Salt Lake City, Utah Federal Fraud Investigation Defense Attorneys
Federal agents and prosecutors with the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the U.S. Department of Justice (DOJ), and other law enforcement authorities have significantly increased and expanded their prosecutions of health care providers suspected of committing Medicare Fraud, Medicaid Fraud, fraud against private insurance companies, as well as violations of the Controlled Substances Act in select cities around the country, including Salt Lake City, Utah. For Utah physicians and business owners this means that it is important not only to carefully reassess your compliance efforts but also to be advised and surrounded by experienced attorneys in the event of a federal investigation.
At Oberheiden, P.C., we represent health care providers in Salt Lake City and throughout Utah in health fraud investigations and prosecutions. Our attorneys have decades of experience – both in private practice and as former federal health care fraud prosecutors. What makes Oberheiden, P.C. different is our national track record of resolving health care fraud investigations with no civil and no criminal liability outcomes for many of our clients.
Experienced Defense Attorneys for Health Care Entities in Salt Lake City, Utah
When you hire Oberheiden, P.C., you will be represented by former Department of Justice officials and seasoned attorneys with significant experience in health care law matters. Salt Lake City health care fraud defense attorneys at Oberheiden, P.C. represent clients in Salt Lake City and surrounding communities who are under audit, investigation, or subject to prosecution for alleged health care fraud.
- Former Department of Justice Trial Attorneys
- Former Assistant United States Attorneys
- Former Federal Health Care Fraud Prosecutors
- Experience of More than 1,000 Health Care Fraud Investigations
Our attorneys have successfully represented physicians, pharmacies, toxicology laboratories, DME companies, home health and hospice agencies, and many more against alleged violations of the Controlled Substances Act, Medicare Fraud, Medicaid Fraud, the Anti-Kickback Statute, and fraud of private insurance plans. Call us immediately if you are concerned about your role or if you are under investigation. As we have for others, we will find a way to help you.
“Trustworthy attorney who also understands the compliance, legal and business aspects of our group”“Our companies have worked with firms all over the country within various specialties and now use [Oberheiden, P.C.] almost exclusively. Nick represented our companies in some federal law investigations. His guidance and expertise allowed us to continue to concentrate on our core business as he dealt with the complex legal issues.” – Satisfied Client
“Our experience with [Oberheiden, P.C.] was overwhelmingly positive! We recently brought a range of complex legal issues to the table, which they responded to with a systematic, prudent approach. Throughout our work together, Oberheiden, P.C. served as an invaluable source of practical guidance and legal leadership. We would recommend them highly and without reservation . . . .” – Satisfied Client
Strategic Legal Defense for All Health Care Fraud Matters in Salt Lake City, Utah
Recent developments indicate that Salt Lake City and Utah health care providers have become the focus of federal law enforcement agencies such as the FBI, the DEA, and the Office of Inspector General (OIG). Our attorneys are prepared to represent Utah physicians and health care executives in cases involving allegations of Medicare Fraud (18 U.S.C. 1347), Medicaid Fraud, as well as violations of the Controlled Substances Act (21 U.S.C. 841), the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law Statute (42 U.S.C. 1395nn), and the federal False Claims Act (31 U.S.C. 3729-3733).
- Prescription Drug Fraud. Salt Lake City pain management physicians and those doctors regularly prescribing Schedules I, II or III are declared targets of the Justice Department and the Drug Enforcement Administration (DEA) because Utah is among the states with the highest opioid fatalities in the country. Providers in Salt Lake City and surrounding communities should contact experienced attorneys to obtain advice of how to avoid becoming a federal target relating to the dispensing or the administration of prescriptions that the government considers illegal (21 U.S.C. 841, 21 U.S.C. 846). Those physicians that are already under investigation should not allow the government to continue building its case, but should take proactive measures and have experienced health care fraud defense attorneys step in and execute a comprehensive defense plan that is based on years of experience and not an experiment.
- Medicare Fraud, Medicaid Fraud. Medicare Fraud and Medicaid Fraud are among the most charged offenses in health care investigations. Generally speaking, Medicare Fraud refers to the receipt of reimbursement from the Centers for Medicare and Medicaid Services (CMS) that are fraudulent, be it because the applied code was inappropriate or be it because the services billed for were actually not provided, 18 U.S.C. 1347. Classic areas of Medicare Fraud investigations are home health and hospice agencies, hospitals, DME, toxicology laboratories, and those physicians that certify and recertify need for Medicare services. Oberheiden, P.C. has a track record of resolving Medicare Fraud and Medicaid Fraud investigations with no civil and no criminal liability for our clients. Call us today and find out how to protect your business, your license, and your livelihood.
- Medicare Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments though a process of reviewing and analyzing claims data in addition to medical documentation that is obtained from the member/provider. Many times this involves a statistical sampling of files in order to establish an error rate. Another type of Medicare audit is conducted by the Zone Program Integrity Contractors (ZPICs). ZPIC audits identify and stop potential fraud and refer these cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that a mishandled audit can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice health care prosecutors with first-hand knowledge of the process navigate our clients through the audit and make sure that they can continue their business and don’t need be worried about their license or a government investigation.
