If your Santa Ana health care business or medical practice is being targeted in a federal fraud investigation, your livelihood, your ability to serve your patients, and your freedom could all be on the line. Our lawyers bring centuries of combined legal experience to defending providers, business owners, and other clients in high-stakes federal health care fraud investigations.
The U.S. Department of Justice (DOJ). The Drug Enforcement Administration (DEA). The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). You knew these agencies existed, but you never expected to have to deal with them in the course of your business or practice.
However, for health care providers and business owners in cities like Santa Ana, the risk of being targeted by federal authorities is greater than ever. The DOJ has publicly announced that it is aggressively targeting health care providers suspected of defrauding Medicare, Medicaid, and Tricare, as well as those suspected of improperly prescribing or dispensing opioid medications. Other forms of health care fraud can lead to intense federal scrutiny as well, with providers targeted in DOJ, DEA, OIG, and other agency investigations facing the potential for fines, treble damages, program exclusion, prison time, and other penalties.
At Oberheiden, P.C., our practice focuses on representing physicians, pharmacists, physician groups, durable medical equipment (DME) companies, laboratories, hospitals, clinics, executives and board members, and other entities and individuals in high-stakes federal matters. Our team of more than 15 defense attorneys includes several former federal health care prosecutors, and together our lawyers have centuries of combined experience on both sides of federal health care cases. If your practice or business in Santa Ana is under investigation, we can help, but it is important that you contact us immediately. To speak with a member of our federal health care fraud defense team in a free and confidential case assessment, call 888-519-4897 now.
What Is Health Care Fraud?
What exactly does it mean to face allegations of health care fraud from the federal government? While health care fraud can take many forms, broadly speaking, most cases involve some form of allegation of improperly billing Medicare, Medicaid, Tricare, or the Department of Labor (DOL) health care benefit program. Any form of “false or fraudulent” billing can potentially lead to charges, as can making improper use of program-reimbursed funds for things like marketing fees and referrals.
In order to determine why you are being investigated, it will be critical to intervene in the government’s investigation, promptly. At this point, you are already at a disadvantage. So you need to engage a legal team that can take swift and decisive action to help level the playing field. With our extensive experience on both sides of federal health care fraud investigations, we can take action immediately on your behalf in order to:
- Determine which agency (or agencies) are handling your investigation;
- Determine the specific factual allegations against you;
- Determine whether the investigation is civil or criminal in nature;
- Determine how close federal prosecutors are to filing charges; and
- Determine what we believe is the most appropriate strategy for securing a favorable outcome as quickly as possible.
Regardless of why you think your practice or business is being targeted and even if you are confident that your billing practices are fully-compliant, you need to avoid making any assumptions or decisions until you have a clear picture of the government’s case against you. Our attorneys can get you there quickly, and we can help you execute a comprehensive defense strategy focused on allowing you to get back to business as usual with minimal consequences.
Sources of Authority in Federal Health Care Fraud Investigations
1. The False Claims Act
The False Claims Act (FCA) is one of the federal government’s primary weapons in the fight against health care program fraud. Investigations conducted by the DOJ, DEA, OIG, and other agencies will routinely involve allegations of False Claims Act violations, including specifically the submission of “false or fraudulent” claims for Medicare, Medicaid, Tricare, or DOL reimbursement. Civil monetary penalties under the FCA apply on a per-claim basis (with each individual billing constituting a separate “claim”), and providers charged civilly can face recoupments, treble damages, litigation costs, program exclusion and other penalties as well. Critically, the FCA also includes criminal provisions for prosecution of intentional violations, with providers facing the potential for substantial fines and years or decades of imprisonment.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) includes civil and criminal penal provisions similar to the False Claims Act, and it prohibits the offering, soliciting, payment, or receipt of any bribe, referral fee, kickback, or other form of “remuneration” in connection with program-reimbursed health care services. This can include marketing fees, management fees, research fees, and various other forms of compensation. The AKS’s prohibitions are extremely broad. In many cases, a provider’s best defense strategy will be to demonstrate that one of the statute’s “safe harbor” provisions applies to the transaction in question.
3. The Stark Law
The Stark Law prohibits physicians and their related entities from making payments from Medicare or Medicaid reimbursed funds that constitute referral fees for “designated health services.” This is more commonly known as the prohibition on “physician self-referrals.” The Stark Law includes provisions for civil penalties only. However, physicians and other individuals and entities targeted in Stark Law investigations can often be at risk for hundreds of thousands or millions of dollars in aggregate financial liability.
4. The Controlled Substances Act
The Controlled Substances Act establishes the DEA registration requirements for providers who prescribe, administer, and dispense prescription drugs. It is also the primary statute the government uses to target health care providers suspected of opioid diversion and other forms of pharmaceutical fraud. Investigations under the Controlled Substances Act can result in serious criminal charges with the potential for substantial fines and long-term imprisonment.
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.” Penalties under 18 U.S.C. 1347 include statutory fines and maximum prison sentences of 10 years, 20 years, or life behind bars depending upon the specific factual circumstances involved (i.e., whether a violation resulted in serious bodily injury or death to a patient).
6. Program Billing Regulations
Violations of the Medicare, Medicaid, Tricare and DOL billing regulations can lead to charges under the False Claims Act, the health care fraud statute, and the other statutes listed above. This is true not only for intentional violations (which can trigger criminal prosecution), but for unintentional violations as well. As a result, it is critical that providers be able to demonstrate ongoing and active efforts to strictly adhere to an up-to-date billing compliance program.
7. Other Federal Criminal Statutes
In criminal health care fraud cases, physicians, pharmacists, executives, board members, and other individuals can face charges under a variety of other federal statutes as well. These include:
- 18 U.S.C. 371 (criminal conspiracy)
- 18 U.S.C. 1028A (identity theft)
- 18 U.S.C. 1341 (mail fraud)
- 18 U.S.C. 1343 (wire fraud)
- 18 U.S.C. 1344 (bank fraud)
- 18 U.S.C. 1357 (money laundering)
- 21 U.S.C. 841 (distribution of controlled substances)
- 26 U.S.C. 7206 (tax fraud)
5 Reasons to Choose Oberheiden, P.C.’s Federal Health Care Fraud Defense Team in Santa Ana, CA
Our attorneys provide skilled, strategic, and aggressive legal representation for federal health care fraud investigations in Santa Ana, CA. When you choose our team of highly-experienced health care fraud defense lawyers to represent you:
- You Will Have Centuries of Federal Experience on Your Side – Our attorneys have handled thousands of investigations and hundreds of trials as defense counsel and former federal prosecutors.
- You Will Have Access to Your Attorneys 24/7 – We are here for you when you need us. When we represent you, we make ourselves available to you 24/7.
- We Will Execute a Highly–Customized Case Strategy – We tailor our representation to the unique facts of each individual case. We will focus your defense strategy on quickly securing a favorable outcome in light of the specific circumstances at hand.
- We Will Pursue Every Available Opportunity for Pretrial Resolution – If at all possible, we will seek to resolve your case without the need to go to trial and ideally before civil or criminal charges are filed.
- We Will Be by Your Side until Your Case Is Over – If it takes going to trial to protect you, our attorneys will vigorously represent you in court. And if necessary, we can fight for a just outcome on appeal.
Contact the Federal Health Care Fraud Defense Team at Oberheiden, P.C.
To discuss your federal health care fraud investigation in Santa Ana with our defense team, please call 888-519-4897 or contact us online. We will schedule your free initial case assessment as soon as possible.
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