Pensacola Health Care Fraud

If you are under federal investigation in connection with your health care practice in Pensacola, you need the experienced Pensacola health care fraud defense lawyers at Oberheiden, P.C., on your side.

Federal law enforcement is currently undertaking a major effort to reduce fraud, waste, and abuse in the health care system. As part of that, they are actively investigating health care providers and business organizations in the Pensacola area as well as in major cities throughout Florida.

Many of these investigations are being spearheaded by the United States Department of Justice (DOJ) and the Department of Health and Human Services’ Office of Inspector General (DHHS – OIG).

These organizations investigate everything from phantom billing and false claims to physician self-referrals and unlawful kickbacks.

Health care providers in Pensacola might also find themselves being investigated by the DEA for alleged misuse of prescription medications (such as opioid medications) or for white-collar crimes that can affect business entities in any field (IRS investigations into tax fraud, for example).

Oberheiden, P.C., is a federal criminal defense law firm with a national presence. Our attorneys bring more than a century’s worth of experience to the table. In fact, several of them are former federal prosecutors, having worked in the Department of Justice or in other prosecutorial roles.

We are dedicated to mounting an aggressive criminal defense for health care professionals, corporate officers, and business owners who stand accused of committing federal crimes. In the majority of our cases, our Pensacola health care fraud defense lawyers have been able to avoid the filing of criminal charges against our health care clients. While we cannot promise specific results in advance, we fight to get the optimal outcome, every time.

What Is Health Care Fraud?

Generally defined, health care fraud refers to intentional misrepresentations, falsehoods, tricks, or schemes devised to wrongfully deprive a health care program (such as Medicare, Medicaid, Tricare, the Department of Labor, or even a private insurance company) of money or other assets.

There are many kinds of health care fraud. Some common examples include:

  • Billing fraud (phantom billing, upcoding, false claims, etc.)
  • Department of Labor (DOL) fraud
  • Anti-Kickback Statute violations
  • Stark Law violations (physician self-referral)
  • Prescription drug fraud and other Controlled Substances Act (CSA) / DEA registration violations
  • Billing for services that are not medically necessary
  • Billing for services you never actually provided
  • Falsifying patient records, prescriptions, physician certifications, or election statements

Federal Health Care Statutes and Other Sources of Law You Need to Know

When prosecutors want to bring health care fraud charges in Pensacola, they have numerous federal statutes to choose from. These statutes also form the basis for most federal investigations into suspicious health care practices.

1. The False Claims Act

True to its name, the False Claims Act (FCA) makes it a criminal act to submit “false or fraudulent” payment claims to any federal health care program, such as Medicare or Medicaid. The most serious penalty under the FCA is a five-year federal prison sentence. But the civil and criminal fines can become a crippling penalty on their own, even without a prison sentence. That’s because these fines can mean tens or hundreds of thousands of dollars for each false claim. And because an FCA conviction can also mean program exclusion, an FCA charge threatens your business’s very existence. Learn more about the civil and criminal penalties for FCA violation (both for individuals and for corporations) here.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) is one of the most complex and challenging pieces of federal health care legislation because its implications are so far-reaching. Under the AKS, it is a crime to intentionally offer, pay, solicit, or receive remuneration in exchange for patient referrals. The question of intent is key. “Remuneration,” meanwhile, is broadly defined. An AKS investigation can be civil or criminal in nature. Our office can help in either scenario.

3. The Stark Law

The Stark Law applies narrowly to “physician self-referrals,” which are illegal under the Stark Law and can result in significant civil penalties. We urge any Pensacola physicians who treat Medicare or Medicaid beneficiaries and who are worried they may be investigated for self-referrals to contact Oberheiden, P.C., right away.

4. The Federal Health Care Fraud Statute

Federal prosecutors often seek charges under multiple statutes at once. 18 U.S.C. 1347, better known as the “health care fraud statute,” is something of a go-to statute, owing to its broad language and application. It reads (in part) as follows:

(a) “Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice –
(1) to defraud any health care benefit program; or
(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program,in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both…”

5. The Controlled Substances Act (CSA)

The Controlled Substances Act makes it illegal to write unnecessary prescriptions, sell prescriptions or medications, dispense medications without proper DEA registration, engage in pharmaceutical fraud, misappropriate opioids or other controlled substances, or possess or distribute certain illegal drugs, among other things.

6. Other Fraud Statutes

Health care fraud charges rarely appear on an indictment alone. In addition to the criminal statutes described above, health care providers in Pensacola may also face allegations of closely related charges, which might include:

  • Mail fraud
  • Wire fraud
  • Bank fraud
  • Forgery
  • Making false statements
  • Federal conspiracy
  • Wrongful use of health information

7. Program Billing Regulations

Agencies, such as the CMS, promulgate their own billing regulations. Violating these regulations, even unintentionally, can result in prosecution. Health care providers in Pensacola are urged to maintain a proactive compliance program to reduce the risk of unwittingly violating a federal billing regulation.

8. DOJ Mandates

You might think that the Department of Justice’s only interest is, well, justice. But the officers and leaders at the DOJ are extremely interested in media coverage too; they maintain an active press department. From time to time, the department issues new departmental mandates. These mandates tell DOJ agents how to allocate their resources and which law enforcement prerogatives to prioritize. The DOJ can even work with other federal agencies to launch task forces. These efforts are typically geared at making high-profile arrests en masse, with the aim of getting maximal media coverage. Paying attention to DOJ mandates can help you get a sense of where the DOJ is likely to strike next. We have seen a tremendous amount of federal law enforcement activity in the Florida health care industry in recent years.

5 Reasons to Choose the Pensacola Federal Health Care Fraud Defense Lawyers at Oberheiden, P.C.

Here are five reasons why health care professionals and business entities in the Pensacola area should trust Oberheiden, P.C., as their federal health care fraud defense attorneys:

  • Our Extensive Experience in Health Care Fraud Investigations – Health care fraud is a highly complex and specific area of law. There is simply no substitute for years of experience working hands-on in these cases. From negotiations with federal investigators and prosecutors to our advocacy at trial, our Pensacola health care fraud defense attorneys have handled thousands of federal health care fraud matters.
  • Our Record of Avoiding Charges – While every case is unique and we cannot guarantee specific results, we have proudly avoided criminal charges in the majority of our cases. Avoiding charges is the most effective way to resolve a criminal investigation, so we do everything we can to achieve that goal every time.
  • Our Focus on Federal Health Care Fraud Defense – If you are facing health care criminal charges, you want to know that this is a field your defense lawyers spend a lot of time in. Health care fraud defense has long been one of our primary areas of professional focus at Oberheiden, P.C. Our Pensacola federal health care defense lawyers are available to represent doctors, pharmacists, physician’s groups, medical clinics, hospitals, hospices, medical laboratories, mobile labs, ambulance providers, diagnostic companies, and virtually any other health care providers in Pensacola.
  • Our Experience on Both Sides – Several of the lawyers at Oberheiden, P.C. are former federal prosecutors. Because they’ve sat on the other side of the same kinds of cases, they bring invaluable perspectives to our clients’ defense.
    • Our Aggressive Defense Strategies – When the stakes are high, you need attorneys who will fight for you with passion and zealous determination. The Pensacola health care fraud defense lawyers at our firm believe in taking an aggressive approach for every client we represent.
    • Discuss Your Federal Health Care Fraud Investigation in Confidence

      If your Pensacola health care practice or company is being targeted in a federal health care fraud investigation, we urge you to contact our office for a free and confidential case assessment. To speak with a member of our Pensacola health care fraud defense attorneys, right away, call (888) 519-4897 or inquire online as soon as possible.

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