Our federal health care fraud defense lawyers bring centuries of combined experience to representing physicians, pharmacists, and other providers in Oregon. Is your business or practice being targeted? Call 888-519-4897 for a free case assessment.
Oberheiden, P.C. is a federal defense law firm with a nationwide presence that represents all types of health care providers in Medicare, Medicaid, Tricare, and Department of Labor (DOL) investigations. With a team that includes nationally-recognized defense attorneys, former federal prosecutors, and the only former federal trial judge currently in private practice, the firm has amassed an impressive record of results in high-stakes federal cases.
If your Oregon health care practice or medical business is under investigation, it is imperative that you seek legal representation promptly. These investigations can move quickly, and federal prosecutors have a mandate to aggressively pursue charges against providers suspected of Medicare, Medicaid, Tricare, and DOL fraud. Even if you are not being accused of intentionally overbilling the government, unintentional billing violations could still lead to civil charges, and a finding of civil liability could mean recoupments, fines, treble (triple) damages, pre-payment review, program exclusion, and other penalties.
10 Common Allegations in Federal Health Care Fraud Allegations
With our attorneys’ experience on both sides of federal health care fraud investigations and prosecutions, we have significant experience in matters involving virtually all types of federal health care fraud allegations. While every case presents unique aspects, some of the most common allegations in investigations involving the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG) and other federal agencies and task forces include:
1. Billing and Coding Errors
Among health care providers who get into trouble with the federal government, most are found liable for billing and coding errors. This includes submission of improper and outdated billing codes, intentional and unintentional upcoding, unbundling of services and supplies, and double-billing the federal government and/or a private insurer.
2. Kickbacks, Bribes, and Rebates
Health care providers, laboratory and clinic administrators, durable medical equipment (DME) company owners, and other individuals and entities can face civil or criminal penalties for engaging in transactions that involve compensation for referrals of Medicare, Medicaid, Tricare, and DOL beneficiaries.
3. Physician Self-Referrals
In addition to the prohibition on unlawful referral fees paid between independent parties, physicians can also face civil liability for so-called “self-referrals” to related entities. The prohibition applies in reverse as well—creating civil penalties for physicians who accept prohibited referrals from their related entities.
4. False and Fraudulent Claims
False and fraudulent claims include all types of improper requests for Medicare, Medicaid, Tricare, or DOL reimbursement. Unintentional false and fraudulent claims can trigger civil liability, while providers found guilty of intentionally overbilling a federal health care benefit program can face criminal fines and incarceration.
5. Billing for Medically-Unnecessary Services, Supplies, or Equipment
All federal health care benefit programs limit reimbursements to services, supplies, and equipment that are deemed “medically necessary” under the applicable program guidelines. Billing for services that do not meet the relevant program’s definition of medical necessity can trigger civil liability even in cases where a provider believes that it has rendered competent medical advice.
6. Billing for Services, Supplies, or Equipment Not Provided
Billing for services, supplies, or equipment not actually provided will often trigger criminal inquiries for so-called “phantom billing.” However, these cases often are not as straightforward as they initially seem, and providers may have a number of potential defenses available.
7. Prescription Drug Fraud
Health care providers can face allegations of prescription drug fraud ranging from prescribing medically-unnecessary medications to diverting opioid prescriptions to drug-dependent individuals. Due to the federal government’s focus on the national opioid crisis, providers targeted in these investigations can expect to face intense scrutiny.
8. Falsifying Patient Records and Inaccurately Reporting Test Results
Similar to allegations of phantom billing, allegations of falsifying patient records or inaccurately reporting test results will often expose health care providers to criminal prosecution. But, here too, there are a variety of defenses to both civil and criminal culpability, and providers accused of submitting fraudulent records in support of program billings must work diligently to present a strategic defense.
9. Fraudulent Physician Certifications and Election Statements for Hospice Care
Hospices and physicians who certify patients for hospice care are finding themselves in the government’s crosshairs with increasing frequency. In investigations targeting hospices and certifying physicians, the DOJ and OIG will often be looking for evidence of certification and election statement fraud.
