Sugar Land Healthcare Fraud Defense Attorney
Veteran Federal Defense Attorneys Aggressive Defending the Interests of healthcare Providers and Business Throughout Fort Bend County
Over the past decade, the federal government has increased enforcement efforts across the board when it comes to healthcare fraud. As a result, a record number of Sugar Land, Texas doctors, dentists, hospitals, pharmacists and other providers are facing federal healthcare fraud charges. If your business or practice is under investigation, you need the experienced Sugar Land federal healthcare defense lawyers at Oberheiden, P.C. Call 888-680-1745 to schedule a free case evaluation today.
The FBI, in conjunction with the DEA, OIG and DOJ, come down hard on healthcare providers suspected of fraud or other abuses. While criminal healthcare fraud laws require the government to prove an intent to defraud, that is not the case when the government brings civil fraud claims. Thus, even an innocent mistake or oversight can land your practice at the center of a Sugar Land healthcare fraud investigation.
If your practice or business is under investigation, your next move should be to call the experienced Sugar Land healthcare fraud defense lawyers at Oberheiden, P.C. Healthcare fraud investigations are incredibly complex and require the assistance of an attorney who is intimately familiar not only with these laws but also the underlying healthcare industry. At Oberheiden, P.C., we have centuries of combined experience representing healthcare providers and businesses in all types of fraud investigations. We regularly handle some of the most complex and high-stakes fraud cases in the country and are well-suited to defend your interests against whatever claims the government brings.
What Is Healthcare Fraud?
Healthcare fraud is an all-encompassing term used to describe a wide range of abuses carried out at the hands of healthcare providers. Of course, the vast majority of providers are honest, hardworking professionals. However, healthcare fraud is a serious problem. In fact, in 2020 alone, the federal government opened 1,148 new fraud investigations, recouping more than $1.8 billion in healthcare fraud judgments and settlements.
While the FBI is primarily responsible for investigating healthcare fraud, it does so with the assistance of several other federal entities, including the Department of Justice, the Health and Human Services Office of Inspector General, the Drug Enforcement Administration, and the Centers for Medicare and Medicaid Services.
Healthcare fraud can involve any of the following:
Referrals are common in the healthcare industry. However, not every referral relationship is permitted under federal law. The two most common referral-based healthcare fraud charges relate to the Anti-Kickback Statute and the Stark Law.
The Anti-Kickback Statute (AKS) makes it illegal to knowingly and willfully “offer, pay, solicit, or receive any remuneration directly or indirectly to induce or reward patient referrals or the generation of business involving any item or service reimbursable by a Federal health care program.” More simply put, the AKS prohibits anyone from paying or receiving anything of value when referring a patient for services when a federal program is footing the bill. The AKS is a criminal statute, meaning if you are convicted under the AKS, you will face significant penalties, including time in federal prison. There are, however, safe harbors under the AKS, which allow for certain types of referral relationships that would otherwise fall within the scope of the AKS.
The Stark Law is another federal healthcare fraud statute imposing restrictions on referrals. More specifically, the Stark Law prohibits what the Centers for Medicare and Medicaid refer to as “physician self-referrals.” A physician self-referral is when a physician refers a patient to receive “designated health services” payable by Medicare or Medicaid to an entity with which the physician or a member of the physician’s immediate family has a financial relationship. The Stark Law is a civil statute, and, aside from the repayment of claims, the government assesses a civil monetary penalty for each service. Physicians who violate the Stark Law may also be excluded from participation in federal healthcare programs.
Violations of the False Claims Act
The False Claims Act is the premier healthcare fraud statute in the United States. While the False Claims Act covers all industries, more than 80% of the recouped funds come from the healthcare industry. The False Claims Act prohibits anyone from knowingly submitting a false or fraudulent claim to the federal government. In this context, the term “knowingly” refers to a provider’s knowledge of the information contained in the claim rather than their conscious intent to defraud the government. Thus, there is no specific intent requirement to violate the False Claims Act.
Violations of the False Claims Act can result in civil or criminal liability. In terms of civil penalties, a violation can result in a fine of up to three times the amount of the claim, plus additional penalties for each violation. Criminal violations of the False Claims Act carry a maximum punishment of up to five years in jail per violation.
