Virginia Health Care Fraud
Proven Virginia Health Care Fraud Defense Attorneys
Federal authorities are aggressively targeting health care providers throughout Virginia in high-stakes fraud investigations. If your business or practice is under investigation, you need the experienced federal defense team at Oberheiden, P.C.
Health care providers in Virginia are in the federal government’s cross-hairs. From opioid diversion to payment of unlawful referral fees (or “kickbacks”), agencies from the Drug Enforcement Administration (DEA) to the Department of Health and Human Services (DHHS) are aggressively targeting providers across the industry for a broad range of federal health care law violations.
Oberheiden, P.C., is a federal health care fraud defense law firm that represents providers and other industry players in civil and criminal investigations in Virginia. Our Virginia health care fraud defense attorneys attorneys rely on well over a century of combined legal experience – including decades of experience as senior federal prosecutors – to help clients make smart decisions and avoid unnecessary consequences due to federal health care fraud investigations.
Are you being targeted for submitting “false or fraudulent” claims to Medicare, Medicaid, or Tricare? Are you being accused of contributing to the nation’s opioid epidemic? Are you, like many providers, at a loss for why you are facing government scrutiny? We can use our extensive experience to help you, and we can deal with the government on your behalf so that you can get back to managing your business or practice as usual.
What Is Health Care Fraud?
What does it mean to be under federal investigation for health care fraud? Unfortunately, this question does not have a straightforward answer, and this underlies the complexity of responding appropriately to an inquiry from the DEA, the DHHS Office of Inspector General (OIG), the Department of Justice (DOJ), or any of the various other federal agencies or task forces involved in health care fraud enforcement.
“Health care fraud” encompasses a broad range of violations under a laundry list of federal statutes, including violations that are both civil and criminal in nature. Additionally, different agencies have different priorities when it comes to health care fraud enforcement. As a result, when facing a federal health care fraud investigation, there are two pieces of information that are critical to the initial stages of formulating an effective defense:
- The nature of the investigation (i.e., is it civil or criminal?); and
- The specific agency(ies) and/or task force(s) involved.
Once this information has been obtained, then it is possible to discern the specific issues or allegations that triggered the investigation and structure a comprehensive defense strategy that is custom-tailored to the specific facts and circumstances involved.
At Oberheiden, P.C., our Virginia health care fraud defense attorneys represent health care providers in federal investigations involving all health care fraud allegations. For example, we routinely represent practitioners, providers, and businesses accused of:
- Medicare, Medicaid, and Tricare coding violations (“billing fraud”)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations
- Controlled Substances Act and DEA registration violations (including prescription drug fraud)
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, and election statements
Regardless of the specific allegations against you (and regardless of whether you know why you are under investigation), it is critical that you engage experienced legal representation immediately. Our federal health care fraud defense team is available 24/7, and we can arrange for you to speak with one of our Virginia health care fraud defense lawyers about your situation in person or over the phone as soon as possible.
Sources of Authority in Federal Health Care Fraud Investigations
1. The False Claims Act
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by the federal government. In addition to applying to government contractors, the False Claims Act also applies to health care providers and other companies that bill Medicare, Medicaid, Tricare, and other health care benefit programs. The False Claims Act includes provisions for civil and criminal penalties. And since these penalties apply on a “per-claim” basis, practitioners and entities accused of violating the False Claims Act can often face exorbitant financial liability (in addition to program exclusion and possible prison time).
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, and receipt of referral fees and all other forms of “remuneration” in connection with referrals for Medicare, Medicaid, Tricare, and DOL beneficiaries. Like the False Claims Act, the Anti-Kickback Statute provides for both civil and criminal prosecution of health care providers. And providers charged with AKS violations can face life-altering and practice-threatening penalties.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals.” While the Stark Law is much more limited in scope than the False Claims Act and the Anti-Kickback Statute, physicians and related entities targeted in Stark Law investigations can still face sizable civil penalties.
4. The Controlled Substances Act
The Controlled Substances Act is one of the primary federal statutes used to prosecute providers suspected of engaging in pharmaceutical fraud. This includes writing prescriptions for unnecessary medications, providing drugs to dependent patients, diverting prescription medications, selling prescriptions, and various other unlawful practices. While the Controlled Substances Act is a substantial piece of legislation that does everything from authorizing the DEA to establishing the federal “Schedules” of controlled substances, it also includes criminal provisions with major penalties.
5. The Federal Health Care Fraud Statute
The health care fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully execute, or attempt to execute, a scheme or artifice – (1) to defraud any health care benefit program; or (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.” Similar to the False Claims Act, the health care fraud statute is extraordinarily broad and provides federal prosecutors with numerous ways to target health care providers and it presents one of the greatest risks in many health care fraud investigations.
6. Program Billing Regulations
In addition to federal statutes such as the ones listed above, health care providers that participate in Medicare, Medicaid, Tricare, DOL, and other health care benefit programs are also subject to these programs’ stringent billing regulations. Intentional and unintentional violations can trigger recoupments and other penalties during audits and investigations. With these regulations constantly changing, providers must maintain comprehensive and proactive compliance programs in order to mitigate their risk of prosecution.
7. DOJ Mandates
The Department of Justice routinely issues releases identifying new law enforcement priorities and task forces, and its directions guide the wave of enforcement proceedings targeting health care providers in specific areas of the industry and for specific types of violations. Recently, the DOJ has intensified its focus on opioid fraud and abuse, launching both the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force within a matter of months.
These are in addition to the numerous federal laws and other sources of authority that apply more generally but which can also come into play in health care fraud investigations. For example, in a health care fraud investigation, it is not uncommon for DOJ prosecutors to seek the evidence necessary to charge practitioners and company executives with mail fraud, wire fraud, tax fraud, money laundering, conspiracy, and various other federal offenses as well.
5 Reasons to Choose Oberheiden, P.C., and our Virginia Federal Health Care Fraud Defense Lawyers
So, you have been contacted by federal authorities. What now? With the extreme complexities and consequences involved in federal health care fraud investigations, your next step should be to engage an experienced and proven federal defense law firm right away. Here are five reasons why health care providers and other Medicare, Medicaid, and Tricare participants in Virginia should hire Oberheiden, P.C.:
- Our Team of Federal Defense Attorneys and Former Prosecutors – Oberheiden, P.C. consists of a team of federal defense attorneys and former federal prosecutors who have devoted their careers to federal health care fraud matters.
- Our Extensive Experience in Health Care Fraud Investigations – Our Virginia health care fraud defense attorneys have handled thousands of federal health care fraud audits, investigations and prosecutions on behalf of health care providers in Virginia and nationwide.
- Our Established Track Record Prior to Charges Being Filed – We have resolved the majority of our cases without our clients facing federal charges.
- Our Focus on Federal Health Care Fraud Defense – Our practice focuses on federal health care fraud defense. Our Virginia health care fraud defense attorneys have experience representing physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually all other types of health care providers.
- Our Proven Defense Strategies and Custom-Tailored Legal Representation – We take an aggressive approach to representing our clients that is designed to allow us to quickly and cost-effectively assert custom-tailored defense strategies.
Discuss Your Federal Health Care Fraud Investigation in Confidence
If your Virginia health care business or practice is being targeted in a federal health care fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with a member of our federal defense team for free, call our Virginia health care fraud defense lawyers 214-692-2171 or inquire online now.
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