Sacramento Health Care Fraud Defense
Experienced Sacramento Health Care Fraud Defense Lawyers
A federal health care fraud investigation can lead to recoupments, fines, program exclusion, prison time, and other penalties. If you have been contacted by federal agents in Sacramento, call 888-519-4897 to speak with one of our highly experienced Sacramento health care fraud defense lawyers immediately.
As a health care provider, meeting your patients’ needs is – and should be – your top priority. But, in today’s medical system where many providers rely heavily on funds from federal benefit programs such as Medicare, Medicaid, and Tricare, an unfortunate reality is that patient care must often take a back seat to legal and regulatory compliance.
Under federal laws such as the False Claims Act and the Anti-Kickback Statute, health care providers who bill these programs can face severe consequences for program billing violations. These providers are also subject to constant scrutiny by federal authorities such as the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS). This scrutiny often leads to invasive and potentially dangerous investigations. If your business or practice is under investigation, you need to take your situation very seriously. You could potentially be exposed to severe financial penalties, loss of program eligibility, loss of licensure and DEA registration, and maybe even federal imprisonment.
At Oberheiden, P.C., our practice is devoted to representing health care providers in federal investigations in Sacramento and across the country. Our health care fraud defense team, which is comprised entirely of senior defense attorneys and former federal prosecutors, has handled thousands of investigations. And our Sacramento health care fraud defense lawyers have helped the majority of our clients resolve their investigations without charges being filed. We also have extensive experience in pretrial, trial, and appellate litigation as well. Regardless of the current status of your federal inquiry, we can use this experience to protect you.
Why Am I under Investigation for Health Care Fraud?
Why have federal authorities chosen to single out your health care business or medical practice for investigation? While there are several potential triggers for these investigations, most are the result of one of three factors:
- Data analysis – With the extraordinary volume of billings that Medicare, Medicaid, Tricare, and the Department of Labor (DOL) receive on a daily basis, the government relies heavily on data analysis to identify fraudulent transactions. If your billings are inconsistent with those of other Sacramento-area providers, this alone could trigger a federal investigation.
- Citizen complaint – Patients, disgruntled former employees, and even competitors can file claims alleging fraudulent billing practices. In these qui tam (or “whistleblower”) lawsuits, the DOJ has an obligation to investigate and citizens can receive sizable financial awards if their allegations lead to successful prosecution.
- Routine audit or investigation – CMS, the DEA, and other agencies conduct routine audits and investigations of health care providers who bill federal government programs. But, even if an investigation is “routine,” it still has the potential to lead to civil or criminal charges.
Health care providers in cities like Sacramento are particularly at risk for garnering unwanted attention from federal authorities. These populous cities have a high concentration of health care providers, and investigations targeting larger providers in these cities can lead to sizable recoupments and fines for the government. We have seen an increasing number of federal investigations targeting providers in Sacramento and other cities for allegations such as:
- Intentional or unintentional billing and coding errors (including, but not limited to, submitting an improper billing code and double-billing multiple programs and/or insurance carriers)
- Billing for medically-unnecessary services
- Billing for services that were not actually rendered
- Offering, soliciting, paying, or accepting any illegal “kickback” or referral fee
- Diverting prescription opioid medications
- Selling, forging, or improperly filling prescriptions
- Falsifying patient records, physician certifications, or election statements
- Using any other “scheme or artifice” to obtain payment from Medicare, Medicaid, Tricare, or the DOL
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 the federal government. Each of the forms of health care fraud listed above can potentially be prosecuted as a federal offense under the FCA. The False Claims Act includes provisions for civil and criminal penalties, and providers accused of intentionally overbilling Medicare, Medicaid, Tricare, or the DOL will need to effectively challenge the government’s evidence of intent in order to avoid criminal sentencing.
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 Medicare, Medicaid, Tricare, and DOL business. Although the AKS’s prohibitions are broad, the statute also includes several “safe harbors” which will protect providers in many instances. Ideally, it will be possible to demonstrate that a transaction was undertaken with a specific focus on safe harbor compliance. If not, then it may be necessary to fit the transaction in question into one of the AKS’s safe harbors in order to avoid civil or criminal penalties.
3. The Stark Law
The Stark Law is a civil statute that applies only to physicians and their “related entities.” It prohibits so-called “physician self-referrals,” and its scope is limited to the “designated health services” enumerated in the statute. Additionally, similar to the Anti-Kickback Statute, the Stark Law’s prohibitions are subject to a number of safe harbors and exceptions.
4. The Controlled Substances Act
The Controlled Substances Act (CSA) is one of the primary federal statutes used to prosecute providers for pharmaceutical fraud. This includes forging prescriptions, prescribing medically-unnecessary drugs, improperly filling prescriptions, and failing to maintain compliance with the conditions of DEA registration. The CSA’s criminal penalties are severe, and providers accused of prescription drug-related fraud crimes will need to present strategic and aggressive defenses in order to avoid indictment, prosecution, conviction, and sentencing.
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 imposes severe criminal penalties as well. And in certain cases, health care providers can face the possibility of life behind bars.
6. Program Billing Regulations
Each of the federal health care benefit programs has its own unique and complex set of governing rules and regulations. Failure to maintain strict compliance with these rules and regulations can lead to liability under the False Claims Act and potentially to criminal prosecution under 18 U.S.C. 1347. Maintaining a comprehensive compliance program can help demonstrate good-faith efforts to comply (thus disproving any allegations of intent) though missteps by billing personnel and other staff members can still lead to potential exposure.
7. Other Federal Criminal Laws
In criminal health care fraud investigations, health care providers and company executives can face a variety of other charges as well. Individuals charged with offenses such as conspiracy, bank fraud, mail fraud, wire fraud, and money laundering can face millions of dollars in fines and decades of federal incarceration. Mounting a successful defense may present the only opportunity to avoid life-altering consequences.
5 Reasons to Choose Oberheiden, P.C., for Your Federal Health Care Fraud Investigation in Sacramento
So, you have been contacted by federal agents, received a target letter, or been served with a subpoena. What do you need to do now? While there are several steps you need to take (and mistakes you need to avoid), the single most important thing you can do is to assemble an experienced defense team immediately. When you choose the Sacramento health care fraud defense lawyers at Oberheiden, P.C.:
- We will promptly intervene in the government’s investigation. This will ensure that your rights are protected and that you have every available opportunity to secure a favorable resolution without charges being filed.
- We will execute a strategic and customized defense. We will customize your defense to the unique facts of your case in order to strategically pursue all opportunities for favorable resolution.
- We will use our extensive experience to your advantage. As nationally recognized health care fraud defense attorneys and former federal health care fraud prosecutors, we have centuries of experience in high-stakes federal investigations.
- We will constantly evaluate and re-evaluate our defense strategy. The best defense strategy today might not be the best defense strategy tomorrow. We will continually re-evaluate your options and take advantage of new leverage as it comes available.
- We will be prepared to go to trial, if necessary. If going to court is your best option, our Sacramento health care fraud defense attorneys will be fully prepared to fight for your freedom at trial.
Contact Us about Your Federal Investigation in Sacramento
If you need legal representation for a federal health care fraud investigation, our Sacramento health care fraud defense attorneys encourage you to contact us promptly for a free initial case assessment. To speak with one of our highly experienced defense attorneys in confidence, call 888-519-4897 or request an appointment online now.