Southern CA Health Care Fraud Defense
Proven Southern CA Health Care Fraud Defense Lawyers
If you or your medical practice are among the many targets of a federal health care fraud investigation in Southern California, you need our experienced Southern CA health care fraud defense lawyers at Oberheiden, P.C.
The federal government is executing a nationwide crackdown on health care fraud and other health care-related crimes such as drug diversion. While new cases are arising all over the country, Southern California has been one of the primary areas of focus for several major federal agencies, including the Drug Enforcement Administration (DEA) and the Department of Health and Human Services’ Office of Inspector General (DHHS – OIG).
Oberheiden, P.C., is a federal health care fraud defense law firm that represents health care professionals, corporate officers, owners, and business entities in both civil and criminal investigations in Southern California.
Our attorneys have more than 100 years of combined legal experience, much of it concentrated in federal health care fraud. Several of the attorneys in our office spent years or decades as senior federal prosecutors, and our Southern CA health care fraud defense attorney have extensive experience in negotiating directly with agencies like the DEA, OIG, and FBI. We use that insight to help our clients make wise decisions and avoid unnecessary consequences during a federal health care fraud investigation.
Please do not underestimate the seriousness of a federal investigation, the danger of interacting with federal agents, or the severity of a formal allegation (let alone conviction). Hire an experienced team of defense veterans to protect you. Contact Oberheiden, P.C., and ask to speak with a health care fraud defense attorney for Southern CA today.
What Is Health Care Fraud?
The United States criminal code contains a surprising number of statutes aimed directly at the health care industry. They are used to put otherwise respected white-collar professionals (such as business owners, nurses, and physicians) in prison for many years for non-violent crimes. Our highly experienced Southern CA health care fraud defense lawyers will review some of those specific statutes in the next section. But at the outset, it should be noted that the term “health care fraud” is something of a catch-all phrase. It may refer to any number of federal offenses or specific sections of the U.S. code. Accordingly, there are many ways to commit “health care fraud.”
When we enter a case, one of our first priorities is to determine two key, preliminary pieces of information:
- The nature of the investigation (is it civil or criminal?)
- The specific agencies and/or task forces involved
Those two items tell us a lot about what’s happening, what’s at stake, and how we should respond for our clients. Different agencies have different priorities when it comes to health care fraud enforcement. The DEA, DOJ, and the Office of the Inspector General of the Department of the Health and Human Services (DHSS – OIG) are among the primary investigators of health care fraud in Southern CA.
Some of the health care fraud allegations that our Southern CA health care fraud defense attorneys have defended against at Oberheiden, P.C., include:
- Billing fraud (Medicare, Medicaid, Tricare, etc.)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations (physician self-referral)
- Controlled Substances Act / DEA registration violations (including prescription drug fraud)
- Providing / Billing for medically unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
The Most Commonly Invoked Health Care Fraud Laws
Below, we review just a handful of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of health care professionals in Southern California.
1. The False Claims Act
The False Claims Act (FCA) is one of the most well-known health care fraud statutes. It prohibits the submission of “false or fraudulent” claims for payment to any federal benefits program. In most cases, the FCA is invoked in billing discrepancies with Medicaid, Medicare, or Tricare. The law applies to anyone who submits payment claims to these or other benefits programs. This includes not only physician’s groups or hospitals, but also many medical supply companies, ambulance operators, mobile health companies, and other entities. FCA penalties are applied per claim, so the toll of each fine and reimbursement can quickly add up to an effectively unpayable sum. Additional consequences of FCA violation can include exclusion from federal benefits programs and/or prison sentences.
2. The Anti-Kickback Statute
When is a mutual marketing arrangement a crime? More often than you might think, thanks to the Anti-Kickback Statute (AKS). This statute makes it a crime to offer, solicit, pay for, or receive a referral fee (or any other form of “remuneration”) in exchange for referring a Medicare, Medicaid, Tricare, or DOL beneficiary. AKS violations may result in civil and/or criminal penalties, depending on the circumstances.
