Riverside Federal Health Care Fraud Defense
Established Riverside Health Care Fraud Defense Lawyers
Health care providers in Riverside, CA, are actively being targeted for prosecution by the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and other federal agencies. If you have received a target letter, subpoena, or any other form of contact from federal authorities, it is important that you speak with our Riverside health care fraud defense lawyers, right away.
As a health care provider in Riverside, CA, one of the greatest threats to your practice is the risk of prosecution for health care fraud. Federal agencies, including the Department of Justice (DOJ), Drug Enforcement Administration (DEA), and Office of Inspector General (OIG) are ramping up their efforts to target health care providers suspected of improperly billing Medicare, Medicaid, Tricare, and the Department of Labor (DOL) health care benefit programs. They are launching aggressive investigations focused on securing the evidence necessary to pursue civil or criminal charges.
If your health care practice or business is under investigation, what do you need to know? What do you need to do? What mistakes do you need to avoid? What are the chances that you could face a conviction at trial? These are all critical questions, and they do not have easy answers. At Oberheiden, P.C., the attorneys on our federal health care fraud defense team have centuries of combined legal experience, and we can use this experience to protect you against unnecessary consequences.
When you are forced to defend yourself against the federal government, everything you say and do has the potential for drastic consequences. With their vast resources and clear law enforcement mandates, agencies such as the DOJ, DEA, and OIG are aggressively targeting and prosecuting health care providers through verdict at trial. Our team of highly experienced defense attorneys and former federal health care fraud prosecutors can help level the playing field, and we can use the knowledge and insights gained from thousands of federal fraud investigations to help you secure a favorable outcome as quickly and discreetly as possible.
What Is Health Care Fraud?
If you have been contacted by federal authorities (or if federal agents have made contact with any other member of your business or practice), understanding that you are under investigation for health care fraud means only understanding part of the story. “Health care fraud” is a broad term with many different connotations. In order to effectively defend your business or practice, you need to have a clear understanding of the specific allegations against you. Depending upon the nature of your business or practice, the adequacy of your business’s or practice’s billing compliance program, and various other factors, these allegations could potentially include:
- Medicare, Medicaid, or Tricare coding errors (which may be classified as “billing fraud”)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations (i.e., unlawful “kickbacks” or referral fees)
- Stark Law violations (i.e., unlawful physician “self-referrals”)
- Controlled Substances Act or DEA registration violations (i.e., prescription drug fraud)
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
When you engage Oberheiden, P.C.’s federal health care fraud defense lawyers to represent you, our attorneys will work quickly to identify the specific form (or forms) of “health care fraud” that are under investigation. To do so, we will promptly intervene in the investigation and make contact with the federal agents and prosecutors handling the investigation to glean information such as:
- What triggered the investigation?
- Which agencies and task forces are involved?
- Is anyone else under investigation?
- Is the investigation currently civil or criminal in nature?
- What evidence has the government collected to date?
Once our highly experienced Riverside health care fraud defense lawyers know what you are up against, then we can shift our focus to developing a customized and comprehensive strategy to resolve the investigation before charges get filed.
Sources of Authority in Federal Health Care Fraud Investigations
1. The False Claims Act
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by a federal health care benefit program. With its broad prohibitions and provisions for both civil and criminal penalties, it is one of the primary statutes involved in federal health care fraud investigations. Both intentional and unintentional billing errors can trigger FCA liability. And with each individual billing constituting a separate “claim,” providers targeted under the FCA can face extraordinary financial exposure.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, and receipt of referral fees and all other forms of “remuneration” in connection with referrals for patients who are Medicare, Medicaid, Tricare, and DOL beneficiaries. The AKS includes provisions for civil and criminal penalties similar to the False Claims Act, and its prohibitions are similarly broad. However, the Anti-Kickback Statute also includes several “safe harbors,” and providers who can demonstrate safe harbor compliance can avoid civil and criminal prosecution.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals.” A self-referral involves a financial relationship between a physician and a “related entity” for “designated health services” to be provided to a Medicare or Medicaid beneficiary. While the Stark Law is not as broad in scope as the False Claims Act and Anti-Kickback Statute, physicians targeted under the Stark Law can still face substantial civil penalties, including fines, recoupments, treble damages, and program exclusion.
4. The Controlled Substances Act
The Controlled Substances Act is the primary federal statute used to prosecute health care providers suspected of all forms of pharmaceutical fraud, including selling prescriptions and diverting opioid medications. The CSA also provides the source of authority for the DEA’s registration program for providers who prescribe, administer, and dispense controlled substance medications. And the DEA routinely audits and investigates both registered and unregistered providers.
5. The Federal 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 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.” Under 18 U.S.C. 1347, potential penalties include criminal fines and federal imprisonment for up to 10 years, in most cases. However, if a violation results in serious bodily injury or death, prosecutors can seek 20 years to life behind bars.
6. Program Billing Regulations
The Medicare, Medicaid, Tricare, and DOL billing regulations are the bane of many health care providers’ existence. Compliance is difficult (and expensive), and even minor flaws in providers’ compliance programs can lead to significant consequences. Violations of program billing regulations are the impetus for many investigations under the False Claims Act and 18 U.S.C. 1347.
7. Other Federal Criminal Statutes
In addition to the health care-specific statutes discussed above, physicians, pharmacists, company executes, and other individuals targeted in federal fraud investigations can face charges under a variety of other criminal statutes as well. Allegations of conspiracy, bank fraud, mail fraud, wire fraud, and money laundering are all common. And each separate offense can carry the potential for substantial fines and long-term federal incarceration.
5 Reasons to Choose Oberheiden, P.C.’s Federal Health Care Fraud Defense Team in Riverside, CA
With all of the various risks involved, health care providers who are being targeted in federal health care fraud investigations must defend themselves vigorously, strategically, and with their long-term best interests in mind. Here are five reasons why providers itrust Oberheiden, P.C.’s Riverside health care fraud defense lawyers to protect them:
- Federal Prosecutorial Experience – Several of our attorneys are former federal prosecutors who have decades of experience in high-stakes investigations involving the DOJ, DEA, OIG, and other federal law enforcement agencies.
- Thousands of Investigations and Hundreds of Trials Handled – Collectively, our Riverside health care fraud defense attorneys have represented clients in thousands of federal investigations and hundreds of criminal trials.
- Record of Favorable Resolutions Prior to Indictment – While our proven Riverside health care fraud defense lawyers have an extensive trial record, we emphasize securing favorable resolutions for our clients prior to charges being filed. We have helped more than 90% of our clients avoid criminal charges.
- Aggressive Pretrial and Trial Representation – If charges are unavoidable, we will do everything possible to protect you against a guilty verdict at trial. Our Riverside health care fraud defense lawyers work as a team to present comprehensive and cohesive defense strategies that leave no room for doubt as to what constitutes a just outcome.
- Customized, Personal, and Professional Legal Representation – We represent our clients with the level of personalization and professionalism they expect and deserve. We want you to feel 100% confident knowing that Oberheiden, P.C.’s defense team is on your side.
Schedule a Free and Confidential Case Assessment at Oberheiden, P.C.
If you are facing a federal health care fraud investigation contact our Riverside health care fraud defense attorneys at Oberheiden, P.C., to schedule a free initial case assessment. To speak with a senior attorney on our federal health care fraud defense team in confidence, call (214) 692-2171 or tell us how to reach you online, now.