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Roanoke Health Care Fraud

Roanoke Health Care Fraud Defense Lawyers

Federal authorities are targeting physicians, pharmacists, clinicians, caretakers, and other health care providers in Roanoke, VA, for various fraud-related offenses. If your business or practice is under investigation, Oberheiden, P.C., can protect you. Call (888) 519-4897 for a free consultation with our Roanoke health care fraud defense lawyers.

As a health care provider, you are aware that your business or practice is subject to a bevy of federal laws and regulations and you do your best to comply. You manage a compliance program, you attend seminars, and you instruct your billing personnel on the perils of coding mistakes. You also are aware that federal agencies such as the Drug Enforcement Administration (DEA) and the Office of Inspector General (OIG) monitor providers’ prescription and billing practices. But you have never realistically considered that you personally could be targeted in a federal “health care fraud” investigation.

Until now.

You received a letter in the mail or a knock on your door; suddenly, everything changed. Agents from the DEA or OIG are looking into your business or practice (or, possibly, agents from the U.S. Department of Justice (DOJ) or Federal Bureau of Investigation (FBI)), and now you don’t know where to turn. Is it serious? Could your business or practice be in jeopardy? Could you lose your license? Could you go to prison? Suddenly, these are all legitimate questions that you need to have answered.

Health Care Fraud Defense Lawyers for Federal Investigations in Roanoke, VA

At Oberheiden, P.C., we represent health care providers in federal health care fraud investigations in Roanoke, VA. With centuries of combined experience in federal matters, our attorneys have handled more than 1,000 investigations and 500 criminal trials. We know what is at stake if you are being targeted by the DEA, OIG, DOJ, or FBI (depending on the nature of the investigation, prison time could be a possibility). But our highly experienced Roanoke health care fraud defense lawyers also know that there are numerous strategies for preventing investigations from leading to civil or criminal charges.

If your Roanoke health care business or practice is under investigation, we encourage you to contact us promptly for a free and confidential consultation. Engaging legal counsel during the investigation is the best way to protect yourself, and we can use our extensive experience in federal health care fraud matters to secure a favorable outcome quickly, discretely, and with minimal disruption to your business or practice.

Why Am I under Investigation for Federal Health Care Fraud?

When you are facing a federal health care fraud investigation, one of the first questions you need answered is, “Why?” Why were you singled out, and why do federal authorities think they have a sufficient basis to look further into your business or practice?

Most federal health care fraud investigations are the result of four triggers:

  • Data Analytics – Federal authorities monitor health care providers’ program billing data on an ongoing basis, and they use analytics to identify certain outliers that tend to be indicative of Medicare, Medicaid, Tricare, or Department of Labor (DOL) fraud. If your billing volume for particular services, tests, or supplies is above normal for your geographic area and your area of practice, this alone can be enough to trigger a federal investigation.
  • Confidential Informant – The DEA, OIG, DOJ, and FBI take complaints from citizens by phone and online. If someone (e.g., a patient or other health care provider) contacted the government with allegations that your business or practice is operating in violation of federal law, this could have triggered the investigation as well.
  • Whistleblower – A third possibility is that someone filed a qui tam (or “whistleblower”) lawsuit under the False Claims Act. The False Claims Act’s qui tam provisions allow citizens to file lawsuits on behalf of the federal government and collect a significant percentage of any amounts the government recovers. This, combined with the fact that the government is obligated to investigate whistleblower claims that meet certain basic threshold criteria, means that whistleblower claims are responsible for many federal health care fraud investigations.
  • Random or Routine Investigation – Finally, agencies such as the DEA also conduct random and routine audits and investigations. If you prescribe medications and you are registered with the DEA, you will face an audit or investigation every few years. But, is this investigation solely related to your status as a DEA-registered health care provider or could there be specific allegations you need to address? In order to defend yourself effectively, this is something you need to know.

