Charleston Healthcare Fraud Defense Lawyer
The federal government has recently shown an increased interest in prosecuting South Carolina healthcare providers, especially those in and around Charleston. If federal authorities contacted you about an investigation into your practice, our California healthcare fraud defense lawyers can help. Call 888-680-1745 now.
The federal government keeps a close eye on providers who bill Medicare, Medicaid and other federally funded programs. While most healthcare providers have no intent on defrauding the government, the few instances of illicit conduct justify the government taking an aggressive position at the first potential sign of healthcare fraud.
If you have been contacted by federal agents with the FBI, DOJ, OIG or DEA, it is critical that you engage legal counsel immediately. Federal healthcare fraud investigations can escalate very quickly, and early and efficient intervention is essential to mitigate the risk of significant consequences. Federal healthcare fraud investigations can lead to criminal charges; however, it is also possible to avoid charges entirely. At Oberheiden, P.C., we focus initially on eliminating the possibility of criminal charges and then develop a comprehensive defense strategy to take on any remaining civil charges.
What Is Healthcare Fraud?
Healthcare fraud is a very broad term referring to a wide range of offenses. However, most often, healthcare fraud relates to a healthcare provider undertaking some course of conduct that the federal government believes shows they are taking advantage of Medicare, Medicaid, Tri-Care or another federally funded program.
The term “fraud” typically connotes an intent to deprive. And this is a requirement in most criminal healthcare fraud actions. However, that isn’t the case in civil healthcare fraud investigations. In other words, all the government needs to do to hold you liable for civil healthcare fraud is that you intended to engage in conduct that defrauded the government. An honest, yet frequent, billing mistake? An innocent, but illegal, referral arrangement? Signing off on another’s fraudulent paperwork? All of these can subject you to civil liability that can result in astronomical fines and exclusion from federal programs.
Some of the most common healthcare fraud investigations include:
Billing and Coding Errors
Practitioners who bill Medicare, Medicaid or any other federally funded program must do so accurately. Even unintentional errors can raise the brows of federal investigators. And once your practice is in the government’s crosshairs, it’s challenging to demonstrate why a civil enforcement action or criminal charges are not warranted.
In recent years, the federal government has come down particularly hard on illicit referral arrangements between physicians and other healthcare providers. Two of the most common federal statutes used to prosecute illegal kickbacks are the Anti-Kickback Statute and the Eliminating Kickbacks in Recovery Act. Both of these statutes carry significant criminal liability –including time in federal prison—if you are convicted.
The Stark Law further limits the situations in which physicians can refer patients. Specifically, the Stark Law precludes a provider from referring a patient to another practice in which the referring provider has an economic interest.
False and Fraudulent Claims
The False Claims Act prohibits any “false or fraudulent” submission to Medicare or any other federally funded program. Intentional violations of the False Claims Act can result in criminal liability. However, even those who commit unintentional violations will still face civil penalties. Further, every false or fraudulent item constitutes a separate violation, meaning the penalties in these cases can be exorbitant.
Billing Medicare or Medicaid for Unnecessary Supplies, Services or Equipment
Providers who bill Medicare and Medicaid can only do so for supplies, services or equipment that is medically necessary. However, the federal government makes the final determination of what is “necessary.” This often results in the government second-guessing providers, who may face liability based on a subjective interpretation of what is a medical necessity.
Prescription Drug Fraud
Given the increasing scope of the opioid epidemic, federal agents with the Drug Enforcement Administration and the Department of Justice have shown a renewed focus on prosecuting providers who prescribe opioid medications. While the vast majority of providers comply with the law, federal agents rely on the few who don’t to justify the aggressive policing of all providers.
Falsifying Patient Records
Allegations that a provider falsified patient records or test results frequently accompany claims that a provider committed billing and coding violations. For example, the government may take the position that a provider falsified records to justify their billing practices.
Regardless of the nature of the government’s case against you, your alleged role, or whether any of the allegations are based in fact, the respected Charleston healthcare fraud defense lawyers at Oberheiden, P.C. are here to help.
Why Choose Oberheiden, P.C. to Represent You in a Healthcare Fraud Case?
If you are facing a federal healthcare fraud investigation, deciding which attorney to represent you is one of the most important decisions you will make regarding your case. While there are countless Charleston healthcare fraud defense attorneys that can provide you with competent representation, you deserve more than mere competence. At Oberheiden, P.C., we bring the following to the table:
Vast Experience – At Oberheiden, P.C., we have significant hands-on experience handling a wide range of healthcare fraud cases from both the defense side as well as the government’s perspective. This gives us unique and valuable insight into how the government views these cases and what defenses may be the most likely to succeed in your particular situation.
Immediate Intervention – While some lawyers like to wait to let things settle before developing a strategy, at Oberheiden, P.C., we hit the ground running to do everything we can to resolve your case as quickly as possible—often without charges ever being filed.
