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Portland Health Care Fraud

fraud

Being under investigation for or charged with health care fraud can have a catastrophic effect on a Portland provider’s reputation, career, and livelihood. If you have been charged with health care fraud, you need to call the experienced federal health care defense team of Oberheiden, P.C. Our attorneys have decades of experience defending business entities and medical providers targeted by fraud prosecutors.

Multiple federal agencies, including the FBI, the Department of Justice and the Office of the Inspector General are always on the lookout for health care providers who are violating federal laws. Health Care fraud leads to billions of dollars in losses to the federal government every year and the federal agencies are dedicated to prosecuting those who cause these losses. Due to this aggressive stance of the federal government on health care fraud, it is critically important that you hire an experienced and well-trained attorney if you find yourself under investigation for fraud.

Health Care Fraud: An Overview

The federal statute that codifies “health care fraud” is 18 U.S.C. §1347. Many federal prosecutors rely on this statute to charge providers with fraud. The language of 18 U.S.C. §1347 states:

(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.

(b)With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.

In more general terms, health care fraud involves misrepresenting information or concealing information from a federal health care program in order to make a financial profit. Health care entities and providers can commit health care fraud in a myriad of ways. Example of types of health care fraud are:

  • billing a federal health care program for services not performed
  • billing a federal health care program for services that are not medically necessary
  • billing a federal health care program for a more complex service than was actually performed.
  • billing a federal health care program for duplicate procedures
  • Accepting kickbacks
  • Paying for patient referrals
  • Prescribing medications that are for no legitimate medical purpose
  • Selling prescription medications

The above is not an exhaustive list of all possible health care fraud violations. Sometimes entities or providers commit violations on the above list but do so by mistake. For an action to be considered fraud, it must be done intentionally. Prosecutors must prove beyond a reasonable doubt, that the entity or provider intentionally tried to deceive a federal health care program with improper practices. Although 18 U.S.C §1347 is the main statute prosecutors use to charge health care entities with fraud, there are several other statutes that can affect Portland entities and providers, such as:

  • Anti-kickback laws: Anti-kickback laws are designed to punish health care entities and providers who pay for the referrals of patients who receive benefits from Medicare.
  • Stark Law: This law makes it illegal for health care providers, mainly doctors, to refer patients for services at an entity in which they have a financial interest.
  • Controlled Substances Act: The laws under this act give the Drug Enforcement Agency the power to investigate entities and providers who are illegally prescribing or selling medications.
  • False Claims Act: The laws under this act are not specific to health care fraud but allow the prosecution of those who intentionally overcharge the government including Medicare for services.

Health Care Fraud at the Oregon State Level

Although health care fraud is often prosecuted at the federal level, there are state laws in Oregon that allow health care fraud to be prosecuted at the state level as well. Medicare is a federally run program, but Medicaid is both a federal and state program. Since Medicaid is funded partially by the state of Oregon, health care entities and providers can be prosecuted at the state level for Medicaid fraud. The Oregon Medicaid Fraud Unit is responsible for prosecuting Medicaid fraud cases; therefore, it is of upmost importance that you speak with an experienced Oregon Medicaid fraud defense lawyer at Oberheiden, P.C. if you are under a state investigation.

Why Oberheiden, P.C.?

The lawyers at Oberheiden, P.C. know all too well the havoc a fraud case can wreck on your business and livelihood. A conviction of health care fraud carries possible punishments of loss of medical licensure, extreme fines, and prison time. Contacting a defense law firm is critical in order to avoid or mitigate these punishments. Clients from Portland and numerous cities throughout the country engage Oberheiden, P.C. for the following reasons:

  • Our Experience: At our firm, we have successfully handled thousands of cases involving health care fraud, from the simple to the complex. Some of our team are former federal prosecutors who understand the intricacies of health care fraud and know how the other side works. Our team of attorneys is trial tested and has tried over 500 federal trials. Together, our lawyers have over 100 years combined legal experience in federal health care matters.
  • Our Proven Track Record: Our lawyers have helped hundreds of health care entities and providers secure favorable outcomes in fraud cases, even when it seemed like all hope was lost. We have helped clients avoid criminal charges and have been able to stop criminal investigations before they progressed to an indictment. We have also negotiated large fines down to nominal amounts and most importantly, for no prison time as a result of a conviction. Oberheiden, P.C. relies on proven strategies to help our clients achieve successful outcomes.
  • Our Representation is Customized: No fraud case is the same. Oberheiden, P.C. implements customized strategies that best fit our client’s unique case. There are a multitude of options that are explored at the onset of a client’s case, and our lawyers are dedicated to finding the best solution to cater to our client’s individual needs.

Call a Portland Health Care Fraud Defense Attorney Today

If your Portland health care business, practice, or organization is currently under investigation, please call Oberheiden, P.C., to schedule an initial consultation with a skilled Portland health care fraud defense attorney. Our team can immediately get started on your case to mount an aggressive defense or help you create a compliance program. We have over 100 years of combined experience in defending clients against charges that can result in imprisonment, significant monetary fines, and damage to their reputations. Call us today at (214) 469-9009 or onlinecontact us online to schedule your confidential consultation.

All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) For informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.

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