Provo, Utah Healthcare Fraud Defense Attorneys

Healthcare providers, entities, and businesses in Provo, Utah or the surrounding areas are at risk of being investigated for healthcare fraud. If you’re being investigated, call the Oberheiden, P.C.. We have legal experience in healthcare fraud defense, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG and grand jury subpoenas, criminal defense, and internal investigations. Our Healthcare Fraud Defense Team includes such talent as a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, several former healthcare fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. We proudly serve clients in Provo as well as throughout the state of Utah.

To learn more about your legal options if you’re being investigated for healthcare fraud, call Oberheiden, P.C. and ask to speak with a member of our Healthcare Fraud Defense Team. Initial calls are free and confidential.

Provo, Utah Is Diligently Observed for Healthcare Fraud

Provo, Utah is one of nine locations in the United States that is diligently observed for healthcare fraud by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is a federal team of prosecutors and investigators from assorted federal agencies including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. Other federal agencies may be part of the team as well.

Provo and the surrounding areas are strictly monitored because of the number of residents in the area who are beneficiaries of federal healthcare programs. The number of beneficiaries increase the number of claims that the federal government receives. The increase in claims to the federal government for reimbursement causes the government to heavily scrutinize the area for higher instances of healthcare fraud. In 2016, the Department of Justice released a statement that they investigated around 300 cases of healthcare fraud. This breaks down to 80 cases involving individual providers and the rest of the cases centered on a healthcare entity or business. The agency recovered more than $900 million in fraudulently paid out claims.

What Is Federal Healthcare Fraud?

Federal healthcare fraud is the attempt of a healthcare provider, business, or entity to receive reimbursement for medical services or equipment from a federal healthcare programs, such as Medicaid, Medicare, Tricare, or federal workers’ compensation. It includes the filing of one or more false claims and is a violation of at least one of the following:

• The Anti-Kickback Statute. Federal healthcare law outright prohibits kickbacks in exchange for referrals. Any individual (including doctors, marketing representatives, and business owners) is subject to prosecution for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
• Stark Law. Stark Law, also known as the Self-Referral Law, prohibits doctors from referring patients to specific healthcare service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest or if there is a compensation arrangement. Note, however, that there are statutory exceptions to this law.
• False Claims Act. If you submit a claim to Medicare or any other federal healthcare program, you are required by law to abide by the False Claims Act. If the claim submitted to the federal government is discovered to be inaccurate, the federal government will likely launch an investigation into your billing practices under the criminal provisions of the False Claims Act.
• Prescription Fraud. The federal government pays special attention to healthcare practices that have an unusually high number of narcotic prescriptions. If you are suspected of running a “pill mill,” you are at a high risk of being investigated for insurance fraud and for violating DEA dispensing rules.
• Billing Fraud. The federal government is persistent about investigating the up-coding of claims. Up-coding means that the next higher code is used for a service when the billing is done. The federal government is also prone to investigating phantom billing (billing for services that were not provided), billing for patients who do not exist (referred to as ghost patients), and billing for equipment or services that are deemed not medically necessary.
• Certification Errors. The home healthcare and hospice industry is frequently a practice that the federal government chooses to maintain a close eye on. The most common accusations include fraudulent certification for home healthcare and hospice care.

Oberheiden, P.C. has a proven track record of success with helping our clients avoid criminal charges. If you’re being investigated in Provo, Utah or the surrounding areas for healthcare fraud, call Oberheiden, P.C. and ask to speak to an experienced healthcare fraud defense lawyer. The call is free and confidential.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former Department of Justice

Brian J. Kuester

Former U.S. Attorney
Former DA

John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach

Former Special Agent (OIG)

Michael Koslow

Former Supervisory Special Agent (FBI)

Chris Quick

Former Special Agent (FBI & IRS-CI)

Ray Yuen

Former Supervisory Special Agent (FBI)

A Look at the Civil and Criminal Penalties of Healthcare Fraud

Healthcare fraud in Provo can lead to civil or criminal charges. Both courts have penalties. Civil penalties include repayment of the amount you or your business received from the program, non-payment of future claims, and exclusion from filing claims with federal healthcare programs. You could also be the center of disciplinary hearings by the state board and you could lose your license and hospital privileges.

