San Diego health care providers are being targeted in federal Medicare, Medicaid, Tricare, and Department of Labor (DOL) fraud investigations. If your practice or business is under investigation, you need a team of experienced federal health care fraud defense attorneys on your side.
Over the past several years, investigations involving the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and Office of Inspector General (OIG) have become commonplace in the health care field. With Medicare, Medicaid, Tricare, and Department of Labor (DOL) fraud scams costing taxpayers billions of dollars every year, these authorities have a mandate to aggressively target and prosecute anyone suspected of submitting false or fraudulent claims.
As a result, while the vast majority of these programs’ losses are the result of intentional frauds perpetrated by scam artists and unscrupulous providers, legitimate health care business owners and professionals are increasingly finding themselves in the government’s crosshairs. And, with even unintentional billing violations having the potential for severe penalties, business owners and professionals who fail to protect themselves are finding out just how serious the consequences of federal health care fraud “audits” and “inquiries” can truly be.
If you have received a target letter or been contacted by agents from the DOJ, DEA, FBI, or OIG, you must take action to defend your business or practice. This starts with engaging an experienced defense team to intervene in the investigation and glean the information needed in order to assert a comprehensive and strategic defense. At Oberheiden, P.C., our attorneys have centuries of combined experience on both sides of federal health care fraud matters, and we can use this experience to make sure you and your business or practice are protected to the greatest extent possible.
What Does It Mean to Be Accused of Health Care Fraud?
The federal definition of “health care fraud” is at once deceptively simple and inordinately complex. The submission of any “false or fraudulent” claim to Medicare, Medicaid, Tricare, or the DOL can lead to health care fraud allegations, regardless of the level of intent (if any) behind the false or fraudulent submission.
Within these extraordinarily broad parameters, health care fraud can take many different forms. In our federal health care fraud defense practice, we routinely represent clients in San Diego, throughout California, and nationwide who are facing specific allegations, including:
- Offering and accepting illegal kickbacks or referral fees
- Engaging in unlawful physician “self-referrals”
- Billing for medically-unnecessary services or supplies
- Billing for services or supplies not actually delivered to patients (known as “phantom billing”)
- Double-billing federal health care benefit programs and private insurance companies
- Improperly prescribing and dispensing controlled-substance medications
- Upcoding, unbundling, and other billing and coding violations
In order to defend yourself in a federal health care fraud investigation, one of the first steps is to determine exactly why you are being targeted for possible prosecution. This can be surprisingly difficult, and it requires a deep understanding of when and how federal authorities target health care providers in fraud investigations. When you engage our firm to represent you, one of our first priorities will be to make contact with the authorities involved to gather the information necessary to understand the scope and nature of your case (i.e., are you facing civil or criminal charges). This is so that we can develop and execute a defense strategy that is custom-tailored to the facts at hand.
Is your health care business or practice under investigation by the DOJ, DEA, FBI, OIG, or another federal law enforcement agency? If so, contact Oberheiden, P.C., now at (888) 519-4897 for a free and confidential case assessment.
Sources of Authority in Federal Health Care Fraud Investigations
1. The False Claims Act
The False Claims Act (FCA) is the source of the “false or fraudulent” claims language that is at the heart of most federal health care fraud investigations. The FCA provides for civil and criminal prosecution of health care fraud cases, with criminal charges requiring evidence of intent to defraud the government. While there are ways to challenge the government’s evidence of intent in court, the best course of action is to try to prevent criminal charges from being filed and to resolve your case civilly during the investigative stage, if at all possible.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, or receipt of referral fees or other forms of “remuneration” in connection with Medicare, Medicaid, Tricare, and DOL beneficiary referrals. The AKS is another statute that provides for both civil and criminal enforcement, with intent again being the distinguishing factor between civil and criminal liability. While the Anti-Kickback Statute’s prohibitions are extremely broad, the potential exposure under the AKS is tempered by the existence of various statutory “safe harbors.” Our attorneys are skilled at asserting safe harbor and various other AKS defenses on behalf of health care providers.
3. The Stark Law
The Stark Law prohibits referrals between physicians and their related entities for “designated health services.” These are commonly known as “physician self-referrals.” The Stark Law is a civil statute, with potential penalties that include recoupments, treble damages, fines, and program exclusion. Similar to the Anti-Kickback Statute, the Stark Law contains a number of safe harbor provisions and exceptions that can insulate physicians and their related entities in many cases – provided that these safe harbors and exceptions are asserted effectively.
4. The Controlled Substances Act
The Controlled Substances Act establishes the DEA registration requirements for providers who prescribe, administer, and dispense controlled substance medications. It is the primary statute that the DEA uses to investigate and prosecute health care providers suspected of engaging in various forms of pharmaceutical fraud. Providers targeted for violations of the Controlled Substances Act can face criminal prosecution and the potential for substantial fines and time behind bars.
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 . . . (1) . . . defraud [or attempt to defraud] any health care benefit program; or (2) . . . obtain [or attempt 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, with potential fines and prison time varying based upon the severity of the allegations involved (i.e., whether they resulted in bodily harm to patients or patient deaths).
6. Program Billing Regulations
The Medicare, Medicaid, Tricare and DOL billing regulations prescribe the manner in which providers are able to bill for reimbursable services and supplies. Violations of these regulations can lead to allegations under the False Claims Act and 18 U.S.C. 1347 – and potentially to allegations of other civil and criminal health care-related offenses as well.
7. DOJ Mandates
The DOJ regularly issues releases highlighting the creation of new law enforcement teams and task forces. Major cities like San Diego are routinely targeted in these new initiatives, and local providers can face intense scrutiny from the DOJ and other collaborating agencies. Current efforts include the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force.
5 Reasons to Choose Oberheiden, P.C. for Federal Health Care Fraud Investigations in San Diego, CA
If you need legal representation for a federal health care fraud investigation in San Diego, our defense team can protect your legal and constitutional rights and fight aggressively to fend off federal charges. When you engage our firm to represent you, we will arrange for you to meet with the attorneys on our team as soon as possible. And if necessary, we can take steps to intervene in the government’s investigation immediately. San Diego health care providers trust Oberheiden, P.C.’s federal defense lawyers for their:
- Exclusive Health Care Focus – Our lawyers maintain an exclusive on federal health care fraud defense, representing clients in all civil and criminal matters nationwide.
- Prior Federal Prosecutorial Experience – Many of the lawyers on our defense team are former federal prosecutors who spent decades fighting health care fraud at the DOJ.
- Aggressive Approach to Intervention – When we take your case, we will aggressively intervene in the government’s investigation in order to gather key information as quickly as possible.
- Focus on Pre–Charge Resolution – We will utilize our knowledge, skill, and resources to attempt to favorably resolve your health care fraud investigation before charges get filed.
- Proven Trial Records – Our attorneys have represented clients in federal district courts across the country. If going to trial is your best option, we will use this experience to fight for a favorable verdict in court.
Contact Us 24/7 to Schedule Your Free Initial Case Assessment
For more information about Oberheiden, P.C.’s federal health care defense practice, please call (888) 519-4897 or request an appointment online. You can reach our offices 24/7. And if you send us a message online, a member of our federal defense team will respond to your inquiry as soon as possible.
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