San Francisco, California Health Care Fraud Defense
Qualified San Francisco Health Care Fraud Defense Attorneys Serving Providers Targeted in Federal Investigations
For health providers, durable medical equipment (DME) companies, and other industry participants in San Francisco, CA that rely on federal benefit program reimbursements, the threat of a federal investigation is a very real concern. Federal authorities including the U.S. Department of Justice (DOJ), the Drug Enforcement Administration (DEA), and the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (DHHS) are aggressively pursuing cases against providers suspected of engaging in fraudulent billing practices, with investigations frequently leading to civil, and in some cases criminal, charges.
What is Health Care Fraud?
In broad terms, federal authorities are cracking down on “health care fraud.” This type of fraud encompasses a wide range of civil and criminal offenses under a variety of federal statutes, and it includes both intentional and unintentional submission of “false and fraudulent” claims to Medicare, Medicaid, Tricare, and other health benefit programs. Federal statutes such as the Anti-Kickback Statute and the Stark Law outlaw a broad range of referral fees and other compensation arrangements as well; and, in many cases, providers will face concurrent charges for multiple federal health fraud offenses.
Attorneys for Health Care Fraud Investigations in San Francisco, California
Oberheiden, P.C. is a team of experienced defense attorneys who have a proven track record of successfully representing clients in health fraud investigations. Our San Francisco health care fraud defense lawyers include several former prosecutors who held senior-level positions within the U.S. Attorney’s Office, and the DOJ. Each of our attorneys is intimately familiar with the complex legal issues involved in federal fraud investigations, and we work closely with all of our clients in order to develop strategic defenses that are custom-tailored to the unique circumstances of each individual case.
From justifying your Medicare billings to asserting the safe harbor protections of the Anti-Kickback Statute or the Stark Law, if there are any opportunities to help you mitigate or avoid liability, we will use them to ensure that you do not face any unnecessary consequences as a result of your investigation.
“It is very clear to me that Nick Oberheiden has a deep understanding of health law issues. Nick has been instrumental in managing and resolving many difficult legal matters. He is always relentlessly focused on the critical issues that matter most. Nick is very dedicated and available and always displays a high degree of professionalism. I would not hesitate in recommending Nick for the most important of legal matters.” – Satisfied Client
“Our experience with Nick Oberheiden 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 to anyone. Simply, the best!” – Satisfied Client
Decades of Experience on Both Sides of Civil and Criminal Health Care Fraud Investigations
If your San Francisco, CA business or practice is being targeted in a health fraud investigation, we strongly encourage you to contact us for a free case evaluation. Prompt intervention is critical, and our lawyers can contact the investigators and prosecutors involved in your case immediately in order to minimize the potential consequences of your investigation as much as possible. We represent San Francisco-area physicians, pharmacists, hospitals, hospices, home health providers, DME companies, and others facing allegations such as:
- False Claims Act Violations. The False Claims Act (FCA) is a federal statute that penalizes health care providers who submit “false and fraudulent” claims for federal program reimbursement. It includes provisions for both civil and criminal penalties, and both intentional and unintentional false claims can lead to substantial liability. In criminal cases under the False Claims Act, licensed professionals, company executives, and other individuals can also face decades of federal imprisonment.
- Anti-Kickback Statute Violations. Under the Anti-Kickback Statute, it is illegal to “knowingly and willfully” offer, pay, solicit, or receive “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” in exchange for a patient referral. Like the False Claims Act, the Anti-Kickback Statute provides for both civil and criminal penalties, and violation of the Anti-Kickback Statute can also lead to FCA liability.
- Stark Law Violations. The Stark Law is a civil statute that prohibits physicians from referring patients to entities in which they own an interest or with which they have certain types of compensation arrangements for the provision of Medicare-reimbursed services or supplies. The Stark Law includes a variety of “safe harbor” provisions, and defending against allegations of illegal “self-referrals” often involves demonstrating that a safe harbor applies.
