Tampa health care providers are at risk for being targeted in federal investigations. If you have received a target letter, subpoena, or any other form of contact from the U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA), Internal Revenue Service (IRS), Office of Inspector General (OIG), or another federal law enforcement agency, call 888-519-4897 now for a free and confidential case assessment.
When facing a federal health care fraud investigation, executing a proactive defense strategy is the key to mitigating the risk of civil charges or a criminal indictment and the potential for prosecution in federal district court. These investigations can move quickly. And by the time that you discover your health care practice or business is being targeted, the government has already begun building its case against you. To stop federal agents and prosecutors in their tracks, you need to intervene in the investigation as soon as possible. This means hiring experienced legal representation.
At Oberheiden, P.C., we routinely represent clients in Tampa, throughout Florida, and nationwide in federal health care fraud investigations. Our attorneys have handled thousands of investigations, and they have centuries of combined experience as defense attorneys and former prosecutors with the U.S. Department of Justice (DOJ). If you are being targeted by the DOJ, Drug Enforcement Administration (DEA), Internal Revenue Service (IRS), Office of Inspector General (OIG), or another federal law enforcement agency, this is the type of experience you need on your side. We are available 24/7 and our attorneys can act immediately on your behalf, if necessary. So call 888-519-4897 now to discuss your case in confidence.
Understanding What It Means to Be Accused of “Health Care Fraud”
What does it mean to be accused of health care fraud? In the context of a federal investigation, it means that the government has reason to believe that you (or someone else within your practice or business) may have improperly billed Medicare, Medicaid, Tricare, or the Department of Labor (DOL). It may also mean they suspect that you have unlawfully used program-reimbursed funds to pay referral fees or other improper forms of compensation. Specific allegations can range from upcoding or unbundling services (which is commonly the result of honest human error by billing administrators) to improperly prescribing opioid medications (which is often a matter of medical judgment).
As a result, in order to defend against the government’s investigation effectively, you need to discern the specific allegations against you. Defending against allegations of billing violations is very different from defending against allegations of prescription drug fraud. You also need to know whether the government’s investigation is civil or criminal in nature. This is because the nature of the investigation determines both (i) the full scope of the defenses you have available, and (ii) the potential penalties that are on the table.
When you engage our federal health care fraud defense team to represent you, uncovering the scope and nature of the government’s investigation will be our first priority. We will quickly intervene in the investigation on your behalf, and we will use our extensive experience and deep knowledge of the federal health care system to determine your potential exposure. Armed with this information, we can quickly craft a custom-tailored defense strategy and we can begin executing this strategy immediately in order to try to prevent charges from being filed. Additionally, if the investigation is currently civil in nature, we can work to keep it this way so that federal prison time is not on the table.
Federal Statutes Used to Investigate and Prosecute Health Care Fraud
1. The False Claims Act
Under the False Claims Act (FCA), it is unlawful to submit any “false or fraudulent” claim for reimbursement to Medicare, Medicaid, Tricare, or the DOL. This includes the intentional or unintentional submission of an inaccurate request for payment. In civil cases (involving unintentional violations), potential penalties include recoupments, treble damages (three times the government’s actual losses), civil monetary penalties, and program exclusion. In criminal cases (involving intentional violations), potential penalties include fines and up to five years in prison for each individual offense.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) applies to rebates, referral fees, and other forms of “remuneration” paid out of federally-reimbursed program funds. It applies to providers and other entities and individuals who offer, solicit, pay, or receive unlawful remuneration. And similar to the False Claims Act, it includes provisions for both civil and criminal penalties.
3. The Stark Law
The Stark Law also prohibits the payment of referral fees, but it applies exclusively to physicians and their related entities. Also unlike the Anti-Kickback Statute, the Stark Law is exclusively civil in nature. The Stark Law applies to referrals fees paid in connection with the provision of “designated health services,” which include:
- Clinical laboratory services
- Physical therapy services
- Occupational therapy services
- Outpatient speech-language pathology services
- Radiology and certain other imaging services
- Radiation therapy services and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
4. The Controlled Substances Act
The Controlled Substances Act imposes criminal penalties for prescription drug fraud, including the issuance of unnecessary prescriptions, the improper filling of prescriptions, and prescription drug diversion. Providers charged under the Controlled Substances Act can face criminal penalties. And even if a violation does not rise to the level of a federal crime, it can still result in the loss of your DEA registration.
5. The Federal Health Care Fraud Statute
The health care fraud statute, 18 U.S.C. 1347, makes it a criminal offense to, “knowingly and willfully execute, or attempt to execute, a scheme . . . to defraud any health care benefit program . . . [or to obtain] money or property owned by, or under the custody or control of, any health care benefit program [by false pretenses].” Most violations of 18 U.S.C. 1347 carry a maximum prison sentence of 10 years. However, violations resulting in serious bodily injury carry a maximum sentence of 20 years, and violations resulting in death carry the potential for life behind bars.
6. Other Federal Criminal Statutes
There are a number of other federal statutes that can come into play in criminal health care fraud investigations as well. Due to the breadth of these statutes, providers will often be at risk for facing multiple counts simply by virtue of engaging in a fraudulent health care-related transaction (and under the criminal conspiracy statute, it is not even necessary to submit a false or fraudulent claim in order to face charges). Common charges in criminal health care fraud cases 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)
Is Your Tampa Health Care Business or Practice Under Investigation? Here Are Five Reasons to Put Oberheiden, P.C.’s Federal Health Care Fraud Defense Team on Your Side.
If you need legal representation for an investigation involving the DOJ, DEA, IRS, OIG, or any other agency or task force in Tampa, here are five reasons to choose the federal defense lawyers at Oberheiden, P.C.:
- We Have Extensive Experience in Federal Health Care Fraud Investigations. Our attorneys have represented clients in federal health care fraud investigations across the country.
- We Will Work with You, One-on-One, to Develop a Comprehensive and Custom-Tailored Defense Strategy. Our senior attorneys work with clients personally and in-depth in order to craft defense strategies that are designed to succeed under the specific facts at hand.
- We Will Work Diligently to Resolve Your Investigation Without Charges Being Filed. In every case, our goal is to fully protect our client by terminating the government’s investigation without charges being filed.
- We Will Make Ourselves Available to You 24/7. When our clients need us, we answer the call. You can expect to reach our federal health care fraud defense team 24/7.
- If Necessary, We Will Use our Federal Trial Experience to Fight for You in Court. Many of our attorneys are seasoned litigators, and we do not back down when it is in our clients’ best interests to go to trial.
If this sounds like your kind of law firm, we encourage you to give us a call. Members of our team are standing by, and we are prepared to begin working with you on your defense strategy immediately. When you are under federal investigation, every decision you make can have drastic consequences. Contact us now to put our attorneys’ knowledge, insights, and experience on your side.
Request a Free Initial Case Assessment at Oberheiden, P.C.
For more information about our legal representation for Tampa health care providers, please contact us to schedule a free initial case assessment. To discuss your DOJ, DEA, IRS, OIG, or other agency investigation with a member of our federal health care fraud defense team in confidence, call 888-519-4897 or tell us how to contact you online now.
All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.