Arkansas Healthcare Fraud Defense Lawyer

Healthcare Fraud Attorneys of Arkansas

What does it mean to be targeted in a federal healthcare fraud investigation? What do you need to know if you have received a subpoena or target letter from the U.S. Department of Justice (DOJ) or the U.S. Department of Health and Human Services’ Office of Inspector General (OIG)? What is the risk that you could be fined – or sentenced to federal prison? Is there a chance that you could lose your license to practice medicine?

Federal Authorities are Targeting Healthcare Providers in Arkansas

If you find yourself asking these questions, you are not alone. With increasing frequency, the DOJ, OIG, and other federal agencies such as the Drug Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), and the Internal Revenue Service (IRS), are targeting healthcare providers for a broad range of fraud-related offenses. This uptick in enforcement efforts within the healthcare industry is largely attributable to three main factors: (i) the federal government’s increased reliance on data analysis to examine healthcare providers’ program (Medicare, Medicaid, Tricare, and Department of Labor (DOL)) billing practices; (ii) the financial incentive audit contractors (such as Zone Program Integrity Contractors (ZPICs)) have to allege fraudulent billing practices; and, (iii) the financial incentives available to whistleblowers who report alleged fraudulent billing practices to the DOJ.

But, regardless of why your business or practice is under investigation, the potential outcomes for violating federal health law are the same. If you do nothing, at a minimum, you are likely to face recoupments, civil fines, and pre-payment review of future claims. Worst case, you could be charged with criminal healthcare fraud and an Arkansas healthcare fraud defense attorney can help you, as you could be faced with the loss of your professional license, program exclusion, and the prospect of years of federal incarceration.

Fortunately, these are not the only options. You have the right to defend yourself during the investigative process; and, in many cases, doing so effectively will result in the investigation being resolved without civil or criminal charges being filed. At Oberheiden, P.C., each Arkansas healthcare fraud defense lawyer has a long track record of successfully representing healthcare professionals during federal fraud investigations, and to date, not a single one of our clients has been forced to cease operations due to an investigation in which our federal health law practice has been involved.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Meet Our Arkansas Federal Healthcare Fraud Lawyers

Oberheiden, P.C. is a team of highly-experienced and nationally-recognized healthcare fraud defense attorneys. All Arkansas healthcare fraud defense attorneys in our firm have significant experience in healthcare fraud cases, and many of our lawyers served as federal healthcare fraud prosecutors with the DOJ prior to entering private practice. Our team also includes the Honorable Joe Kendall, the only former federal trial judge currently in private practice, who has particular experience in cases involving healthcare fraud allegations.

Meet our team.

10 Common Allegations Against Arkansas Healthcare Providers

Healthcare fraud investigations can focus on a variety of different allegations. When you engage our defense team to represent you, one of our first steps will be to determine the scope and nature of the government’s investigation (including whether the investigation is currently civil or criminal in nature). Some of the most common fraud-related allegations against healthcare professionals include:

1. Billing and Coding Errors

Billing and coding errors are among the most common triggers for a federal health care fraud investigation. Even unintentional – and arguably minor – mistakes can trigger federal government scrutiny; and, once a provider is in the government’s crosshairs, demonstrating that civil enforcement action or criminal prosecution is unwarranted can be extremely difficult. However, we have successfully handled hundreds of cases in Arkansas and nationwide involving allegations of unintentional and unintentional billing violations, and we can use our comprehensive knowledge of the federal program billing regulations to defend you.

2. Kickbacks, Bribes, and Rebates

The federal Anti-Kickback Statute imposes civil and criminal penalties for healthcare providers who are parties to a broad range of transactions. While this includes illicit transactions such as kickbacks and bribes, it includes a number of referral and other compensation-based arrangements as well. In fact, the Anti-Kickback Statute is so broad that most types of referral-related transactions have the potential to initially fall within the statute’s scope, especially between providers and pharmaceutical companies. Then it becomes incumbent upon the provider to demonstrate that one of the statute’s “safe harbor” provisions applies.

3. Physician Self-Referrals

The Stark Law applies to a subset of referral transactions commonly known as “physician self-referrals.” While the Stark Law is more limited in scope and exclusively civil in nature, it still presents the potential for substantial penalties in federal healthcare fraud investigations targeting physicians and their “related entities” for Stark Law violations.

4. False and Fraudulent Claims

Under the False Claims Act, it is a federal offense to submit any “false or fraudulent” claim under Medicare, Medicaid, Tricare, or the DOL healthcare benefit program. The False Claims Act imposes criminal penalties for intentional False Claims Act violations and civil penalties for unintentional billing and coding errors. These False Claims Act penalties apply on a “per claim” basis, which means that providers can face inordinate fines and damages in many cases.

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

Billing for medically-unnecessary services, supplies, or equipment is a common issue in federal healthcare fraud investigations. Under Medicare, Medicaid, Tricare, and DOL billing regulations, the federal government – not the billing healthcare provider – determines what constitutes “medical necessity.” This means that health care providers can not only find themselves being second-guessed but that they can often face penalties based on federal agents’ subjective determination of medical necessity.

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

Billing for services, supplies, or equipment not provided is another common allegation against healthcare providers, especially those with busy practices using ancillary service providers. Whether due to oversights, clerical mistakes, or coding errors, these violations should not subject providers to practice or business-threatening penalties.

7. Prescription Drug Fraud

Prescription drug fraud, particularly fraud involving opioid medications, has become a top federal law enforcement priority. In an effort to curtail the nation’s opioid epidemic, federal authorities including the DEA and the DOJ have chosen to target healthcare professionals who prescribe and dispense these medications. While some providers are undoubtedly distributing opioid medications improperly, most have clear and medically-sound reasons for prescribing these and other medications to their patients.

8. Falsifying Patient Records and Inaccurately Reporting Test Results

In billing and coding fraud investigations, federal agents and prosecutors will often include allegations that providers have falsified patient records and test results in order to justify fraudulent program billings. Once again, while these allegations may be founded in some cases, it is far more common that the government’s allegations are based upon misplaced assumptions or incomplete information.

9. Fraudulent Physician Certifications

The same holds true for cases involving alleged fraudulent physician certifications. While federal agents and prosecutors will often try to argue that certifications are the product of financial motive or influence from other outside factors rather than a physician’s independent medical examination, the evidence will often prove otherwise once it has been assembled and presented effectively.

10. Issues with Election Statements for Hospice Care

Among other allegations, hospices targeted in federal investigations will often face allegations of falsifying election statements as well. This includes forging patients’ signatures, failing to provide patients with complete and accurate information regarding the nature of hospice care, and submitting fraudulent election statements in support of Medicare billings.

Q&A with Founding Attorney Dr. Nick Oberheiden: Defending Against Allegations of Healthcare Fraud

Request a Confidential Assessment of Your Healthcare Fraud Investigation in Arkansas

We have former federal prosecutors on our team who are experienced in defending against the criminal charges that can come from healthcare fraud. For more information about how our highly-experienced Arkansas healthcare fraud defense lawyers can help you, please contact us to schedule a confidential case assessment. To speak with a member of our team as soon as possible, call 888-680-1745 or tell us how to reach you online now.

Additional Pages for Arkansas

• Arkansas federal criminal defense
• Arkansas Medicare fraud defense