Oregon Healthcare Fraud Defense
Our federal healthcare 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 888-680-1745 for a free case assessment.
Oberheiden, P.C. is a federal defense law firm with a nationwide presence, including Oregon, that represents all types of healthcare 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 healthcare practice or medical business is under investigation, it is imperative that you get a healthcare fraud attorney and seek legal representation immediately. 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 Healthcare Fraud Allegations
With our attorneys’ experience on both sides of federal healthcare fraud investigations and prosecutions, we have significant experience in matters involving virtually all types of federal healthcare 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 healthcare 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 This includes submission of improper and outdated billing codes, intentional and unintentional upcoding, unbundling of services and supplies, and double-billing the federal government and/or a private insurer.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
Healthcare 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 healthcare benefit program can face criminal fines and incarceration.
5. Billing for Medically-Unnecessary Services, Supplies, or Equipment
All federal healthcare 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
Healthcare 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 healthcare 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. Healthcare Fraud Attempt and Conspiracy
In many cases, federal prosecutors will pursue charges against healthcare 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 healthcare fraud scheme.
The breadth of potential allegations in federal healthcare 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 healthcare 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 healthcare 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.
- Healthcare Fraud Statute (18 U.S.C. § 1347) – Under 18 U.S.C. § 1347, known as the federal healthcare fraud statute, providers can face statutory fines and up to 10 years of federal imprisonment for “defraud[ing] any healthcare 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 Healthcare Providers Choose Oberheiden, P.C.
With the potential for significant financial penalties, pre-payment review, program exclusion, and even federal imprisonment, Oregon healthcare 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 healthcare providers in Oregon and nationwide put their trust in the federal healthcare fraud defense team at Oberheiden, P.C.:
1. Past Prosecutorial and Federal Courtroom Experience
Several of our healthcare fraud defense attorneys spent long careers prosecuting healthcare 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 Healthcare Fraud Defense
Our firm has earned a national reputation for healthcare 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 Healthcare System
In addition to their extensive experience on both sides of federal healthcare fraud investigations, our attorneys have spent years studying the federal healthcare 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 healthcare 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.
FAQs About Oregon Healthcare Fraud Defense
What is the difference between the Anti-Kickback Statute and the Stark Law?
While both the Anti-Kickback Statute and the Stark Law place significant limits on a provider’s ability to receive referral payments, the two laws are very different in several respects. The Anti-Kickback Statute is a criminal law that prohibits providers from receiving or paying anything of value for referring a patient whose medical bills are covered under a federal program, such as Medicaid or Medicare. On the other hand, the Stark Law applies to all patients, regardless of whether they receive government benefits. However, the Stark Law is aimed at limiting the situations in which a provider refers patients to another practice in which the referring party has a financial interest. While both statutes can result in significant civil liability, only the Anti-Kickback Statute carries the possibility of criminal sanctions. If you are at the center of a healthcare fraud investigation, contact an experienced Oregon federal healthcare fraud defense attorney as soon as possible.
What is the False Claims Act?
The False Claims Act is one of the main healthcare fraud statute in the United States. The False Claims Act precludes anyone from knowingly submitting a false or fraudulent claim to a federally funded program, including Medicare or Medicaid. In this context, knowingly refers to the submission of the claim, rather than the intent to defraud the government. Thus, liability can attach anytime you submit a claim that contained errors you either knew about of should have known about. Because of this, even well-intentioned providers and practices frequently find themselves at the center of a federal healthcare investigation. However, good intentions alone will not prevent a finding of liability. An experienced Oregon federal healthcare fraud defense attorney can help you better understand the nature of the government’s allegations and what you can do to defend against them.
Should I speak with investigators about a healthcare fraud claim?
Not without first speaking to an experienced Oregon federal healthcare fraud defense attorney. To be sure, communicating, and even cooperating with federal investigators is not something that should be ruled out in every case. however, the risks of doing so on your own are simply too great. When you speak with investigators, everything you say will be documented. Thus, if you leave out small—but important—details, or make an innocent misstatement of fact, it can be taken as evidence of wrongdoing. It is much safer to consult with an Oregon federal healthcare fraud defense attorney to determine the extent of the investigation before responding to federal investigators.
Why don’t we call ourselves the best healthcare fraud defense lawyers?
Make no mistake, at Oberheiden, P.C., we believe that we are some of the best Medicare fraud defense attorneys in the country. However, we refrain from labeling ourselves as such for a few reasons. Primarily, we pride ourselves on our reputation and our integrity, and we feel that making bold claims that cannot be substantiated go against the image we want to portray. Additionally, the ethical rules that govern lawyers’ conduct prevent them from making any potentially misleading statements in their marketing. To us, “the best healthcare fraud lawyer” is a subjective term, and it isn’t up to us to say we’re the best. We also believe that our track record speaks for itself.
Request a Confidential Initial Case Assessment at Oberheiden, P.C.
To schedule your confidential initial case assessment with a member of Oberheiden, P.C.’s federal healthcare fraud defense team, please call 888-680-1745 or contact us online. We will arrange for you to speak with one of our senior attorneys as soon as possible.