Criminal penalties include a criminal record, expensive fines, and you could also receive a federal prison sentence of:

• Up to 10 years for each count of healthcare fraud
• Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
• Life sentence if the healthcare fraud resulted in the death of a patient

Healthcare providers and businesses in Provo often ask us about the worst-case scenario for an allegation of this nature. The worst-case scenario is criminal charges and receiving a federal prison sentence. Whether or not you will face either of those will depend on many factors such as how severe the injuries were that were suffered by the patient, whether the prosecutor plans to pursue criminal charges, and why the investigation started.

Oberheiden, P.C. works to provide compelling and strategic legal defenses in Provo and the surrounding areas for providers, entities, and businesses facing healthcare fraud allegations. We utilize our dual experience as former healthcare prosecutors and as defense attorneys to provide the right defenses for each of our clients. If you’re under investigation for healthcare fraud, call us now. The call is free and confidential.

Is the Investigation Against You Criminal?

Healthcare fraud investigations can be civil or criminal in Provo, Utah or the surrounding areas. Investigations often start off as civil and then become criminal. This is why it is important to immediately contact Oberheiden, P.C. right away if you’re under investigation.

Being contacted by a prosecutor isn’t a good sign to rely on to determine if the investigation against you is criminal. Federal agencies with prosecutors have both civil and criminal prosecutors. That’s why you cannot use this as an indicator.

Signs of a criminal investigation include the receipt or serving of search warrants, seizure warrants, arrest warrants, target letters, contact from a federal criminal prosecutor, involvement from the IRS, or the receipt of a grand jury subpoena.

Healthcare Fraud Defenses in Provo, Utah

Oberheiden, P.C. is a healthcare fraud defense firm providing advocacy to individual healthcare providers, entire systems, and businesses in Provo, Utah and the surrounding areas. We’ve handled hundreds of healthcare fraud defenses cases. Several members of our firm have experience as former healthcare auditors and former healthcare fraud prosecutors with the Department of Justice and the Medicare Fraud Strike Force. We use our experience to develop strategic healthcare fraud defenses for our Provo clients.

Contact with the federal government. The main priority of our firm is to help clients avoid criminal charges. We’ve learned from our experience that the most effective way to do this is to immediately contact the federal government on behalf of our clients. This provides less uninterrupted time to the federal government to conduct their investigation against you or your business. Directly after we are retained, we contact the federal government. Within hours, we can usually get answers to the most important questions:

• What is the investigation about?
• What is the purpose of it?
• How long will the investigation take?
• What is the most likely outcome?

Analyzing evidence and the legal standards. The federal government must use evidence to meet a high legal standard to show that you committed a crime and that you acted with criminal intent. We analyze the evidence and the legal standards in each case. The federal government tries to use billing inaccuracies to try to prove that you committed a crime. However, we’ve found that billing inaccuracies rarely occur because of an actual crime. Rather, they happen because someone makes a mistake. While mistakes should be corrected, they shouldn’t lead to criminal penalties. The most common errors that cause healthcare fraud investigations include hiring unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in healthcare.

Strategic legal defenses for each case. Oberheiden, P.C. studies the facts involved in each case to develop strategic legal defenses for our Provo clients. This may also include researching and utilizing applicable statutory loopholes and exceptions. For instance, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a healthcare fraud case.

Working to protect your professional reputation. Healthcare fraud allegations can do damage to your professional reputation. It’s one of the main concerns that our clients have when they are being investigated. Oberheiden, P.C. looks to correct any misinformation given to the public by the media. We also address slanderous comments.

If you’re being investigated for healthcare fraud in Provo, Utah or the surrounding areas, call Oberheiden, P.C.. The initial call is free and confidential.

Frequently Asked Questions

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Additional Pages for Provo, Utah

• Provo Medicare fraud defense