Laser Focus – Our veteran defense attorneys handle one kind of case—healthcare fraud cases. This not only gives us unrivaled experience in this complex area of the law but also means you won’t need to spend your valuable time getting us up to speed on the nuances of the healthcare industry.
Personalized Representation – At Oberheiden, P.C., we have centuries of combined experience handling healthcare fraud cases. Over this time, we’ve come to realize that no two cases are the same. Thus, we take as much time as necessary to custom-tailor a strategy that suits the specific situation you are facing.
Aggressive Litigators – While it’s generally best for you to resolve a case early on in the process, sometimes that’s not an option. Perhaps the government is trying to make an example out of you, or you cannot risk pleading guilty to even a minor offense. Whatever the case, with more than 500 federal trials under our belt, Oberheiden, P.C. healthcare fraud defense lawyers will be ready for trial when the situation calls for it.
With your profession, reputation and freedom on the line, you cannot risk taking any chances. Pick up the phone and call Oberheiden, P.C., to schedule a free case evaluation today.
Frequently Asked Questions
What is a qui tam lawsuit?
Also known as a whistleblower claim, a qui tam lawsuit is a case brought by an individual who believes they discovered evidence of healthcare fraud. Qui tam refers to the “qui tam” provision of the False Claims Act, which provides a monetary incentive for private citizens who bring healthcare fraud to light. If successful, a whistleblower can recover up to 30% of the amount recovered in a healthcare fraud action. Once a whistleblower comes forward with evidence of fraud, the federal government must conduct an independent investigation. Depending on the result of this investigation, federal prosecutors may adopt the case. However, even if the federal government declines to intervene, the whistleblower can proceed with the case at their own expense. If you face allegations brought by a whistleblower, it is essential that you immediately contact a Charleston federal healthcare fraud attorney.
Which healthcare providers are most frequently targeted for healthcare fraud?
The federal government routinely brings healthcare fraud cases against every type of healthcare provider. Generally, practices with higher patient volumes and those who bill a significant portion of their business through Medicare or Medicaid are at the greatest risk of incurring federal scrutiny. Thus, if you operate any of the following facilities and believe you or your business is under investigation for healthcare fraud charges, it is imperative to seek out a dedicated Charleston federal healthcare fraud defense attorney:
- DNA testing facilities;
- Drug rehabilitation facilities;
- Healthcare marketing agencies;
- Home healthcare agencies;
- Hospice providers;
- Mobile healthcare clinics;
- Outpatient surgical centers;
- Pharmacies; and
- Toxicologists and toxicology laboratories.
What is the Anti-Kickback Statute?
The Anti-Kickback Statute is a federal statute that limits the situations in which a healthcare provider can receive payment for referring a patient whose medical expenses are being paid by Medicare, Medicaid, or any other federally funded healthcare program. In this context, “payment” refers to anything of value—not just cash. For example, the payment or receipt of vacations, goods, or even a prestigious position within a company can be considered a violation of the Anti-Kickback Statute. The Anti-Kickback Statute is a criminal law and can carry the possibility of incarceration and other criminal sanctions. However, those in violation may also face civil liability under the False Claims Act. If you are facing a violation under the Anti-Kickback Statute, it is crucial you protect yourself by reaching out to a dedicated Charleston federal healthcare fraud defense attorney immediately.
Which federal agencies investigate allegations of healthcare fraud?
The Federal Bureau of Investigation (FBI) is the primary government agency responsible for investigating healthcare fraud claims. However, the FBI routinely works in conjunction with other federal agencies, including:
- The Centers for Medicare and Medicaid Services (CMS)
- The Department of Defense (DOD)
- The Department of Health and Human Services (HHS)
- The Department of Justice (DOJ)
- The Department of Labor (DOL)
- The Drug Enforcement Administration (DEA)
- The Office of Inspector General (OIG)
Often, one of these agencies comes across evidence of potential fraud and initiates its own internal investigation. As soon as it appears that the allegations have merit, the agency will contact the FBI. FBI agents will then work with agents from the referring agency to further investigate the claim. If you are at the center of a healthcare fraud investigation, the first thing to do is to contact a dedicated Charleston federal healthcare fraud defense attorney to learn more about the accusations and what you can do to defend against them.
Contact Oberheiden. P.C. to Schedule a Free Consultation with an Experienced Charleston Healthcare Fraud Defense Attorney
If you recently learned that you or your practice is at the center of a healthcare fraud investigation, contact the Charleston federal healthcare fraud defense attorneys at Oberheiden, P.C., for immediate assistance. You can contact our Charleston healthcare fraud defense lawyers at 888-680-1745 or contact us online. If a member of our team is not available immediately, we will respond to your inquiry as soon as possible.