Richmond Health Care Fraud

Proven Richmond Health Care Fraud Defense Lawyers

Medical practices, pharmacies, pain management clinics, drug testing facilities, hospices, and other health care providers in Richmond, VA, are being targeted in federal fraud investigations. Our Richmond health care fraud defense lawyers are helping them avoid civil and criminal prosecution.

Medicare fraud, Medicaid fraud, Tricare fraud, and fraudulent billing practices targeting the U.S. Department of Labor (DOL) cost the federal government billions of dollars every year. While scam artists are to blame for much of this, a significant portion of the government’s losses are due to billing mistakes, coding errors, and other improper practices – both intentional and unintentional – committed by legitimate health care providers.

As a result, and since health care providers are easier to track than scam artists who devote their time to figuring out how to game the system, federal authorities are increasingly targeting health care providers in Medicare, Medicaid, Tricare, and DOL fraud investigations. These investigations are typically undertaken by agencies such as the U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and Office of Inspector General (OIG). And while they are often civil in nature, federal prosecutors will not hesitate to indict health care providers on criminal charges.

Federal Health Care Fraud Defense Lawyers Serving Richmond, VA

While health care fraud is unfortunately a very real problem, what is equally unfortunate is that DOJ, DEA, FBI, and OIG investigations targeting health care providers are often misguided. Whether relying on generalized billing data or allegations from “whistleblowers” (who are usually disgruntled patients or former employees), it is not at all uncommon for the accusations underlying a federal health care fraud investigation to be completely unsubstantiated.

As a health care provider in Richmond, what does this mean for you? Can you simply ignore the government’s investigation if you are confident in your business’s or practice’s Medicare or Medicaid compliance program? Experience shows that the answer to this question is a resounding “No.” In order to protect yourself, you need to execute a strategic defense, and this starts with hiring experienced Richmond health care fraud defense lawyers at Oberheiden, P.C.

Understanding Your Federal Health Care Fraud Investigation

At Oberheiden, P.C., we offer strategic and aggressive defense representation for health care fraud investigations in Richmond, VA. By limiting our practice on federal defense and by focusing on representing physicians, pharmacists, clinic operators, and other health care providers, our highly experienced Richmond health care fraud defense lawyers have amassed a substantial track record in health care fraud investigations. This includes resolving the majority of our clients’ cases without charges being filed. We handle investigations targeting all types of providers (both individual licensed practitioners and business organizations) and involving all types of health care fraud allegations.

Call us today at (888) 519-4897 for a free and confidential assessment of your DOJ, DEA, FBI, or OIG investigation involving allegations of:

  • Anti-Kickback Statute violations (illegal “kickbacks”)
  • Billing for services not actually rendered to patients
  • Controlled Substances Act and DEA registration violations (including prescription drug fraud)
  • Department of Labor (DOL) fraud
  • Falsifying patient records, prescriptions, physician certifications, and election statements
  • Medicare, Medicaid, or Tricare coding violations
  • Providing and billing for medically-unnecessary services
  • Stark Law violations (unlawful “physician self-referrals”)

With our substantial experience in federal health care fraud matters, our Richmond health care fraud defense lawyers are able to quickly intervene in the government’s evidence and immediately begin gathering the information we need to execute a strategic defense. This includes information such as:

  • The federal agency (or agencies) handling the investigation
  • Whether the investigation is civil or criminal in nature
  • Where the allegations against your business or practice originated
  • How long the investigation has been ongoing
  • How close federal prosecutors are to filing civil charges or seeking an indictment

How and Why: Sources of Authority and Law Enforcement Mandates in Health Care Fraud Investigations

1. Anti-Kickback Statute

The Anti-Kickback Statute (AKS) prohibits health care providers from offering, soliciting, paying, or accepting bribes, kickbacks, referral fees, or other forms of remuneration in connection with federal program-reimbursed health care services, equipment, or supplies. While the AKS is extremely broad in its scope and includes provisions for both civil and criminal prosecution, it also includes a number of “safe harbor” provisions that can provide complete defenses to liability in federal health care fraud investigations.