Our Roanoke health care fraud defense lawyers have extensive experience intervening in all types of health care fraud investigations and arguing against flawed allegations in order to protect our clients from federal charges. We routinely handle investigations in Virginia and nationwide involving allegations such as:

  • Medicare, Medicaid, Tricare, or Department of Labor (DOL) billing fraud
  • Providing and billing for medically-unnecessary services
  • Billing for services not actually rendered to patients (known as “phantom billing”)
  • Prescription drug diversion and other Controlled Substances Act violations
  • Falsifying patient records, prescriptions, physician certifications, and election statements
  • Illegal kickbacks or referral fees
  • Illegal physician self-referrals

6 Ways Federal Authorities Target Providers in Health Care Fraud Investigations

1. The False Claims Act

Most federal health care fraud investigations involve allegations under the False Claims Act (FCA). The FCA prohibits the submission of any “false or fraudulent” claim for payment under any federal health care benefit program. The False Claims Act includes civil and criminal penal provisions. And since the FCA’s penalties apply on a per claim basis (i.e., for each individual billing or coding violation submitted), providers targeted under the FCA will often be at risk for substantial financial liability.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) also includes provisions for civil and criminal penalties, and it prohibits the offering, solicitation, payment, or receipt of any kickback, referral fee, or other form of “remuneration” in connection with a referral for services, supplies, or equipment billed to Medicare, Medicaid, Tricare, or the DOL. However, the AKS also includes a laundry list of “safe harbors.” And if the government is investigating a relationship or transaction that qualifies for safe harbor protection, we can use this to defend you.

3. The Stark Law

The Stark Law prohibits so-called “physician self-referrals.” While the Stark Law’s prohibitions are similar to the anti-kickback provisions of the AKS in certain respects, there are many unique aspects of the Stark Law that require careful analysis and consideration in investigations targeting physicians’ referral practices.

4. The Controlled Substances Act

In the health care context, most investigations under the Controlled Substances Act involve allegations of prescription drug diversion. This includes selling prescriptions, forging prescriptions, improperly filling prescriptions, and providing prescriptions to drug-dependent patients.

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.” 18 U.S.C. 1347 is a criminal statute that imposes substantial fines and maximum prison sentences of 10 to 20 years behind bars.

6. Program Billing Regulations

Medicare, Medicaid, and the other government health care benefit programs each have their own unique sets of rules and regulations. Providers who fail to maintain strict compliance with these regulations can face fines, civil assessments, recoupments, program exclusion, and other penalties under the False Claims Act, 18 U.S.C. 1347, and other federal laws.

Oberheiden, P.C. | Trusted Roanoke Health Care Fraud Defense Attorneys

In order to mitigate the risk of practice-threatening and life-altering consequences due to a federal health care fraud investigation, it is imperative to engage experienced defense counsel immediately. At Oberheiden, P.C., we offer:

  • A defense team comprised exclusively of senior attorneys and former federal prosecutors who have centuries of combined experience on both sides of federal health care fraud investigations.
  • An exclusive focus on federal health care fraud defense that has allowed us to defend physicians, pharmacists, laboratories, clinics, hospices, home health agencies, durable medical equipment (DME) company executives, and other clients across the country.
  • Emphasis of pre-indictment and pretrial resolutions that protect our clients against the risk of an unfavorable jury verdict at trial.
  • Strategic defense representation that relies on exhaustive knowledge of the federal health care law regime and a detailed understanding of the medical issues involved in our clients’ investigations.
  • An unwavering commitment to protecting our clients against federal charges no matter how heavily the evidence may appear to be stacked against them.

Schedule a Free and Confidential Consultation at Oberheiden, P.C.

For more information about how our Roanoke health care fraud defense attorneys can protect you during the government’s investigation, please contact us to schedule a free and confidential initial consultation. With office locations around the country, we represent health care providers in Roanoke, throughout Virginia, and nationwide. To schedule your consultation as soon as possible, call (888) 519-4897 or tell us how to reach you online now.

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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