false” or “fraudulent” claims to Medicare, Medicaid, or TriCare. You may have been told that you’re contributing to the nation’s opioid epidemic. You may be the target of an investigation, the reasons for which you don’t even fully understand. If you’re facing these difficulties, we’d like to help. It’s our goal to clear your name so that you can get back to the business you know best.
What Is Health Care Fraud?
To respond appropriately to an inquiry from the DEA, the DHHS Office of the Inspector General, or the Department of Justice (DOJ), the first step is understanding the basis for that inquiry. A number of agencies investigate alleged health care fraud, and the term can include any number of potential violations – both civil and criminal in nature.
To formulate the most effective defense possible, it’s important to answer two initial questions:
- Is this case civil or criminal; and
- What special task forces or agencies are involved in the investigation?
To answer those questions, a basic understanding of the different sources of authority involved in health care fraud investigations is helpful. Briefly, the laws pertinent to most health care fraud allegations are as follows:
1. The False Claims Act
Submitting false claims willingly to federal government programs like Medicare, Medicaid, and Tricare constitutes a violation of the False Claims Act (FCA). Under this law, you cannot submit any false claim (e.g., services not rendered, services unnecessary, and billing for more expensive services) for reimbursement. The law gives prosecutors the power to seek charges on a “per claim” basis, which could result in extravagant fines and both civil and criminal penalties.
2. The Anti-Kickback Statute
Health care professionals working with patients on Medicare, Medicaid, Tricare, and DOL programs cannot refer patients to services where they receive a referral fee (kickback) in return. Doing so is a direct violation of the Anti-Kickback Statute (AKS). Under the AKS, you could face criminal and civil penalties, including jail time and the loss of your practice.
3. The Stark Law
While the Stark Law‘s scope is limited in comparison to other federal statutes, it is not one to ignore and can result in sizeable civil penalties. Knowingly referring a patient to another service, office, or program, from which you stand to gain financially, is a violation of Stark Law. One example would be a physician that partially owns a laboratory and refers patients to that laboratory for all diagnostic testing simply for financial gain, even if there is not a medically sound reason for doing so.
4. The Controlled Substances Act
The CSA was created to control and regulate dangerous substances, and it’s one of the primary federal statutes utilized to prosecute providers suspected of engaging in pharmaceutical fraud. Pharmaceutical fraud can include knowingly selling prescription drugs, reselling prescription medications, trading counterfeit drugs, receiving kickbacks from manufacturers to prescribe one medication over another, and any number of other unlawful practices. Depending on its severity, a violation of the CSA can result not only in the loss of your practice, but in substantial civil and/or criminal penalties as well.
5. The Federal Health Care Fraud Statute
The federal health care fraud statute, 18 U.S.C. 1347, makes it a federal crime to knowingly and intentionally defraud any health care benefit program, or to obtain, through false statements or promises, any of the money or property under the control of any health care benefit program. Like the False Claims Act, this statute is very broad and provides federal prosecutors with a wide range of opportunities to target health care providers.
6. Program Billing Regulations
In addition to being subject to the aforementioned federal statutes, health care providers who participate in Medicare, Medicaid, Tricare, DOL, or other similar health benefit programs are also subject to the strict billing regulations of those companies. Willfully or unknowingly violating those regulations could result in losing your ability to work with those programs as well as a variety of other penalties that may stem from an audit and investigation. Maintaining a continually updated in-house compliance program to keep abreast of the constantly changing rules for these programs is a wise decision to help mitigate your risk of prosecution.
All medical professionals should also monitor the Department of Justice news releases that are routinely issued on their website. Doing so will help you to identify potential risks to your practice and to track what priorities the DOJ has for the health care industry. Currently, the DOJ is focusing efforts on their Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force and is seeking out physicians who have violated these laws.
In addition to the foregoing statutes, health care providers and related entities also need to be aware that DOJ prosecutors can also choose to seek evidence necessary to charge providers and company executives with crimes like mail fraud, wire fraud, tax fraud, money laundering, and a variety of other federal offenses as well. Being informed is the first step to being prepared. Once you are informed, you can turn to counsel to help you structure a defense uniquely customized to your particular circumstances. The highly experienced Orange County health care fraud defense lawyers at Oberheiden, P.C., should be that choice.
Five Reasons to Choose Our Orange County Health Care Fraud Defense Attorneys at Oberheiden, P.C.
Once you are the subject of a federal investigation, you may find yourself overwhelmed. Providers facing these sorts of investigations can turn to Oberheiden, P.C., knowing that when they do, they’re relying on a firm with experience and knowledge of the various types of allegations that they may be facing. Our highly skilled Orange County health care fraud defense lawyers have defended clients throughout the health care industry accused under all of the statutes and provisions mentioned above.
As a medical provider, you have too much at stake to avoid hiring a firm with experience in these matters. Here are five reasons medical providers choose Oberheiden, P.C.:
- Our Team Includes Former Federal Prosecutors – We have a team of seasoned litigators, and many of our defense attorneys include former federal prosecutors who have devoted their careers to health care fraud cases.
- Our Extensive Knowledge of the Federal Health Care Fraud System – Our highly skilled Orange County health care fraud defense lawyers understand these investigations, and we can help you to identify what triggered an investigation in the first place. Our health care fraud attorneys have handled thousands of health care fraud audits, investigations, and prosecutions, including numerous cases in Orange County. We can put that knowledge and experience to work for you.
- Our Robust Track Record – We get involved in the case as early as possible, and we have a track record of stopping investigations before they reach federal indictment.
- Our Focus on Federal Health Care Defense – Our firm focuses exclusively on federal law cases, and our established Orange County health care fraud defense lawyers have the experience required to defend clients representing all sectors of health care, including hospice care, physicians, pharmacies, hospitals, home care services, emergency clinics, and more.
- Our Customized Defense Strategies that Work – We have proven defense strategies and years of experience implementing them. Our Orange County health care fraud defense attorneys tailor our approach to the unique aspects of our clients’ cases so that they receive the aggressive, effective defense they need.
Discuss Your Health Care Fraud Defense Today in Confidence
As a medical professional working in Orange County, you know the damage that can be done by allegations of health care fraud, even if you are innocent. That is why our team suggests you speak with an attorney as quickly as possible after these allegations arise. Contact one of our health care fraud defense attorneys for a risk-free, confidential consultation at (888) 519-4897 or inquire online now. Our dedicated Orange County health care fraud defense attorneys are available 24 hours a day, 7 days a week, to discuss your concerns.