The Anti-Kickback Statute’s safe harbor provisions apply to relationships and transactions including (but not limited to):

  • Bona fide employment relationships
  • Discounts
  • Group purchasing organizations
  • Investment Interests
  • Lease or rental of office space or equipment
  • Management contracts
  • Personal service arrangements
  • Practitioner recruitment
  • Price reductions
  • Referral services
  • Sale of health care practice
  • Waivers of copayments, coinsurance, and deductibles
  • Warranties

2. Controlled Substances Act

The Controlled Substances Act is the primary federal statute governing the prescription, administration, and dispensing of medications. As such, it is the primary federal statute used to prosecute providers suspected of engaging in pharmaceutical fraud. While the DOJ pursues health care providers suspected of pharmaceutical fraud involving all types of prescription medications, it is currently devoting substantial resources to targeting providers suspected of opioid-related offenses.

3. False Claims Act

The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim to Medicare, Medicaid, Tricare, or the Department of Labor. This includes both knowing and intentional violations. In order for a violation to be considered “knowing,” it is enough if a provider should have known that a reimbursement request was unlawful.

Like the Anti-Kickback Statute, the False Claims Act includes provisions for civil and criminal prosecution. Civil penalties under the FCA include civil assessments, recoupments, fines, and program exclusion, while criminal penalties include fines and federal imprisonment.

4. Health Care Fraud Statute

The health care fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully execute[], or attempt[] to execute, a scheme . . . to defraud any health care benefit program . . . [or obtain by] false or fraudulent pretenses . . . any of the money or property owned by, or under the custody or control of, any health care benefit program.” 18 U.S.C. 1347 is a criminal statute, and health care providers convicted under the statute can face substantial fines and up to 20 years of imprisonment for each individual violation.

In order to be found guilty under the health care fraud statute, a provider “need not have actual knowledge of [18 U.S.C. 1347] or specific intent to commit a violation of [the law].”

5. Stark Law

The Stark Law prohibits “physician self-referrals,” which are defined as referrals to entities or individuals with which a physician (or a family member) has a financial relationship. The Stark Law applies to referrals for services, supplies, and equipment billed to Medicare and Medicaid; as a “strict liability” statute, proof of intent is not required.

Unlike the other statutes discussed above, the Stark Law exclusively provides for civil penalties.

6. Program Billing Regulations

In addition to these and other statutes (such as the federal laws that establish the crimes of mail fraud, wire fraud, and tax evasion), health care providers that bill Medicare, Medicaid, Tricare, and the DOL are subject to a bevy of extraordinarily complex billing regulations. Violations of these regulations can be prosecuted as violations of the False Claims Act and 18 U.S.C. 1347 (among others), and providers that fail to implement comprehensive compliance programs are at high risk for federal prosecution.

7. DOJ Mandates

As the nation’s chief law enforcement authority, the Department of Justice is responsible for identifying investigative priorities for other agencies. Combatting Medicare and Medicaid fraud has been a top DOJ priority for years. And recently, the DOJ has significantly ramped up its efforts to target health care providers suspected of contributing to the nation’s opioid epidemic.

Why Choose Oberheiden, P.C., for Your Health Care Fraud Investigation in Richmond, VA?

With civil monetary penalties, a federal criminal conviction (if not multiple convictions), and your health care business or practice on the line, it is critical that you engage defense counsel as soon as possible. You want to do this during the investigation, before the allegations against you lead to civil or criminal charges. Why should you choose the Richmond health care fraud defense lawyers at Oberheiden, P.C.?

  • Our attorneys have centuries of combined legal experience in federal health care fraud matters.
  • Our Richmond health care fraud defense attorneys include former senior DOJ prosecutors who have handled more than 1,000 investigations and 500 criminal trials.
  • We take a team approach that puts the full weight of our experience on your side. Unlike other firms, we do not employ any junior associates or paralegals.
  • We focus on pretrial resolution, and we take an aggressive approach that has resulted in the majority of our clients never facing federal charges.
  • As our client, your interests come first. No matter what it takes, we will not stop fighting until we are confident that we have secured the most favorable outcome possible.

Contact Us Now for a Free and Confidential Consultation

To speak with the attorneys on our health care fraud defense team about your investigation in Richmond, VA, contact us now to schedule a free and confidential consultation. You can call our Richmond health care fraud defense lawyers 24/7 at (888) 519-4897. And if you contact us online, a member of our team will be in touch as soon as possible.

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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