West Virginia Health Care Fraud Defense

With a nationwide reputation and thousands of cases handled, Oberheiden, P.C.’s federal defense team offers skilled and aggressive legal representation for health care providers in West Virginia. If your business or practice is under investigation, call 888-519-4897 to speak with attorney in confidence.

Health care providers that bill Medicare, Medicaid, Tricare, and the Department of Labor (DOL) are subject to a bevy of federal laws and regulations. For those that prescribe or dispense medications as a part of their practice, the compliance obligations are even more onerous. Oversights and mistakes can have drastic consequences, and allegations of intentional fraud can lead to criminal fines and federal imprisonment.

At Oberheiden, P.C. we provide skilled and aggressive legal representation for West Virginia health care providers facing allegations of Medicare, Medicaid, Tricare, DOL, and prescription drug fraud. We provide representation at all stages of the process, from investigation through trial and appeal, and we seek to achieve favorable results for our clients by the most-efficient means possible. With centuries of combined experience and thousands of cases handled, our attorneys are intimately familiar with the laws, rules, process, and procedures involved in federal health care fraud cases, and we use this experience to protect our clients against dangerous and damaging allegations.

Experienced Federal Attorneys for Defense of Health Care Fraud Investigations and Charges in West Virginia

Our attorneys’ experience includes representing health care providers against virtually all health care fraud investigations in federal investigations and prosecutions involving the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and other federal agencies and task forces. We have successfully defended physicians, pharmacists, clinic owners, hospital and hospice administrators, durable medical equipment (DME) company executives, and other clients in cases involving the Anti-Kickback Statute, the Controlled Substances Act, the False Claims Act, the Stark Law, the federal health care statute (18 U.S.C. § 1347), and various other federal laws.

Although every case presents unique elements, most federal health care fraud cases tend to focus on the same general types of allegations. These include:

1. Billing and Coding Errors

Billing and coding errors are among the most-common allegations against health care providers. This includes patient-facing providers as well as suppliers and other entities that bill Medicare, Medicaid, Tricare, and the DOL. Typical allegations of “billing and coding fraud” include intentional and unintentional:

  • Double-billing – Submitting bills for the same services, supplies, or equipment to one or more federal health care benefit programs and/or private insurers.
  • Unbundling – Billing for services, supplies, and equipment at their individual billing rates rather than the discounted “bundled” rates provided for under the applicable program billing regulations.
  • Upcoding – Billing for a similar or related service that has a higher reimbursement rate than the service actually rendered.
  • Use of incorrect billing codes – Billing for an unrelated service, supply, or piece of equipment that is more expensive than the one which should have been billed.

2. Kickbacks, Bribes, and Rebates

Under the federal Anti-Kickback Statute (AKS), it is unlawful for health care providers to offer, solicit, pay, or receive any form of “remuneration” in exchange for referrals of business for federal health care benefit program beneficiaries. This includes rebates, kickbacks, bribes, and other forms of payment, both in cash and in kind. Depending upon the severity of the allegations (i.e. whether federal prosecutors allege intentional violations of the law), providers can face either civil or criminal penalties under the AKS.

3. Physician Self-Referrals

Under the Stark Law, physicians are prohibited from making referrals for Medicare or Medicaid-reimbursed “designated health services” to entities with which they have a financial relationship or in which they own an investment interest. This prohibition on so-called “self-referrals” applies to:

  • Clinical laboratory services
  • Physical therapy services
  • Occupational therapy services
  • Outpatient speech-language pathology services
  • Radiology and certain other imaging services
  • Radiation therapy services and supplies
  • Durable medical equipment and supplies
  • Parenteral and enteral nutrients, equipment, and supplies
  • Prosthetics, orthotics, and prosthetic devices and supplies
  • Home health services
  • Outpatient prescription drugs
  • Inpatient and outpatient hospital services

While the Stark Law is exclusively a civil statute, physicians and their related entities can still face severe penalties in self-referral investigations, including fines, recoupments, treble damages, pre-payment review, and program exclusion.

