What do you need to know if your San Francisco health care practice or medical business is under investigation for fraud? Find out from the federal health care fraud defense lawyers at Oberheiden, P.C. For a free and confidential case assessment, call (888) 519-4897.
For health care providers and other entities in the health care industry, federal fraud investigations can lead to devastating consequences. Laws such as the False Claims Act and Anti-Kickback Statute impose civil and criminal penalties for statutory violations. And physicians, pharmacists, company executives, and other individuals targeted in these investigations can face crippling financial penalties, loss of federal health care benefit program eligibility, and even federal imprisonment.
At Oberheiden, P.C., our federal health care fraud defense team is committed to protecting health care clients in federal fraud investigations in San Francisco and nationwide. We represent our clients at all stages of the process – from initial target letter or subpoena through trial and appeal, while constantly striving to achieve a favorable outcome as quickly and cost-effectively as possible. Comprised entirely of seasoned litigators (including several former federal health care fraud prosecutors), our team is capable of effectively representing clients under the most challenging of circumstances and when the most severe penalties possible are on the table.
So, your business or practice is under investigation for health care fraud. What now? Accepting that you are at risk for practice or business-threatening fines and program exclusion, and possibly even at risk for being sentenced to prison, your immediate first step needs to be to engage experienced legal representation. At Oberheiden, P.C., our defense attorneys are available 24/7, and we can arrange for you to meet with a member of our federal health care fraud defense team over the phone or in person as soon as possible.
What Is Health Care Fraud?
What comes to mind when you think about “health care fraud”? For most people, the term conjures up images of seedy practitioners and scam artists who devote more effort to gaming the system than they do to treating their patients. But, while this is undoubtedly one example, legitimate – and even prominent – health care providers can get caught up in federal health care fraud investigations as well. And with the federal government’s heavy reliance on analysis of billing data and claims from whistleblowers, a provider’s reputation is virtually meaningless when it comes to the risk of being targeted in a federal investigation.
One of the most common misconceptions about health care fraud is that, in order to be liable, you need to have overbilled the government with intent. But, while intent is a factor in criminal prosecutions under the False Claims Act, Anti-Kickback Statute, and various other federal health care laws, evidence of intent is not necessary to establish liability for civil health care fraud. As a result, even providers who do their best to maintain effective billing compliance programs can face liability for “fraudulent” billing practices such as:
- Improperly prescribing, administering, or dispensing prescription medications (such as prescription opioids), regardless of intent
- Offering, paying, soliciting, or accepting an illegal “kickback” or referral fee, even without knowledge that the transaction was unlawful
- Unintentionally overbilling Medicare, Medicaid, Tricare, or the Department of Labor (DOL) health care benefit program
- Unintentionally billing Medicare, Medicaid, Tricare, or the DOL for medically-unnecessary services or supplies
- Unintentionally billing Medicare, Medicaid, Tricare, or the DOL for services or supplies not actually rendered to patients
- Violating the standards for maintenance of patient records and election statements or for issuing prescriptions or physician certifications
Do you know why your health care practice or business is under investigation? This is somewhat of a trick question. At this point, even if you think you may know why your practice or business is being targeted, the answer needs to be a resounding, “No.”
Until you intervene in the government’s investigation, the simple fact is that you don’t know why you are being targeted. To defend yourself, you need to know what the government knows (or thinks it knows), and you need to know it now. With our attorneys’ experience on both sides of thousands of federal investigations, we can take the steps necessary to promptly intervene in your investigation and determine the scope and nature (i.e., civil or criminal) of the charges against you.
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. This includes improper billings submitted to Medicare, Medicaid, Tricare, and the DOL. Civil penalties under the FCA include fines, recoupments, treble damages, and program exclusion; while providers, executives, board members, and other individuals, who are charged criminally, can face financial penalties and federal incarceration.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits health care providers from offering, paying, soliciting, or receiving referral fees or other forms of “remuneration” in connection with Medicare, Medicaid, Tricare, and DOL beneficiary referrals. While Anti-Kickback Statute investigations often target providers and other entities that actively offer or solicit unlawful payments, simply accepting an improper payment – even without bad intent – is enough to trigger AKS liability.
3. The Stark Law
The Stark Law prohibits improper payments between physicians and their related entities – or so-called “physician self-referrals.” The Stark Law imposes civil penalties similar to the False Claims Act (unlike the FCA and the AKS, the Stark Law does not include provisions for criminal prosecution). However, physicians and executives who intentionally engage in improper referral transactions involving program-reimbursed funds can face charges under other statutes as well.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act (CSA) is the primary statute that the DEA uses to investigate and prosecute health care providers for pharmaceutical fraud and other prescription drug-related offenses. The CSA also establishes the federal registration regime for providers who administer, prescribe, and dispense controlled-substance medications. In addition, providers whose practices involve prescription drugs can face both routine and non-routine investigations.
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.” Violations of 18 U.S.C. 1347 carry penalties that include fines and prison sentences ranging from 10 years to life behind bars.
6. Program Billing Regulations
The Medicare, Medicaid, Tricare, and DOL billing regulations are extraordinarily complex, and they are at the center of many federal health care fraud investigations. Program participants who violate the applicable regulations can face charges under the False Claims Act, 18 U.S.C. 1347, and other federal civil and criminal statutes.
7. Other Federal Criminal Statutes
In addition to the statutes discussed above, health care providers and other individuals and entities targeted in federal health care fraud investigations can face charges under a bevy of other criminal statutes as well. For example, bank fraud, mail fraud, wire fraud, money laundering, and conspiracy charges are all common in criminal federal health care fraud prosecutions.
5 Reasons to Choose Oberheiden, P.C.’s Defense Lawyers for Your Federal Health Care Fraud Investigation in San Francisco
If you, or someone within your business or practice, has been contacted by the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), Office of Inspector General (OIG), or any other federal law enforcement agency, it is imperative that you engage legal counsel immediately. Here are five reasons why health care providers in San Francisco and nationwide trust the defense lawyers at Oberheiden, P.C.:
- Thousands of Federal Cases Handled – Our attorneys have handled thousands of federal cases. This includes not only our experience as defense attorneys, but also many of our attorneys’ past experience as federal health care fraud prosecutors with the DOJ.
- Proven Pretrial Results – We have resolved the vast majority of our clients’ cases prior to trial, often without charges ever being filed.
- Aggressive and Strategic Representation – Once we intervene in the government’s investigation, we do not stop applying pressure until we have achieved our desired result. We provide aggressive and strategic representation, and we are constantly looking for the leverage and evidence we need to protect our clients.
- Unwavering Commitment to Favorable Outcomes – We want the best for our clients, no matter what. We are passionate about what we do, and we are committed to our clients’ best interests.
- Meticulous Trial Preparation – If it takes going to court to protect you, you can rest assured that our attorneys will be meticulously prepared. We are skilled litigators, and we have relationships with top medical experts around the country.
Speak with a Federal Health Care Defense Lawyer at Oberheiden, P.C.
If you need to speak with a member of our federal health care fraud defense team, please call (888) 519-4897 or contact us online. You can reach us 24/7. And if an attorney is not available immediately, a member of our team will be in touch as soon as possible.
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