California Healthcare Fraud Defense Attorneys
Proven California Healthcare Fraud Attorneys
California Healthcare Fraud
Defense Team Lead
California Healthcare Fraud
Defense Team Lead
Former Prosecutor
California Healthcare Fraud
Defense Team Lead
California is a key battleground in the federal government’s fight against healthcare fraud. Healthcare providers from San Diego to San Francisco are at risk from fraud investigations. Have you been contacted by federal authorities? Experienced California healthcare fraud defense attorneys from our team can help. Call 888-680-1745 now.
As a healthcare provider, one of the greatest threats to your practice is a federal investigation. Billing fraud in federal benefit programs leads to government interest in all those billing Medicare, Medicaid, and Tricare in the healthcare industry. As a result, legitimate healthcare providers and medical professionals get caught up in high-stakes federal cases. In California, large numbers of patients and providers mean a high perceived risk for fraud.
Oberheiden, P.C. can help protect healthcare providers against unwarranted consequences due to aggressive fraud investigations. With a nationwide presence, we have seen the scope of the federal government’s efforts to combat program fraud in California and across the country. We know that California providers are at risk for falling within the government’s crosshairs. But, we also know that fraud allegations can be wrong.
It is critical to hire legal counsel when contacted by federal agents. Federal inquiries can grow quickly. Intervening early in the matter can limit the risk of negative outcomes. Federal investigations can lead to criminal charges, but it is possible to avoid charges entirely. At Oberheiden, P.C., we focus on keeping our clients’ cases civil. Our California healthcare fraud defense lawyers aim to resolve matters without criminal charges filed.
What Is Healthcare Fraud?
Are you under investigation by the DOJ, DEA, or OIG? If so, you are likely a suspect of federal healthcare fraud. So, what is “healthcare fraud”?
Legitimate healthcare providers are stunned to hear of allegations of fraud from the federal government. Many are equally surprised to learn of the broad definition for “healthcare fraud”. The term does not refer to any specific type of unlawful action. Rather, it refers to a range of offenses defined under a variety of statutes. All generally mean improperly receiving funds from Medicare, Medicaid, Tricare, and other programs. A healthcare fraud investigation could mean that your Medicare billings have certain markers for fraud.
A part of healthcare fraud many providers find surprising is that “fraud” does not imply “intent.” Evidence of intent is generally required for a criminal prosecution. But, civil investigations can lead to fines, program exclusion, and other penalties. These penalties can even be for accidental violations. You can do your best to comply with federal program billing guidelines, but you are not immune from prosecution. If you have improperly billed the federal government, you could face civil charges. A judgment against you will almost certainly have damaging results for your business or practice.
At Oberheiden, P.C., each California healthcare fraud defense lawyer represents healthcare providers in civil and criminal fraud investigations. Allegations may involve:
- Anti-Kickback Statute violations
- Controlled Substances Act violations (including prescription drug fraud)
- False Claims Act violations
- Stark Law violations
- Medicare, Medicaid, and Tricare fraud
- Department of Labor (DOL) fraud
- Providing and billing for medically-unnecessary services (or health insurance company fraud)
- Billing for services not actually rendered to patients
- Falsifying patient medical records, prescriptions, physician certifications, and election statements
- All other forms of “healthcare fraud”
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)
1. False Claims Act (FCA)
The False Claims Act (FCA) prohibits billing a federal government program with a false or fraudulent claim. This includes both intentional and unintentional billing errors. It covers all providers billing to Medicare, Medicaid, Tricare and/or any other federal benefit program(s). Civil penalties for accidental infringements of the FCA include fines, recoupments, treble damages, and program exclusion. Providers charged criminally under the FCA may spend time in federal prison.
2. Anti-Kickback Statute (AKS)
The Anti-Kickback Statute (AKS) bars the offer of; payment for; request for; or receipt of referral fees or any form of goods or services in exchange for referring a Medicare, Medicaid, Tricare, or DOL recipient for treatment. Like the False Claims Act, the AKS includes both civil and criminal enforcement provisions. The AKS’s prohibitions are quite broad, but the law also includes several “safe harbors.” Showing safe harbor compliance is a key defense strategy for many providers.
3. Stark Law
The Stark Law prohibits physician self-referrals. A civil statute, its scope is limited to physicians, their family members, and their related entities. Similar to the Anti-Kickback Statute, the Stark Law contains broad restrictions that safe harbors and exclusions help ease.
4. Controlled Substances Act (CSA)
The Controlled Substances Act (CSA) charges providers who prescribe, administer, and dispense prescription medicines improperly. The Act also covers DEA registration violations. Other allegations include prescribing medically unnecessary drugs, diverting drugs, and other forms of drug fraud.
5. Federal Healthcare Fraud Statute
According to the healthcare fraud statute, 18 U.S.C. 1347, it is a federal crime to knowingly and willfully execute, or attempt to execute, a scheme or deception to: – (1) to defraud any healthcare benefit program; or (2) Obtain, by means of false or fraudulent acts, representations, or promises, any money or property owned by, or under the custody or control of, any healthcare benefit program. ” The definitions of “knowingly” and “willfully” are much broader than most people would expect. And as a result, many providers will be at risk for criminal prosecution under 18 U.S.C. 1347 in federal healthcare fraud investigations.
