Philadelphia Health Care Providers and Business Owners Federal Investigations Defense Lawyer
Health care businesses, hospitals, pharmacies, laboratories, medical practices, home health and hospice agencies, durable medical equipment (DME) companies, and other industry participants in Philadelphia, PA need to understand the seriousness of the new wave of health care fraud prosecutions that is currently hitting Philadelphia and surrounding communities.
The Drug Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG) under leadership of the Department of Justice have begun to systematically target Philadelphia health care entities and providers to prosecute alleged fraud found in prescription policies, billing practices, and kickback relationships.
In this climate of investigation, being proactive is the best advice any lawyer may provide. Surround yourself with experienced lawyers that have the experience and the track record of resolving health care audits, investigations, and prosecutions by obtaining no civil and no criminal liability outcomes for their clients.
What is Health Care Fraud?
In broad terms, Philadelphia federal authorities are cracking down on “health care fraud.” Health care fraud stands for a variety of offenses, some of which are criminal in nature while others do not require intentional misconduct or even knowledge. All federal health care fraud statutes have in common that penalties for wrongdoings can be serve and may even include criminal prosecution. Frequent fraud charges against Philadelphia providers include Medicare Fraud (18 U.S.C. 1347), Medicaid Fraud, as well as violations of the Controlled Substances Act (21 U.S.C. 841), the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law Statute (42 U.S.C. 1395nn), and the federal False Claims Act (31 U.S.C. 3729-3733).
Attorneys for Health Care Fraud Investigations in Philadelphia
Oberheiden, P.C. is a team of experienced defense attorneys with a proven track record of successfully representing clients in health care fraud audits, investigations, and prosecutions. Our health care fraud defense lawyers include several former prosecutors, who held senior-level positions within the U.S. Attorney’s Office and the Department of Justice. Each of our attorneys has first-hand knowledge and specific backgrounds in health care cases. Together with our clients, we will identify the proper strategy depending on the specific circumstances of each individual case.
Our experience includes:
- More than 1,000 health care fraud investigations
- Dismissal of state and federal indictments
- More than 500 criminal trials
- More than 70 years of Department of Justice experience
From justifying your Medicare billings to asserting the safe harbor protections of the Anti-Kickback Statute or the Stark Law, if there are any opportunities to help you mitigate or avoid liability, we will use them to ensure that you do not face any unjust penalties as a result of your investigation.
Decades of Experience With Audits and on Both Sides of Civil and Criminal Health Care Fraud Investigations
If your Philadelphia, PA business or practice is subject to audit or investigation, we strongly encourage you to contact us at your earliest convenience for a free case evaluation. One of the reasons Oberheiden, P.C. resolves so many health care fraud cases with no civil or criminal penalties for our clients is our proactive approach, aggressively intervening and stopping the investigation before it gets out of hands. Prompt intervention is critical, and our attorneys know how to communicate with auditors, agents, and prosecutors to protect your license, livelihood, and freedom. We represent physicians, pharmacies, hospitals, hospices, home health providers, DME companies, and many others facing allegations such as:
- Prescription Drug Fraud. All providers in Philadelphia need to know that the Justice Department has significantly increased its investigation of pain medicine prescribing physicians. That said, it is absolutely essential to make sure your practice is in full compliance with the Controlled Substances Act and other drug diversion statutes. Further, it is important to realize that prescription fraud cases are federal criminal prosecutions. Clients approached by law enforcement should immediately contact experienced lawyers to protect their rights. Oberheiden, P.C. is on the forefront of defending physicians in Philadelphia and surrounding communities against unjust accusations of fraud and diversion.
- Medicare Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments though a process of reviewing and analyzing claims data in addition to medical documentation that is obtained from the member/provider. Many times this involves a statistical sampling of files in order to establish an error rate. Another type of Medicare audit is conducted by the Zone Program Integrity Contractors (ZPICs). ZPIC audits identify and stop potential fraud and refer these cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that a mishandled audit can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice health care prosecutors with first-hand knowledge of the process navigate our clients through the audit and make sure that they can continue their business and don’t need be worried about their license or a government investigation.
- False Medical Claims. The False Claims Act (FCA) is a federal statute that contains civil and criminal penalties for health care providers who submit “false and fraudulent” claims for federal program (e.g. Medicare, Tricare, Department of Labor) reimbursement. Investigations under the FCA require professional expertise because the law does not require intent or actual knowledge of the falseness of the claims. The mere submission of a false claim (e.g. by applying the wrong code) is enough to subject your practice to enormous fines ranging from $ 11,000 per claim to treble damages and more. Worse, if the case is not handled professionally, a referral for criminal prosecution is possible.
