Southern FL Health Care Fraud
If you are being investigated for health care fraud in Southern Florida, you need the experienced federal defense team at Oberheiden, P.C.
As the United States government renews its focus on the issues of fraud, waste, abuse, and prescription misuse within the health care industry, providers in Southern Florida are being targeted for investigation.
Because Miami is home to one of the largest populations of Medicaid / Medicare recipients, the federal government has allocated additional resources to the Southern Florida area, including the Miami-based Medicare Fraud Strike Force office. Health care companies and providers working in South Florida may be more likely to come under scrutiny as a result.
What you need to understand is that the early stages of an investigation are extremely important. Don’t make the mistake of thinking it is premature to contact a lawyer. The early stages represent the best opportunity for ending the matter before it matures into a grand jury proceeding or criminal indictment.
Oberheiden, P.C., is a federal health care fraud defense firm that represents health care professionals, corporate officers, owners, and business entities in both civil and criminal investigations in Southern Florida.
The attorneys in our firm offer more than 100 years of cumulative legal experience, and several are former federal prosecutors. Our Southern FL health care fraud defense attorneys also have extensive experience in negotiating directly with agencies like the Drug Enforcement Administration (DEA) and the Department of Health and Human Services Office of the Inspector General (DHSS – OIG).
That experience has helped us bring the majority of our clients’ cases to a close with zero criminal charges filed. Let us fight to protect you from the serious threat of criminal prosecution. Call us for a free consultation today.
What Is Health Care Fraud?
Health care fraud can take many forms. Any act of misrepresentation to a health care program can constitute health care fraud. Prosecutors have their choice of many, many federal statutes that might apply in cases of health care fraud. Some statutes apply only when the alleged victim is a federal program (e.g., Medicare, Medicaid, Tricare, the Department of Labor, etc.), while others also apply to the defrauding of a private insurance company. The precise nature of the charges determines the potential penalties in your matter as well as the best strategy for defense.
Some of the health care fraud allegations that our Southern FL 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
When we enter a case, one of our first priorities is to determine two important items of information:
- The nature of the investigation (is it civil or criminal?)
- The specific agencies and/or task forces involved
These two items tell us a lot about what’s happening, what’s at stake, and how our Southern FL health care fraud defense lawyers should respond to best protect our clients. We then develop a tailored strategy for the situation at hand, always grounded in our aggressive, tested-and-proven approach to defense.
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 Florida.
1. The False Claims Act
The False Claims Act (FCA) 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. Unfortunately, our Southern FL health care fraud defense attorneys have seen many instances throughout the Sunshine State where a health care practice has made simple clerical errors or good-faith mistakes of judgment that were later misconstrued by law enforcement agents as evidence of criminal fraud. The penalties can be steep. 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
The Anti-Kickback Statute (AKS) 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. The statute’s prohibitions extend to a wider range of business arrangements than many people realize. Indeed, we have helped many clients who were utterly shocked to find themselves accused of violating the Anti-Kickback Statute. 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 “self-refer.” Here again, the statute covers a broader range of conduct than is apparent at first glance. We have helped many physicians who were only trying to help their patients by referring them to the best-available source of care – only to later learn that the referral constituted an alleged violation of the Stark Law. Our Southern FL health care fraud defense attorneys are available to assist physicians or entities accused of Stark Law violations.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is a complex and multifaceted statute. This same law is used to put away illicit drug dealers, to regulate prescription medications and those who prescribe them, and to target health care professionals for criminal prosecution.
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
- Other unlawful practices
5. The Federal Health Care Fraud Statute
18 U.S.C. 1347 is a broad and far-reaching statute that is most widely referred to as simply “the health care fraud statute.” It 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.”
The broad language here gives prosecutors considerable discretion. Nevertheless, our proven Southern FL health care fraud defense attorneys have a track record of avoiding or defeating such health care fraud allegations in the majority of our cases.
6. Other Fraud Statutes
In addition to the criminal statutes described above, health care providers frequently face allegations of wire fraud, mail fraud, forgery, making false statements, federal conspiracy to commit health care fraud, and other serious charges.
7. Program Billing Regulations
Federal health care benefits programs establish their own rules and regulations, the violation of which (even if unintentional) may lead to overwhelming penalties. Care providers in Southern FL can mitigate the risk of prosecution by maintaining a compliance program.
8. DOJ Mandates
Department of Justice mandates are public announcements or internal instructions about which kinds of cases DOJ agents should prioritize. Currently, health care fraud and opioid diversion are among the Department’s top priorities. Case in point: the recent launch of both the Prescription Interdiction & Litigation (PIL) Task Force and the Opioid Fraud and Abuse Detection Unit.
5 Reasons to Trust Oberheiden, P.C. and Our Southern FL Federal Health Care Fraud Defense Lawyers
Here are five reasons why health care providers and other Medicare, Medicaid, and Tricare participants in Southern FL 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 FL and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, our Southern FL health care fraud defense attorneys have reached a resolution in which our client ultimately does not face criminal charges.
- Our Focus on Federal Health Care Fraud Defense – Much of our defense work is concentrated in the highly specific area of federal health care fraud defense. We have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually every other category of health care providers.
- 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” helps us negotiate efficiently and effectively with current federal prosecutors.
- Our Aggressive Defense Strategies – We take an aggressive approach to defending our clients, precisely because the stakes are so high. Our Southern FL health care fraud defense attorneys also offer an Emergency Defense Package for urgent legal crises.
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 FL health care practice or company is being targeted in a federal health care fraud investigation, our Southern FL health care fraud defense attorneys strongly encourage you to contact us for a confidential case assessment. To speak with a member of our federal defense team for free, call (214) 692-2171 or inquire online, right away.
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