6. Program Billing Regulations
Medicare, Medicaid, Tricare and the DOL have their own complex set of billing rules and regulations. Violations can be prosecuted as breaking False Claims Act laws and 18 U.S.C. 1347. Providers who fail to employ compliance programs can be at risk for substantial penalties.
7. DOJ Mandates
The Department of Justice is the nation’s chief law enforcement agency. Part of its role is to set policy for federal law enforcement initiatives and priorities. The DOJ devotes much of its resources to combat healthcare fraud. There is a special emphasis on Medicare fraud and opioid prescription-related offenses. The DOJ decides which states need the most attention. California is among the states getting the most.
5 Reasons to Choose Oberheiden, P.C., for Your Federal Healthcare Fraud Case in California
During a federal healthcare fraud investigation, your choice of California healthcare fraud defense attorney impacts the outcome of your case. There are five reasons why healthcare providers in California and nationwide trustdefense teamOberheiden, P.C.
- Experience on Both Sides of Healthcare Fraud Investigations – Many of our attorneys are former prosecutors with experience in the DOJ.
- Favorable Results Prior to Charges Being Filed – Our healthcare fraud defense attorneys resolve the majority of cases without civil or criminal charges.
- Exclusive Focus on Federal Healthcare Fraud Defense – Our practice focuses on federal healthcare fraud defense. We are known for our experience in complex federal investigations throughout California and nationwide.
- Aggressive Intervention and Personalized Representation – We take an aggressive approach starting with early intervention in the government’s investigation. Plus, we customize our arguments to the facts of each individual case.
- Trial-Ready Defense Strategies – We seek to resolve all cases as quickly as possible. But, we are ready for trial when in our client’s best interest.
Frequently Asked Questions
Q: What is the Stark Law?
The Stark Law limits when a physician can make a referral for certain services reimbursable by Medicare. In particular, the law prohibits a provider from referring patients to another provider with whom there is a financial relationship. For example, a doctor who is a co-owner of a lab must be careful when referring patients to the lab. Not all referrals are illegal under the Stark Law. Important exceptions apply. To learn more about creating a legal referral program, contact us today.
Q: What is the Eliminating Kickbacks in Recovery Act?
Congress passed the Eliminating Kickbacks in Recovery Act (EKRA) to reduce the number of people profiting from referrals for treatment. The EKRA forbids accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or labs. While the EKRA focuses on payments made by those listed above, the law’s reach goes beyond these groups. This is because any healthcare provider or professional referring patients to these facilities may be counter to the law’s anti-kickback provision. Operating or referring patients to a recovery home, clinical treatment facility, or lab, can be tricky. It is important to discuss the referral arrangement with an accredited California healthcare fraud defense attorney.
Q: Why am I being accused of ‘healthcare fraud’?
Federal agencies aggressively target physicians, pharmacists, and other providers for healthcare fraud in California. Healthcare fraud is a broad term covering various types of civil and criminal offenses. Included are violations of the False Claims Act, the Anti-Kickback Statute, and the Stark Law. Billing and coding violations are common triggers for federal attention. There are, however, numerous other alleged forms of wrongdoing that can lead to federal action.
Q: Should I cooperate with federal investigators?
It may make sense to cooperate with federal agents in some healthcare fraud cases. But, you should not do so until you’ve spoken with a fraud defense attorney. When speaking to government agents on your own, you are likely unaware of the investigation’s reach. You also don't know what information the government already has. Therefore, a minor omission or misstatement can raise suspicion. Such suspicions can potentially result in additional, and unnecessary federal review. If you believe you are under investigation for healthcare fraud, contact a proven healthcare fraud defense attorney as soon as possible. You and your attorney can examine the allegations and determine the best response to avoid charges.
Q: What can I do to avoid healthcare fraud charges?
The best way to avoid healthcare fraud charges is to take a proactive approach to compliance. Develop a strong compliance plan to give employees proper direction. You always want their actions to comply with applicable laws and regulations. A concrete plan also conveys management’s commitment to compliance. When the federal government identifies a potential violation, one factor considered is the existence of an effective compliance program. A healthcare fraud defense attorney can identify potential areas of non-compliance and work with you to address any flaws. However, if the government has already initiated an investigation, it is essential to meet with your own attorney to create a defense strategy.
Schedule a Free Initial Consultation with Our California Healthcare Fraud Defense Attorney
To commit healthcare fraud is against the law and can lead to a healthcare fraud indictment. If you would like to speak with our federal health care fraud defense team about your investigation in California, we encourage you to contact us 24/7. You can call a California healthcare fraud defense lawyer at our firm for a free consultation at 888-680-1745 or contact us online. If a member of our team is not available immediately, please leave a message. We will respond to your inquiry as soon as possible.
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