San Jose Health Care Fraud
Health care fraud allegations are causing many San Jose practitioners and business owners to face severe consequences in high-stakes federal investigations. If your practice or business is under investigation for health care fraud, it is important that you speak with our San Jose health care fraud defense lawyers promptly.
From overbilling Medicare and Medicaid to improperly providing access to opioid medications, health care providers in San Jose and around the country are facing a litany of allegations in federal investigations. These allegations have the potential to cause long-term damage, even if they do not ultimately lead to federal charges. From reputational harm to licensing action by state medical boards, there are a variety of ways that health care fraud allegations can cause devastating consequences, even without fines or prison time.
At Oberheiden, P.C., we provide skilled and aggressive legal representation for federal health care fraud investigations in San Jose, CA. We focus our practice on representing health care providers and medical businesses in federal investigations, and we have achieved favorable outcomes at all stages from investigation through appeal. In our experience, most investigations targeting legitimate health care providers are misguided in some way. Whether the allegations against you are completely unwarranted or you are being unfairly targeted for criminal (as opposed to civil) prosecution, we can use our experience to strategically defend you and seek a favorable outcome as quickly and discreetly as possible.
If your practice or business is under investigation for health care fraud, there are steps you need to be taking in order to minimize your risk for federal prosecution. The San Jose health care fraud defense lawyers on our health care fraud defense team can guide you through everything you need to know, and we encourage you to contact us promptly for a free and confidential consultation.
Understanding Health Care Fraud Allegations
Under federal law, “health care fraud” is a general term that describes a broad array of civil and criminal allegations. While there is a federal health care fraud statute, 18 U.S.C. 1347, health care fraud can take a variety of other forms and be prosecuted under a variety of other statutes as well. For example, we routinely represent health care providers and medical business owners who are facing federal investigations based upon allegations such as:
- Medicare, Medicaid, and Tricare coding violations (“billing fraud”)
- Department of Labor (DOL) fraud
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients (or “phantom billing”)
- Unlawful “kickbacks” or referral fees (Anti-Kickback Statute violations)
- Unlawful physician “self-referrals” (Stark Law violations)
- Prescription drug fraud (Controlled Substances Act violations)
- Falsifying patient records, prescriptions, physician certifications, and election statements
Regardless of the specific allegations against you and regardless of how accurate or inaccurate you believe they may be, you need to take them extremely seriously. Your investigation is not simply going to go away on its own. To have any chance of avoiding federal prosecution (possibly even criminal prosecution with the potential for long-term federal imprisonment), you need to mount a strategic and effective defense.
When we represent health care providers and medical business owners in federal fraud investigations, we emphasize being as proactive and aggressive as possible. The reason for this is simple: If we can resolve your case at the investigative stage, you will not face charges and you will not face the inherent uncertainty of taking your case to trial. In order to protect you, our San Jose health care fraud defense lawyers will:
- Intervene in the investigation to determine the scope and nature (i.e., civil or criminal) of the allegations against you;
- Advise you and your personnel on how to deal (or not deal) with federal agents and other mistakes to avoid;
- Strategically assert affirmative defenses that challenge the underlying basis of the government’s investigation; and
- Challenge the government’s methods and assumptions in order to convince prosecutors that charges are not warranted.
Experienced San Jose Health Care Fraud Defense Attorneys for All Health Care Fraud Matters
With our extensive experience on both sides of federal health care fraud investigations (several of our defense attorneys are former prosecutors with the U.S. Department of Justice (DOJ)), we have handled cases involving all types of fraud-related allegations. This includes allegations under:
1. The False Claims Act
The False Claims Act (FCA) imposes civil and criminal penalties for the submission of “false or fraudulent” claims for federal health care program reimbursement. This includes all forms of billing violations, including upcoding, unbundling, phantom billing, and billing for medically-unnecessary services and supplies. Civil penalties under the FCA include recoupments, civil assessments, fines, and program exclusion, while criminal violations (those committed with “intent”) carry fines and prison time.
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-reimbursed health care services. Like the False Claims Act, the AKS has provisions for civil and criminal penalties, with intent being the distinguishing factor between civil and criminal liability.
In federal health care fraud investigations under the Anti-Kickback Statute, a key defense strategy is often to establish protection under one of the statute’s “safe harbor” provisions. The AKS includes safe harbors for:
- Bona fide employment relationships
- Group purchasing organizations
- Investment Interests
- Management contracts
- Office and equipment rentals
- Personal service arrangements
- Practitioner recruitment
- Price reductions
- Referral services
- Sale of health care practice
- Waivers of copayments, coinsurance, and deductibles
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals.” It is exclusively a civil statute. However, even in civil cases, physicians and their “related entities” can face substantial financial liability and loss of Medicare and Medicaid eligibility. Similar to the Anti-Kickback Statute, the Stark Law contains broad prohibitions that are tempered by a list of statutory and regulatory exceptions. If an exception applies in your case, our skilled San Jose health care fraud defense lawyers can use this to protect you against prosecution.
4. The Controlled Substances Act
The Controlled Substances Act is one of the primary federal statutes used to prosecute health care providers who commit pharmaceutical fraud. This includes overbilling for prescriptions, billing for medically-unnecessary prescriptions, forging and falsifying prescriptions, improperly filling prescriptions, and providing opioid medications to drug-dependent individuals. The Controlled Substances Act includes substantial criminal penalties, and health care providers and medical business executives targeted under the Controlled Substances Act must be prepared to vigorously defend themselves.
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.” Violations of 18 U.S.C. 1347 carry fines and up to 10 years of imprisonment in most cases, with longer terms (20 years to life) for violations resulting in serious bodily injury or death.
6. Program Billing Regulations
Health care providers who violate Medicare, Medicaid, Tricare, and DOL billing regulations can face prosecution under the False Claims Act, 18 U.S.C. 1347, and various other federal laws. Under the civil enforcement provisions of many of these laws, providers can be penalized if they “should have known” of the submission of an improper claim or claims.
7. Other Federal Criminal Laws
In criminal health care fraud investigations, providers and company owners and executives can (and often will) face charges for multiple offenses, not simply those that are health care related. This includes charges for attempt, conspiracy, bank fraud, mail and wire fraud, money laundering, tax evasion, and various other white-collar crimes.
Trusted San Jose Health Care Fraud Defense Lawyers
With centuries of combined legal experience in federal health care fraud investigations, Oberheiden, P.C.’s health care fraud defense attorneys are trusted advocates for licensed health care providers, business owners, company executives and board members, and other clients in civil and criminal matters. Here is what you can expect when you engage our health care fraud defense team to represent you in San Jose, CA:
- Proactive and aggressive legal representation focused on securing a prompt and favorable resolution.
- Defense strategies backed by experience in more than 1,000 investigations and 500 criminal trials.
- Unwavering commitment to your best interests and a client-first approach in all aspects of your representation.
- Direct access to your team of senior health care fraud defense attorneys (we do not employ any junior associates or paralegals).
- Personalized case strategies that utilize the facts and circumstances of your investigation to protect you against long-term consequences.
Schedule a Free Initial Consultation at Oberheiden, P.C.
Is your health care business or medical practice under investigation in San Jose, CA? If so, we strongly encourage you to schedule a free initial consultation with our health care fraud defense team. You can reach us 24/7; if necessary, our San Jose health care fraud defense attorneys can get to work on your case immediately. To learn more about how we defend health care providers in federal fraud investigations, call (888) 519-4897 or get in touch online now.