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Virginia Healthcare Fraud

Proven Virginia Healthcare Fraud Defense Attorneys

Virginia Healthcare Fraud

Federal authorities are aggressively targeting healthcare 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.

Healthcare 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 healthcare law violations.

Oberheiden, P.C., is a federal healthcare fraud defense law firm that represents providers and other industry players in civil and criminal investigations in Virginia. Our Virginia healthcare 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 healthcare 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 Healthcare Fraud?

What does it mean to be under federal investigation for healthcare 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 healthcare fraud enforcement.

“Healthcare 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 healthcare fraud enforcement. As a result, when facing a federal healthcare 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., Virginia healthcare fraud defense attorneys represent healthcare providers in federal investigations involving all healthcare 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 healthcare fraud defense team is available 24/7, and we can arrange for you to speak with one of our Virginia healthcare fraud defense lawyers about your situation in person or over the phone as soon as possible.

Sources of Authority in Federal Healthcare 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 healthcare providers and other companies that bill Medicare, Medicaid, Tricare, and other healthcare 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 healthcare 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 Healthcare Fraud Statute

The healthcare 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 healthcare 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 healthcare benefit program.” Similar to the False Claims Act, the healthcare fraud statute is extraordinarily broad and provides federal prosecutors with numerous ways to target healthcare providers and it presents one of the greatest risks in many healthcare fraud investigations.

6. Program Billing Regulations

In addition to federal statutes such as the ones listed above, healthcare providers that participate in Medicare, Medicaid, Tricare, DOL, and other healthcare 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 healthcare 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 healthcare fraud investigations. For example, in a healthcare 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 Healthcare Fraud Defense Lawyers

So, you have been contacted by federal authorities. What now? With the extreme complexities and consequences involved in federal healthcare fraud investigations, your next step should be to engage an experienced and proven federal defense law firm right away. Here are five reasons why healthcare 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 healthcare fraud matters.
  • Our Extensive Experience in Healthcare Fraud Investigations – Our Virginia healthcare fraud defense attorneys have handled thousands of federal healthcare fraud audits, investigations and prosecutions on behalf of healthcare 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 Healthcare Fraud Defense – Our practice focuses on federal healthcare fraud defense. Our Virginia healthcare fraud defense attorneys have experience representing physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually all other types of healthcare 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.

Frequently Asked Questions

What is the False Claims Act?


The False Claims Act is the main federal healthcare fraud statute in the United States. The False Claims Act prevents anyone from knowingly submitting a false or fraudulent claim to a federally funded program. However, it is important to understand that “knowingly” in this context refers to the submission of the claim and not an intent to defraud the government. Thus, even an unintentional billing code mistake or pattern or minor errors can result in civil liability. However, there are several defenses to alleged violations of the False Claims Act, many of which involve a practitioner’s lack of knowledge of the errors. An experienced Virginia federal healthcare fraud defense attorney can help you better understand the nature of the government’s allegations and how to best defend against them.

What is the difference between the Anti-Kickback Statute and the Stark Law?


Both the Anti-Kickback Statute (AKS) and the Stark Law limit a provider’s ability to receive referral payments. However, the two laws are distinct in several respects. The AKS is a criminal law that forbids providers from receiving or paying anything of value for referring a patient whose medical bills are covered under a federal program, such as Medicaid or Medicare. Meanwhile, the Stark Law applies to all patients—even those who do not receive government benefits. Furthermore, the Stark Law limits the situations in which a provider refers patients to another practice in which the referring party has a financial interest. Both statutes can result in significant civil liability, however, only the AKS carries the possibility of criminal sanctions. If you are under investigation for healthcare fraud, get in touch with an experienced Virginia federal healthcare fraud defense attorney immediately to protect your interests.

When are physician kickbacks allowed?


In the healthcare industry, kickbacks or referral fees are common. However, some referral arrangements run afoul of federal healthcare fraud laws. For example, the Eliminating Kickback in Recovery Act prohibits physicians from accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or laboratories. The Anti-Kickback Statute prohibits a physician (or anyone else) from paying or receiving anything of value for referring a patient whose medical bills are being covered by a federally funded program. Lastly, the Stark Law imposes civil liability on providers who refer patients to practice in which they have a financial interest. While nothing prohibits referral arrangements in general, healthcare providers should consult with a Virginia federal healthcare fraud defense attorney to ensure that an arrangement does not violate federal law.

Which federal agencies are in charge of investigating healthcare fraud?


Federal healthcare fraud laws are very complex, and this is reflected in the government’s enforcement structure. Primarily, the Federal Bureau of Investigation is responsible for investigating claims of healthcare fraud. However, the FBI often cooperated with one or more other federal agencies. Thus, if the DEA, OIG, DEA or other federal agency is contacting you with questions about an investigation, you should assume that you are under investigation for healthcare fraud and take the necessary precautions. The most important thing to keep in mind is that anything you say to an investigator can be used against you later. Thus, it is best not to speak with any federal agent or investigator until you speak with a Virginia federal healthcare fraud defense attorney first. A lawyer can help you understand the nature of the investigation, what is at stake, and how to effectively respond to investigators to minimize your risk.

Discuss Your Federal Healthcare Fraud Investigation in Confidence

If your Virginia healthcare business or practice is being targeted in a federal healthcare fraud investigation, we strongly encourage you to contact our federal defense team for a confidential case assessment. To speak with a Virginia healthcare fraud lawyer for free, call 888-680-1745 or inquire 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.

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