Memphis and Nashville, Tennessee Physicians and Health Care Business
Former DOJ-Prosecutors Represent Physicians and Health Care Business Owners in Memphis, Nashville, And All of Tennessee
Has your health care practice or business been contacted by the U.S. Department of Justice (DOJ), the Office of Inspector General (OIG), the Drug Enforcement Administration (DEA) or the Medicare Fraud Strike Force? Are you under audit or have some questions about compliance? If so, you are not the only one. Indeed, health providers in Nashville and Memphis, Tennessee are increasingly finding themselves a target of health care fraud investigations. In the current climate of Medicare fraud and opioid prescription fraud prosecutions, Tennessee medical providers that do not take affirmative steps to protect themselves with experienced legal representation may be subject to scrutiny and investigations. Don’t let this happen to you!
Experienced Health Care Fraud Defense Attorneys Helping Clients in Tennessee
Tennessee doctors and business owners can rely on Oberheiden, P.C.. Our attorneys represent, advise, and defend physicians and health businesses against government audits and health fraud investigations—applying decades of experience from previously held positions at the Department of Justice.
All Tennessee clients are represented by experienced health care defense attorneys and former federal prosecutors. Oberheiden, P.C. does not use junior lawyers or associates. Call us today to speak to former DOJ officials and attorneys with specific experience in health defense cases.
The Government Is Targeting Nashville and Memphis, Tennessee Health Care Providers
Tennessee physicians and operators of health companies are not immune from the currently evolving wave of prosecutions against medical providers and business owners. Attorney General Jeff Sessions and other government officials have made it clear that the prosecution of health fraud is a top law enforcement priority for the years to come.
From prescription drug fraud (contributing to the nation’s opioid crisis) to Medicare billing fraud, government prosecutors and investigators operate under strict mandates to aggressively pursue cases against providers they suspect are engaged in any type of health care fraud — increasingly also in Tennessee.
For their investigations, federal agencies rely on sophisticated data analytics to comb through millions of health benefit program billings and they actively call on “whistleblowers” to report suspected health fraud. Nonetheless, health providers in Tennessee should know that, while some of these government inquiries result in substantial recoupments from fraudulent providers, far more investigations end up targeting legitimate health care practices and businesses with billing issues as a result of human error.
If your Nashville or Memphis health practice or business is under federal investigation, we encourage you to immediately contact us for a free case assessment. Oberheiden, P.C. is a team of federal law defense lawyers and former federal prosecutors who have decades of experience on both sides of federal health care fraud investigations and prosecutions. We can quickly assess your case, intervene in the investigation and implement a comprehensive defense strategy. Our goal in every case is to resolve our clients’ investigations without federal prosecutors filing civil or criminal charges.
What Are Some of the Grounds for Audits and Investigations?
- Medicare and Medicaid Fraud. The Department of Health and Human Services and the Office of Inspector General (OIG) have significantly increased their audit and enforcement activity against Tennessee physicians, psychologists, psychiatrists, and health care business owners (e.g. hospice, home health, DME, toxicology laboratory, cardiologists, pharmacies) that accept Medicare and Medicaid insurance plans. In many of these cases, the mere fact that, for example, a doctor in Memphis bills Medicare more than his or her peers is sufficient to open a fraud investigation on the basis of overutilization.
- Prescription Drug Fraud. Currently, federal agencies are aggressively pursuing charges against Nashville and Memphis health providers they suspect of involvement in prescription drug fraud, which includes fraud involving narcotic medications. Our attorneys have defended physicians, nurses, pharmacists, facility executives, caregivers, administrators, among others accused of involvement in a wide range of prescription drug schemes. Through our broad experience in federal health care law, we are very familiar with the complex issues involved in prescription drug fraud investigations.
- Billing/Coding Violations. Many health fraud investigations focus on billing practices that include specific violations of applicable program billing guidelines. If your practice or business is being accused by the federal government of upcoding, double-billing, unbundling, billing for services nor actually rendered or of medically-unnecessary services, our attorneys’ goal will be to utilize all available evidence to disprove such allegations or, if necessary, to mitigate your civil or criminal exposure.
- Kickbacks. Under the federal Anti-Kickback Statute, it is unlawful for any health provider to offer or pay any form of remuneration for patient referrals involving a Tricare, Medicare, Medicaid or other program beneficiary (noting that civil or criminal liability is subject to numerous “safe harbors” and exemptions under the AKS). While the law prohibits solicitation or receipt of illegal “kickbacks” as well, providers on both sides of a kickback transaction may face criminal and civil penalties.
- Physician “Self-Referrals.” The federal Stark Law imposes civil penalties for physician “self-referrals.” In short, physicians are prohibited from referring federal health care benefit program beneficiaries to entities with which they (or their immediate family members) have financial ties. In a Stark Law investigation, both a referring physician and the treating entity may face significant civil liability. Similar to the AKS, the Stark Law includes exceptions, which our attorneys capitalize on for the goal of representations — to protect our clients’ interests.
- Certification Errors. All patients receiving care from a home health agency or hospice must be certified by a licensed physician. Whether it is from a failure to conduct an in-person examination of the patient to outright falsification of patient records, physicians and affiliated hospices and home health agencies can each be investigated for a variety of allegations related to certification fraud.
Our attorneys’ experience includes representing all types of health providers. We represent physicians, pharmacists and other licensed health care practitioners, medical facilities and hospitals, hospices and home health agencies, durable medical equipment (DME) companies, toxicology laboratories and other providers in health fraud audits, investigations and prosecutions.