- Illegal Kickbacks, Bribes, and Referral Fees. The Anti-Kickback Statute prohibits the offering, solicitation, payment, or receipt of any form of compensation for a patient referral. It is important to realize that the Anti-Kickback Statute is extremely broad and covers any person, not just physicians, and any form of remuneration, including indirect circumvention schemes like “consulting arrangements.” Oberheiden, P.C. has a national track record of intervening into Anti-Kickback violations by taking the position that alleged payments fall under one of the accepted exceptions to the statute. Salt Lake City physicians, health care executives, board of directors, marketers, hospitals, toxicology laboratories, pharmacies, and any other entity accused of violations, should keep in mind that AKS investigations can quickly turn into criminal felony cases. From our experience, it is absolutely critical to contact experienced attorneys the moment you find out that your business may be on the government’s radar. You will not get a second chance. We offer a forceful defense to Utah businesses that is based on a proven track record in Anti-Kickback cases. Call today to find out how we can turn the case around.
- False and Fraudulent Claims. The False Claims Act (FCA) is among the most widely enforced health care law statutes in Salt Lake City. The FCA is a hybrid statute, which means violations can be sanctioned through civil penalties but also through criminal prosecution. The FCA sanctions the submission of “false and fraudulent” claims to Medicare, Medicaid, Tricare, and other government benefit programs. Any “false” submission for reimbursement, even those without any intent or knowledge, subject providers and entities to draconian recoupments and fines. Our Firm has handled FCA investigations across the United States by offering clients proven defense strategies and compelling negotiation skills. Call us today if you received an OIG subpoena or other notice of a False Claims Act investigation against you or your business.
- Illegal Physician “Self-Referrals”. Utah physicians are frequently accused of violating federal Stark Law. In general terms, Stark Law prohibits certain referrals from physicians to entities in which these referring physicians have a financial interest. Penalties for violations can be extreme and caution is in order if the Office of Inspector General or the Department of Health and Human Services informs you about an investigation. Oberheiden, P.C. has extensive experience in Stark Law matters and we have resolved, on a national basis, Stark Law cases by avoiding any fines or recoupments for our clients. Call us today to find out how.
The attorneys at Oberheiden, P.C. are available to discuss your concerns or situation in a free and confidential consultation. Think about it. You have nothing to loose. Speak to one of our former Department of Justice health care prosecutors today and find out how we assess your case. Get reliable guidance from experienced attorneys with a proven track record.
Utah Health Care Fraud Investigations: Answers to Frequently-Asked Questions (FAQs)
Q: What should I do if my health care business or practice is under investigation?
If your Salt Lake City, Utah business or practice is being investigated by the federal government, among the steps we often recommend to our clients to eliminate the need for a continued investigation are:
- Comprehensive internal assessment by outside professionals with a focus on identifying and resolving potential compliance issues—before the government can reveal them.
- Enforcing your compliance efforts to demonstrate to the investigating authorities that you have no intent to violate the law.
- Engaging experienced attorneys to intervene in the investigation and advise you in all aspects of responding to the government’s inquiry.
- Executing a comprehensive defense strategy focused on the scope of the investigation and the relevant facts at hand.
Q: What are the requirements for a valid physician certification for home health care?
Under the pertinent federal regulations, in order to qualify for Medicare coverage, a home health patient must receive an in-person assessment from a Utah physician who subsequently certifies that the beneficiary is:
- Confined to the home;
- In need of skilled services;
- Under the care of a physician; and,
- Receiving services under a physician-reviewed care plan.
The in-person assessment (or “face-to-face encounter”) must occur no earlier than 90 days prior to the commencement of home health services and no later than 30 days after the commencement of services. Home health patients must also receive re-certification every 60 days.
Q: What are the potential consequences of a federal health care fraud investigation in Utah?
It is no secret that health care fraud statutes contain draconian consequences if found in violation. The exact outcome depends on whether the investigation is civil or criminal in nature, the scope of the government inquiry, the alleged damage amount suffered by the government, the volume and duration of alleged illegal activity, the available evidence, the findings of criminal intent. On a case-by-case basis, the penalties for federal health care fraud can include:
- Recoupments and denial of future claims
- Fines imposed on a per-claim basis
- Treble (triple) damages
- Loss of Medicare, Medicaid, and Tricare eligibility (program exclusion)
- Professional licensing action
- Loss of assignment privileges
- Loss of hospital privileges
- Long-term federal imprisonment
Contact Oberheiden, P.C. for a Complimentary Case Assessment
If you have concerns about your practice or if you are under investigation in Salt Lake City, Utah, we urge you to speak to us immediately. The sooner our attorneys can intervene and take defense measures, the more likely it is for us to resolve the matter before it goes out of hand. We take your case seriously, and we will make ourselves available to you. We offer complimentary case assessments, so call (888) 519-4897 or contact us online to schedule a risk-free appointment now.
Areas We Serve in Salt Lake City, Utah
Subject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel. The areas include: Salt Lake City, Provo, Alpine, American Fork, Beaver, Bluffdale, Bountiful, Brigham City, Cedar City, Centerville, Clearfield, Clinton, Cottonwood Heights, Draper, Eagle Mountain, Ephraim, Farmington, Grantsville, Heber City, Herriman, Highland, Holladay, Hurricane, Kaysville, Layton, Lehi, Logan, Midvale, Murray, North Ogden, Ogden, Orem, Payson, Pleasant Grove, Riverton, Roy, St. George, Sandy, Saratoga Springs, South Jordan, South Ogden, South Salt Lake, Springville, Syracuse, Spanish Fork, Taylorsville, Tooele, Washington, West Jordan, West Valley City, Woods Cross.
Compliance – Litigation – Defense
Serving the State of Utah and Surrounding Areas