3. The Stark Law
Under the federal Stark Law, it is illegal for physicians to engage in so-called “self-referral.” While many providers understand this basic concept, you may be surprised to find yourself accused of violating the Stark Law when you had no idea you were “self-referring.” For example, a doctor may stand accused of breaking the Stark Law for unwittingly referring a patient to a business that the doctor has a distant or tenuous financial relationship with. Our federal defense attorneys are available to assist physicians or entities accused of Stark Law violations in Southern CA.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is a complex and multifaceted statute that establishes a regulatory system while also providing various criminal penalties – many of which are extremely and excessively harsh. The CSA is what gives the Drug Enforcement Administration much of its authority. Remember: the DEA isn’t just a regulatory organization; it is a law enforcement agency too. Common allegations made under the CSA include: prescribing medications unnecessarily, providing addictive drugs to patients with a history of abuse, misappropriating prescription substances, “selling” prescriptions, pharmaceutical fraud, and other unlawful practices.
5. The Federal Health Care Fraud Statute
Referred to generally as “the health care fraud statute,” 18 U.S.C. 1347 makes it a crime to:
“knowingly and willfully execute, or attempt to execute, a scheme or artifice –
(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.”
Congress designed the health care fraud statute to give prosecutors and investigators wide breadth and authority. Accordingly, it is a useful tool to federal prosecutors in Southern CA who have been directed to amplify their efforts against health care providers.
6. Other Fraud Statutes
A health care fraud indictment often lists other, non-industry-specific charges, too. Wire fraud, mail fraud, bank fraud, and money laundering are common examples. Prosecutors are prone to building health care conspiracy cases as well, such as “conspiracy to commit health care fraud.”
7. Program Billing Regulations
Agencies like the CMS are authorized to propagate their own billing regulations, which carry the force of law. Whereas most fraud cases require proof of intent, when it comes to federal program billing regulations, even an unintentional violation can lead to criminal penalties (or civil recoupment actions, often adding up to millions of dollars). These often come about as a result of a routine audit or investigation. For this reason, Southern CA care providers should set up a proactive compliance program to mitigate the risk of prosecution.
8. DOJ Mandates
The DOJ frequently issues press releases and/or directives, which tell DOJ operatives how to prioritize their efforts. Currently, the DOJ has mandated that health care fraud and opioid fraud and abuse be made national priorities. That is reflected in the recent launch of both the Prescription Interdiction & Litigation (PIL) Task Force and the Opioid Fraud and Abuse Detection Unit within a matter of months. These new efforts, combined with the existing Medicaid Fraud Strike Force office in Los Angeles, are now responsible for many of the health care arrests in Southern California.
5 Reasons to Trust Oberheiden, P.C., as a Federal Health Care Fraud Defense Firm for Southern CA
Here are five reasons why health care providers and other Medicare, Medicaid, and Tricare participants in Southern CA should choose Oberheiden, P.C., as their federal health care fraud defense lawyer:
- Our Extensive Experience in Health Care Fraud Investigations – We have handled thousands of federal health care fraud audits, investigations, and prosecutions on behalf of health care providers in Southern CA and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, our Southern CA health care fraud defense lawyers have reached a resolution in which the client did not have to face any criminal charges.
- Our Focus on Federal Health Care Fraud Defense – Much of our defense work over the years has been in the highly specific area of federal health care fraud defense. We have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually all other types of health care provider.
- Our Experience on Both Sides – Oberheiden, P.C., is comprised of both long-established federal defense attorneys and deeply experienced former federal prosecutors. We believe this “dual perspective” is of tremendous benefit to our clients.
- Our Aggressive Defense Strategies – Our Southern CA health care fraud defense attorneys take an aggressive approach to representing our clients. Our law firm has been intentionally designed so that we can quickly and cost-effectively develop custom-tailored defense strategies for our clients, even on an emergency basis as needed.
Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm could become the most important decision you will ever make.
Discuss Your Federal Health Care Fraud Investigation in Confidence
If your Southern CA health care practice or company is being targeted in a federal health care fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with a member of our Southern CA health care fraud defense lawyers for free, call (888) 519-4897 or inquire online, right away.