West Palm Beach Health Care Fraud
Federal law enforcement is aggressively targeting health care providers in West Palm Beach, FL. If your business or practice is being investigated, you need the experienced West Palm Beach health care fraud defense attorneys at Oberheiden, P.C., right away.
Agencies, including the DOJ, OIG, and DEA, are making a concerted effort to rein in health care fraud, waste, and abuse in America. Accordingly, federal agents have set their sights on key cities and regions where fraud has been most rampant or where a particularly large number of federal beneficiaries reside. West Palm Beach is one of those areas.
We are a federal health care fraud defense firm representing both individual providers and business entities in West Palm Beach.
The attorneys at Oberheiden, P.C., are backed by their more than a century’s worth of cumulative legal experience. Several of the lawyers on our staff worked as federal prosecutors at the Department of Justice or in other federal prosecutorial roles before transitioning to private legal defense.
Our skilled West Palm Beach health care fraud defense attorneys have a reputation for sparing our clients from criminal charges and a track record to back it up. Let us use our experience and insight to defend you against federal scrutiny. There’s a lot on the line – including your freedom, potentially – and we will do everything we can to protect it. In the majority of our cases, our clients have maintained their practice, their license, and their reputation without a single criminal charge ever being filed.
What Is Health Care Fraud?
What does it mean to be under investigation for health care fraud in West Palm Beach? That depends on a number of things, for example:
- Which agencies are involved in investigating you?
- Is your investigation currently civil or criminal in nature?
- What conduct or activity alerted federal authorities to your practice?
- What kind of services have you billed the government for?
- How long has the investigation been going on?
- If charges are being considered, are they imminent? And which statutes are on the table?
There are many kinds of health care fraud. Some common examples include:
- Billing fraud (Medicare, Medicaid, Tricare, etc.)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations (physician self-referral)
- Controlled Substances Act / DEA registration violations (including prescription drug fraud)
- Providing / Billing for medically unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
When a client hires us, we go to work immediately toward getting the facts we need. In addition to contacting the investigating agencies directly, we conduct our own investigation to determine exactly what’s going on and how we can most effectively defend against the government’s suspicions. In the next section, we review several of the criminal statutes and other laws most commonly used in health care fraud cases.
The Most Commonly Invoked Health Care Fraud Laws
Below, we review just a handful of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of health care professionals in West Palm Beach, FL.
1. The False Claims Act
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” invoices or claims to the federal government. Any health care provider or business that submits a claim for payment to a program such as Tricare, Medicare, or Medicaid will be subject to the requirements of the FCA as well as the civil and criminal penalties for violating it. Those penalties can be steep, as they apply on a “per claim” basis, and they can also include program exclusion and/or time in federal prison.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offering, paying, soliciting, or receiving of remuneration (including referral fees) in exchange for patient referrals if the patient is a federal beneficiary. As with the False Claims Act, the AKS provides for both civil and criminal prosecution of a health care provider. An AKS charge can be life-altering, and it may threaten your medical practice’s very existence.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals,” a term that has been defined more broadly than you might expect. Even though the Stark Law is more limited in scope than the Anti-Kickback Statute, it still results in far too many cases of doctors and medical practices being charged when the facts really do not warrant the Stark Law’s sizable civil penalties.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is the primary source of the United States’ drug policies, and it is also used to prosecute health care providers who are suspected of misusing their DEA registration or otherwise engaging in pharmaceutical fraud. This includes writing unnecessary prescriptions, selling prescriptions or selling medications, providing certain substances to drug-dependent patients, opioid diversion, and other unlawful practices. Most “pill mill” investigations in West Palm Beach pertain to the Controlled Substances Act.
5. The Federal Health Care Fraud Statute
For federal prosecutors, 18 U.S.C. 1347 functions as a go-to charging instrument. It is written broadly and is generally referred to as simply “the health care fraud statute.” Its plain text makes it a federal crime 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.”
6. Other Fraud Statutes
In addition to the criminal statutes described above, health care providers in West Palm Beach may face allegations of other, related charges. These include:
- Wire fraud
- Mail fraud
- Making false statements
- Federal conspiracy
- Wrongful use of health information
7. Program Billing Regulations
The above statutes notwithstanding, health care benefits agencies such as the CMS may establish their own rules and regulations. Violating these program billing regulations may have extremely serious consequences, even if there is no evidence of intent (whereas most health care fraud statutes do require proof of intent). Care providers in West Palm Beach can mitigate their risk of prosecution by maintaining a proactive compliance program.
8. DOJ Mandates
Mandates from the Department of Justice are public announcements or internal memoranda about which legal matters DOJ agents should prioritize. Currently, health care fraud and opioid diversion are among the Department’s top priorities. The DOJ made the seriousness of this priority clear when it recently announced the formation of dual federal task forces within mere months of each other: the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force.
5 Reasons to Trust Oberheiden, P.C. and Our West Palm Beach Federal Health Care Fraud Defense Lawyers
Here are five reasons why health care providers and other Medicare, Medicaid, and Tricare participants in West Palm Beach should choose Oberheiden, P.C., as their federal health care fraud defense lawyer:
- Our Extensive Experience in Health Care Fraud Investigations – Our proven West Palm Beach health care fraud defense attorneys have handled thousands of federal health care fraud audits, investigations, and prosecutions on behalf of health care providers in West Palm Beach and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, we have been able to end criminal investigations without the filing of criminal charges.
- Our Focus on Federal Health Care Fraud Defense – Health care fraud defense is one of our principal focuses as a law firm. Our established West Palm Beach health care fraud defense lawyers have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually every other category of health care provider.
- Our Experience on Both Sides – Several of the senior defense attorneys on our team are also former federal prosecutors, having spent years or decades working for the other side. We believe this “dual perspective” helps us negotiate efficiently and effectively with current federal prosecutors.
- Our Aggressive Defense Strategies – Our committed West Palm Beach health care fraud defense attorneys take an aggressive approach to defending our clients in every single case. Your freedom and your financial interests may depend on it. We never lose sight of that, and it drives every second we spend representing you.
Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm can make all the difference in the outcome of your investigation or criminal matter.
Discuss Your Federal Health Care Fraud Investigation in Confidence
If your West Palm Beach health care practice or company 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 our West Palm Beach health care fraud defense lawyers for free, call 214-692-2171 or inquire online, right away.