10. Health Care Fraud Attempt and Conspiracy
In many cases, federal prosecutors will pursue charges against health care providers who have not actually overbilled Medicare, Medicaid, Tricare, or the DOL. The attempt and conspiracy provisions of the U.S. Code allow prosecutors to bring criminal charges under a broad array of circumstances, often against individuals who were only minimally or tangentially involved in an alleged health care fraud scheme.
Sources of Authority in Federal Health Care Fraud Investigations
The breadth of potential allegations in federal health care fraud investigations stems from the laundry list of statutes under which federal prosecutors have the ability to pursue charges. The statutes most-commonly involved in health care fraud investigations are:
- False Claims Act – The False Claims Act prohibits the submission of any “false or fraudulent claim” for federal government reimbursement, and includes provisions for both civil and criminal penalties.
- Anti–Kickback Statute – The Anti-Kickback Statute also includes civil and criminal penal provisions, and it prohibits the offer, payment, solicitation, or receipt of any form of remuneration in exchange for a referral for services, supplies, or equipment to be reimbursed by a federal health care benefit program.
- Stark Law – The Stark Law is the statute that prohibits physician “self-referrals.” While the Stark Law is exclusively a civil statute, physicians and their related entities can still face enormous financial liability and other practice-threatening penalties.
- Health Care Fraud Statute (18 U.S.C. § 1347) – Under 18 U.S.C. § 1347, known as the federal health care fraud statute, providers can face statutory fines and up to 10 years of federal imprisonment for “defraud[ing] any health care benefit program.” For cases involving serious bodily injury or death, potential prison sentences increase to 20 years to life.
- Controlled Substances Act – The Controlled Substances Act imposes criminal penalties for opioid diversion and other forms of prescription drug fraud. The Controlled Substances Act also provides the statutory authority for the DEA’s registration program, and all DEA registrants are subject to regular investigations every three years.
Why Oregon Health Care Providers Choose Oberheiden, P.C.
With the potential for significant financial penalties, pre-payment review, program exclusion, and even federal imprisonment, Oregon health care providers targeted in federal investigations must make every effort to protect themselves to the greatest extent possible. For most providers, this starts with engaging experienced legal representation. Here are five reasons why health care providers in Oregon and nationwide put their trust in the federal health care fraud defense team at Oberheiden, P.C.:
1. Past Prosecutorial and Federal Courtroom Experience
Several of our health care fraud defense attorneys spent long careers prosecuting health care fraud cases with the DOJ prior to entering private practice. Our defense team also includes the only former federal district court judge currently in private practice.
2. National Reputation for Health Care Fraud Defense
Our firm has earned a national reputation for health care fraud defense. Our attorneys have successfully represented clients in numerous federal jurisdictions, and they have appeared on media outlets to discuss high-profile federal investigations across the country.
3. Aggressive Intervention and Pre-Trial Litigation Strategies
When a client contacts us during an ongoing investigation, we emphasize prompt intervention and aggressive pre-trial tactics. Whenever possible, we seek to resolve our clients’ investigations favorably without civil or criminal charges being filed.
4. Custom-Tailored Legal Representation
We work closely with our clients to understand the unique circumstances of their investigations and craft custom-tailored defense strategies that take all relevant details into consideration.
5. In-Depth Knowledge of the Federal Health Care System
In addition to their extensive experience on both sides of federal health care fraud investigations, our attorneys have spent years studying the federal health care system, and we have helped many clients develop and implement comprehensive billing compliance programs. This knowledge allows our team to hit the ground running and immediately begin having informed and strategy-focused discussions with our clients.
If you need legal representation for a federal health care fraud investigation in Portland, Eugene, Salem, or any other part of Oregon, we encourage you to contact us promptly to learn more about what our team of highly-experienced defense attorneys can do to help. If federal agents from the DEA, DOJ, OIG, or any other federal agency are looking into your business or practice, you do not have time to waste, so contact us for your confidential initial case assessment now.
Request a Confidential Initial Case Assessment at Oberheiden, P.C.
To schedule a confidential initial case assessment with a member of Oberheiden, P.C.’s federal health care fraud defense team, please call 888-519-4897 or contact us online. We will arrange for you to speak with one of our senior attorneys as soon as possible.