- Prescription Drug Fraud. With the nation’s opioid epidemic being labeled a top priority for the DOJ and DEA, providers in San Francisco that prescribe, administer, and dispense narcotic medications are particularly susceptible to being targeted in federal investigations. Prescription drug fraud allegations can lead to charges under the FCA, federal controlled substance laws, and various other criminal statutes, and providers charged with prescription drug fraud can face enormous penalties.
- Billing Fraud. Billing fraud is a form of health fraud that commonly leads to charges under the False Claims Act. The submission of any improper reimbursement request to Medicare, Medicaid, Tricare, or another federal benefits program can result in liability, and federal investigators and prosecutors routinely pursue cases based on allegations of upcoding, double-billing, phantom billing, billing for medically-unnecessary services, and other billing and coding violations.
- Physician Certification Fraud. Home health providers and hospices rely heavily on physician certifications, and these certifications are also subject to close government scrutiny. If there is any reason to suspect that a physician certification may be fraudulent, San Francisco-area hospices and home health companies can expect to face invasive investigations that encompass years of past certifications and federal health care benefit program reimbursements.
Answers to FAQs: Defending Against Health Care Fraud Investigations in California
Q: Why is my health care business or medical practice being investigated?
If your health business or medical practice is being targeted in a federal investigation, there are potentially a number of different reasons why. Recently, federal authorities have stepped up their efforts to combat fraud targeting programs such as Medicare, Medicaid, and Tricare, and providers in certain areas (including the San Francisco Bay Area) are facing enhanced scrutiny simply as a result of the government’s efforts to curb waste and abuse.
There are other reasons why your particular business or practice may be the target of an investigation as well. These include:
- Receiving an unfavorable determination in a RAC, MAC, or ZPIC audit
- Having billing records that are inconsistent with those of other local providers (even if there is clear justification based on the unique aspects of your business or practice)
- Being targeted in a whistleblower (or qui tam) complaint
Q: What are some potential defenses to health care fraud allegations?
While there are numerous potential defenses to health fraud allegations, the defenses you have available will depend upon the specific allegations against you and the unique facts involved in your case. In broad terms, some of the most-effective defense strategies in health care fraud investigations include:
- Asserting statutory safe harbors and exceptions
- Asserting Constitutional protections
- Challenging the government’s evidence of culpability or intent
- Demonstrating that your billing practices fall outside of the statutory prohibitions
- Using your billing or patient records to demonstrate compliance with the law
Q: If federal investigators have already singled out my business or practice, is it worth trying to defend against the government’s allegations?
Yes, absolutely. With the potential for insurmountable financial penalties, long-term federal imprisonment, loss of benefit program eligibility, and loss of your professional license, you need to use all available means to defend against the government’s allegations. You need an experienced defense team that can intervene in the investigation and relies upon decades of experience to swiftly implement a strategy designed to help you avoid unnecessary consequences.
Q: What outcomes can I reasonably expect from my investigation?
In every case, our goal is to resolve our client’s investigation without charges being filed. Oftentimes, closing an investigation favorably is a matter of helping investigators and prosecutors understand the unique aspects of a particular business or practice, and demonstrating that any apparent violations are in fact compliant with the law. If someone within your business or practice has submitted erroneous reimbursement requests, you may be liable to refund any amounts that were improperly paid, but we can fight to help you avoid any accusations of criminal culpability.
Free Consultation from an Experienced San Francisco Health Care Fraud Defense Attorney
At Oberheiden, P.C., every engagement begins with a free case assessment. When you contact us, we will arrange for you to meet with our team of San Francisco Health Care Fraud Defense Attorneys right away.. If you decide to move forward, we will intervene in the investigation immediately, and we will work closely with you and your key personnel to implement a defense strategy that is custom-tailored to the circumstances at hand. To get started, call (888) 519-4897 from San Francisco, CA or request an appointment online and we will be in touch as soon as possible.