FAQs: What Providers in Nashville and Memphis Need to Know about Health Care Fraud Investigations
Q: What can happen if my practice or business is under investigation for health care fraud?
If your practice or business becomes a target in a health fraud investigation, there are a number of potential outcomes. For example:
- The investigation is closed without charges or liability
- The investigation is resolved with a negotiated settlement (or plea deal) prior to charges being filed
- A plea deal is negotiated after charges have been filed
- Proceeding with a civil trial and being found either not liable or liable
- Proceeding with a trial on criminal charges and being found not guilty or guilty
Of course, the likelihood of each of these potential outcomes depends on a variety of factors, including the scope of the investigation and the specific form (or forms) of fraud being alleged. While all cases are different and each depends on its specific facts, at Oberheiden, P.C., our goal is to keep our clients’ investigations civil in nature and to resolve each case without charges being filed.
Q: How does the False Claims Act apply to health care providers?
If your practice or business bills Medicare, Tricare, Medicaid or another health benefit program, any government investigation against you will likely involve allegations under the False Claims Act. The False Claims Act prohibits the submission of “false and fraudulent” claims for government compensation. This prohibition includes reimbursement requests for health services and supplies. Any billing and coding violations, self-referrals, kickbacks, and other forms of health fraud all have the potential to lead to False Claims Act liability. False Claims Act investigations may be civil or criminal in nature, with potential penalties including devastating financial liability, loss of assignment privileges, exclusion from federal health care programs and long-term federal imprisonment.
Q: What actions or practices can be charged as prescription drug fraud?
“Prescription drug fraud” is a broad term that encompasses all forms of health fraud involving the prescription, administration and dispensing of controlled-substance medications. The most common allegations in prescription drug fraud investigations include:
- Prescribing narcotics to a drug-dependent patient
- Allowing unauthorized use of a practitioner’s DEA number
- Failure to follow the rules for electronic and hard-copy prescriptions
- Prescribing narcotics outside of acceptable medical treatment principles
- Prescribing non medically-necessary medications or without proper justification
Learn more about each of these examples of prescription drug fraud.
Q: What are some examples of the safe harbors and exemptions under the Stark Law and Anti-Kickback Statute?
While it is the federal government’s policy that health care benefit program funds should not be used to compensate providers for patient referrals, the Stark Law and AKS both recognize that there are various circumstances under which the payment of compensation related to a government program patient is both appropriate and sometimes necessary. When our attorneys represent clients in kickback and self-referral investigations, they focus on identifying all applicable safe harbors and on how these can be used to insulate our clients from liability. Such safe harbors include:
- Bona Fide employment relationships and incidental staff benefits
- Personal service arrangements
- Certain forms of non-monetary compensation
- Indirect compensation arrangements
- Discounts and group purchasing arrangements
- In-office ancillary services
- Referral agreements for specialty services
- Isolated transactions
- Price reductions involving eligible managed care organizations
- Waivers of coinsurance and deductibles
Why Choose Oberheiden, P.C. in Memphis and Nashville?
When you need legal representation to defend yourself against a federal health fraud investigation, you need to choose a firm that has the experience and capabilities required to provide you with the strongest possible defense. At Oberheiden, P.C., we offer:
- A practice devoted to federal health care fraud defense serving our client across the nation.
- Decades of experience as defense attorneys and as former federal health care prosecutors.
- Extensive experience in health fraud investigations and prosecutions.
- A team approach that puts the full weight of our experience on clients’ side.
- Uncompromising dedication to protecting our clients as efficiently as possible.
To speak with the attorneys on our federal health care fraud defense team, please call (888) 519-4897 or send us your contact information online. We are available every day of the year, and we will take immediate action to intervene on your behalf in your federal investigation.
“Dr. Oberheiden has successfully represented our company in various federal health matters involving the OIG, the Department of Labor, and the Department of Health and Human Services. Dr. Oberheiden quickly understands all issues and is able to convincingly present the client’s side of the story. From my experience with other lawyers, I consider Dr. Oberheiden to be among the best attorneys we have ever used. Should we ever need legal help, the first thing our company will do is to call Dr. Oberheiden.” – Firm Client“Impeccable Service”
“Our experience with [Oberheiden, P.C.] was overwhelmingly positive! We recently brought a range of complex legal issues to the table, which they responded to with a systematic, prudent approach. Throughout our work together, Oberheiden, P.C. served as an invaluable source of practical guidance and legal leadership. We would recommend them highly and without reservation to anyone.” – Firm Client
Areas We Serve in Tennessee
Subject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel. Knoxville, Nashville, Memphis, Chattanooga, Murfreesboro, Gatlinburg, Franklin, Clarksville, Johnson City, Jackson, Cleveland, Kingsport, Sevierville, Cookeville, Oak Ridge, Maryville, Mt. Juliet, Pigeon Forge, Bristol, Gallatin, Dickson, Tullahoma, Bartlett, Germantown, Morristown, Collierville, Crossville, La Vergne, Goodlettsville, Lynchburg, Dyersburg, Jonesborough, Ashland City, Nolensville, Pulaski, Rogersville, Hohenwald.
Free Consultation With Skilled and Effective Tennessee Health Care Fraud Defense Lawyers
If you are or if you think you are under investigation, you should immediately seek professional guidance. Oberheiden, P.C. offers free and confidential consultations, including on weekends, to discuss your situation and to find a way to avoid or fight criminal charges. Contact us today.
Compliance – Litigation – Defense