4. False and Fraudulent Claims

Under the False Claims Act (FCA), all types of health care providers can face civil or criminal prosecution for submitting any “false or fraudulent claim” for federal program reimbursement. This includes billing and coding violations as well as all other improper requests for reimbursement. Since the False Claims Act’s civil and criminal penalties apply on a per-claim basis, health care providers targeted under the FCA will often be at risk for extraordinary (and practice-threatening) financial liability.

5. Billing for Medically-Unnecessary Services, Supplies, or Equipment

Billing for medically-unnecessary services, supplies, or equipment is considered a “false or fraudulent claim” under the False Claims Act. Allegations of intentionally rendering medically-unnecessary services to patients can also lead to criminal prosecution under the federal health care fraud statute.

6. Billing for Services, Supplies, or Equipment Not Provided

Providers accused of billing for services, supplies, or equipment not provided can face prosecution under the False Claims Act and the federal health care fraud statute as well. While these cases will often entail allegations of intentional program fraud, providers will often have legitimate explanations for apparent patterns of “phantom billing” practices.

7. Prescription Drug Fraud

Prescription drug fraud is a serious offense that carries the potential for substantial fines and long-term imprisonment under the federal Controlled Substances Act. West Virginia is among several opioid “hot spots” in which federal authorities are aggressively targeting health care providers that prescribe and dispense opioid medications, and providers must have comprehensive records to support their opioid prescription, administration, and distribution practices.

8. Falsifying Patient Records and Inaccurately Reporting Test Results

Allegations of falsifying patient records and inaccurately reporting test results can lead to a variety of serious civil and criminal allegations. We have extensive experience representing providers in these types of cases, and our attorneys can use their in-depth knowledge of the legal and medical principles involved in federal health care fraud cases to counter any misguided allegations of intentionally defrauding federal government benefit programs.

9. Fraudulent Physician Certifications and Election Statements for Hospice Care

The physician certification and patient election statement requirements are unique aspects of hospice care. They are also at the center of many federal investigations targeting hospices and certifying physicians; and, left unchecked, allegations of physician certification or election statement fraud can lead to serious charges and severe consequences.

10. Health Care Fraud Attempt and Conspiracy

Due to the extreme breadth of the federal attempt and conspiracy statutes, allegations of attempt and conspiracy can lead to significant exposure for West Virginia health care providers even in cases where no actual fraudulent billing or prescription practices have occurred. As a result, even providers who are certain that they have not improperly billed Medicare, Medicaid, Tricare, or the DOL must still take any inquiries from federal authorities extremely seriously.

Why Choose Oberheiden, P.C. in West Virginia?

Our federal health care fraud defense team is comprised entirely of senior attorneys, many of whom spent decades prosecuting federal health care fraud cases with the DOJ prior to entering private practice. Our results speak for themselves, and our attention to detail and attentiveness to our clients’ needs make us trusted advocates and advisors for health care providers nationwide.

When you choose Oberheiden, P.C. for your federal health care fraud case in West Virginia:

  • We will take action as soon as possible. At the first available opportunity, we will intervene in the government’s investigation and begin gathering the information we need to defend you effectively.
  • We will seek a prompt pre-trial resolution. We have resolved the majority of our clients’ cases without charges being filed. If you have already been charged (or if charges cannot be avoided), we will work diligently to secure a favorable pre-trial resolution.
  • We will meticulously examine every detail. In federal health care fraud cases, the details matter. From which regulations were effective at a particular point in time to why an employee chose a particular billing code, we will seek to use all relevant facts to your advantage.
  • We will keep you informed and involved. The more you know about your case, the more input you can provide, and the more input you can provide, the more we can customize our defense your particular facts and circumstances. We work closely with our clients to make sure we are presenting the strongest possible defense.
  • We will fight unwaveringly to protect you. As long as we are your defense counsel, we will do everything in our power to protect you against the severe consequences of a conviction at trial.

Oberheiden, P.C. | Federal Health Care Fraud Defense Attorneys Serving West Virginia

If your West Virginia health care business or medical practice is being targeted by the DEA, DOJ, OIG, or any other federal authority, our defense attorneys can help protect you. To speak with a member of our federal health care fraud defense team in confidence, call 888-519-4897 or request a free case assessment online now.

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