- Anti-Kickback Statute Violations. Under the Anti-Kickback Statute, it is illegal to “knowingly and willfully” offer, pay, solicit, or receive “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” in exchange for a patient referral. Like the False Claims Act, the Anti-Kickback Statute provides for both civil and criminal penalties. When you are facing kickback violations, time is of the essence to confront the government with a recognized and experienced defense team. Oberheiden, P.C. has concluded many kickback investigations with no civil and criminal liability for our clients. We are delighted to do the same for you.
- Stark Law Violations. The Stark Law is a civil statute that prohibits physicians from referring patients to entities in which they own an interest or with which they have certain types of compensation arrangements for the provision of Medicare-reimbursed services or supplies. The Stark Law includes a variety of “safe harbor” provisions, and defending against allegations of illegal “self-referrals” often involves demonstrating that a safe harbor applies.
- Billing Fraud. Billing fraud is a form of health care fraud that commonly leads to charges under the False Claims Act. The submission of any improper reimbursement request to Medicare, Medicaid, Tricare, or another federal benefits program can result in liability, and federal investigators and prosecutors routinely pursue cases based on allegations of upcoding, double-billing, phantom billing, billing for medically-unnecessary services, and other billing and coding violations.
- Home Health & Hospice Agency Fraud. Home health providers and Medicare businesses in Philadelphia depend on physician certifications to qualify for services reimbursement under pertinent Medicare rules. The flip-side of this gatekeeper role of medical providers is that government agents try hard to discredit the doctors and, with it, the agencies, claiming fraudulent certifications and re-certifications. Oberheiden, P.C. has had great success representing medical providers and agencies alike against government investigations—and in the court room. To find out how, call our team of senior attorneys today for a free and confidential case assessment.
Answers to FAQs: Defending Against Health Care Fraud Investigations in Philadelphia
Q: Why is my health care business or medical practice being investigated?
A number of reasons may explain why your health care business or medical practice is being targeted in a federal investigation. As publicly announced, the Justice Department and other federal agencies have recently intensified their efforts to prosecute fraud. Philadelphia is on the short list of cities that is under extra scrutiny due to its large size population and history of health care fraud findings. Additionally, there are other reasons why your particular business or practice may be the target of an investigation as well. These include:
- Receiving an unfavorable determination in a RAC, MAC, or ZPIC audit
- Having billing records that are inconsistent with those of other local providers (even if there is clear justification based on the unique aspects of your business or practice)
- Being targeted in a whistleblower (or qui tam) complaint
Q: What are some potential defenses to health care fraud allegations?
Defending health care fraud allegations requires skillset and experience. More than 1,000 health care fraud cases handled has taught our attorneys to critically question the government’s case and to independently analyze the facts with our clients. Doing so allows us to better understand the case and to build defenses around the actual facts that we learn from our clients. Oberheiden, P.C. has resolved health care cases across the United States by diligently researching defenses, making powerful presentations at the U.S. Attorney’s Office, and by applying decades of insights gained in health care law enforcement positions as former Assistant United States Attorneys. Generally speaking, some of the most-effective defense strategies in health care fraud investigations include:
- Claiming statutory safe harbors and exceptions
- Asserting Constitutional protections
- Challenging the government’s case for lack of intent
- Using your billing or patient records to demonstrate compliance with the law
Q: What outcomes can I reasonably expect from my investigation?
Priority in every health care fraud matter is to stop the investigation, to avoid prosecution. This applies to ZPIC audits, requests for production pursuant to a grand jury subpoena, and every other aspect of a fraud claim. Where charges have already been filed, we have good news for our clients. The government must convince 12 jurors that you did something wrong. We only need to convince 1 juror that you did nothing wrong!
Contact Us Now for a Free Case Assessment
At Oberheiden, P.C., every engagement begins with a free case assessment. When you contact us, we will arrange for you to meet with our health care fraud defense team right away. If you decide to move forward, we will intervene in the investigation immediately, and we will work closely with you and your key personnel to implement a defense strategy that is custom-tailored to the circumstances at hand. The easiest thing in the entire process is to make a phone call. Call (888) 519-4897 from Philadelphia, PA or request an appointment online and we will be in touch as soon as possible.
Areas We Serve in Philadelphia, PA
Subject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel. The areas include: Philadelphia, Chestnut Hill, Camden, Gloucester City, Yeadon, Collingswood, Darby, Pennsauken, Lansdowne, Audubon, Drexel Hill, Bellmawr, Cherry Hill, Haddonfield, Woodbury, Springfield, Manayunk, Mt. Airy, Bristol, Doylestown, New Hope, Kennett Square, Phoenixville, West Chester, Media, Wayne, Ambler, Ardmore, Jenkintown, Skippack, Bethlehem, Bryan Athyn.
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