Why Choose the Sugar Land Federal Healthcare Fraud Defense Lawyers at Oberheiden P.C.?
If you or your practice is under investigation for healthcare fraud or already facing charges, one of the most important decisions you will make regarding your case is which attorney you select to represent you. Certainly, there are many qualified lawyers who can competently handle your case; however, with so much at stake, why settle for mere competence?
At Oberheiden, P.C., we focus our practice exclusively on healthcare fraud defense. We have centuries of experience handling some of the most complex and high-stakes cases and have a successful track record over 500+ jury trials and more than 1,000 cases that never reached a trial. In many of these cases, we were able to get the government to drop all charges against our clients. We attribute much of our success to our background; many of our senior attorneys spent years prosecuting healthcare fraud cases on behalf of the government before joining Oberheiden, P.C. This provides us with a unique and valuable perspective into how the government views these claims and the best ways to defend against them.
Frequently Asked Questions:
What is the difference between Medicare fraud and Medicare abuse?
Medicare fraud and Medicare abuse are related concepts, both involving a provider’s misconduct as it pertains to billing Medicare or Medicaid. Typically, Medicare abuse consists of any conduct that results in unnecessary costs to the Medicare program. For example, billing the government for unnecessary services or those that do not meet the professionally recognized standard of care. Medicare abuse, while generally less serious than Medicare fraud, can still result in civil or criminal liability. Medicare fraud, on the other hand, involves submitting claims that are known to be false or fraudulent. Additionally, Medicare fraud also covers illegal referral or kickback arrangements. If you face allegations of Medicare fraud, it is imperative to reach out to a dedicated Sugar Land healthcare fraud defense lawyer at Oberheiden, P.C. as soon as possible.
What is a whistleblower lawsuit?
A whistleblower lawsuit is a type of civil claim filed under the False Claims Act. However, what makes a whistleblower lawsuit unique is that it is filed by a private citizen on behalf of the federal government. Whistleblower claims are allowed under the qui tam provision of the False Claims Act, which allows a whistleblower to obtain a portion of any damages the federal government recovers through the case. Once a whistleblower files a claim, they will present any evidence of fraud to federal investigators, who will conduct an independent investigation. The federal government then has the option to intervene in the case, taking over the prosecution, or allow the whistleblower to continue with the case on their own. If you face a whistleblower lawsuit, early intervention is key. This can limit the scope of the investigation and lead to a more favorable resolution. To learn more about how to defend against a whistleblower lawsuit, contact the dedicated Sugar Land healthcare fraud defense lawyers at Oberheiden, P.C. today.
What should I look for in a Sugar Land healthcare fraud defense lawyer?
If you face federal healthcare fraud charges in Sugar Land, there are a few important things to keep in mind when selecting an attorney to represent you. First, the federal prosecutors assigned to your case are, in all likelihood, highly skilled lawyers with decades of experience handling healthcare fraud claims. Additionally, by the time you learn of the investigation, it has probably been going on for some time because federal authorities rarely inform someone when they are at the center of an investigation until prosecutors are ready to file charges. Thus, when searching for a Sugar Land healthcare fraud defense attorney, you want a lawyer who is experienced handling these complex cases and ready to immediately get involved in your case. At Oberheiden, P.C., we have centuries of experience defending healthcare providers and have handled more than 500 trials and 1,000 cases that ended without the need for a trial. We also have a sizeable team of former high-ranking federal prosecutors who command an unrivaled knowledge of the complex U.S. healthcare fraud laws. To learn more about how Oberheiden, P.C. can help you defend against the allegations you face, give us a call to schedule a free consultation today.
Contact Oberheiden. P.C. to Schedule a Free Case Evaluation with a Sugar Land, TX Healthcare Fraud Defense Attorney
If you believe that you or your practice is under investigation for healthcare fraud, contact the Sugar Land healthcare fraud defense attorneys at Oberheiden, P.C., for immediate assistance. You can reach our Sugar Land law office at 888-680-1745 or through our online contact form. We have attorneys standing by to discuss your case with you. If a member of our team is not available immediately, we will get back to you as soon as possible.