Hawaii Healthcare Fraud Attorneys
Hawaii Healthcare Defense
Team Lead
Contact Nick1050 Queen Street #100
Honolulu, HI 96814
888-680-1745
Our federal healthcare fraud defense team provides skilled legal representation for licensed providers, executives, administrators, and business owners in Hawaii. If you are facing an audit or investigation, the Hawaii healthcare fraud attorneys at Oberheiden, P.C. can help you avoid drastic consequences.
Why are auditors or federal investigators scrutinizing your medical practice’s billing records? What is healthcare fraud? Could you really be guilty of violating health care law? If so, what do you need to do in order to avoid severe civil or criminal penalties? With increasing frequency, healthcare providers in Hawaii are being forced to grapple with these difficult questions.
Combating fraud, waste, and abuse in the federal healthcare benefit systems is a top priority for senior officials at the Centers for Medicare and Medicaid Services (CMS), the U.S. Department of Defense (DOD), the U.S. Department of Justice (DOJ), the U.S. Department of Health and Human Services (DHHS), the U.S. Department of Veterans Affairs (VA), and other federal agencies. Fighting the nation’s opioid epidemic is a top federal priority as well, and the DOJ and other agencies have chosen to tackle the problem by targeting healthcare providers that prescribe and dispense opioid medications. These factors combine to create extreme risks for healthcare providers, and those that are targeted for prosecution can face serious consequences such as loss of program eligibility, recoupments, fines, treble damages, and even federal imprisonment.
Two Months, Two High-Profile Cases of Criminal Healthcare Fraud in Hawaii
Consider this: In May 2019, a physical therapist in Oahu was sentenced to 42 months in prison, $3.7 million in restitution, and a $3.7 million forfeiture for submitting false claims to Medicare, Medicaid, and Tricare over a six-year period. According to the DOJ, his unlawful conduct included misrepresenting that he treated patients who were in fact seen by unlicensed staff members and “rounding up” the duration of patient visits to the maximum time allowed. At the sentencing stage of the doctor’s case, the judge emphasized the importance of imposing a substantial sentence in order to, “deter[] others from committing similar crimes.”
Two months later, a doctor in Maui pleaded guilty to two counts of healthcare fraud and one count of prescription drug fraud following a Drug Enforcement Administration (DEA) investigation. According to the DOJ, the doctor was charged with billing Medicare and Medicaid for prescriptions that he wrote for his patients but then subsequently delivered to other individuals. He was also charged with keeping prescribed medications in order to “creat[e] a stockpile from which he could provide ‘trial samples’ to patients without writing them a prescription.”
These are just two of the most high-profile cases from recent years. Many more health care providers and medical businesses in Hawaii are facing audits and investigations, and those that are not prepared to defend themselves are facing severe penalties.
When is it Time to Be Concerned?
Program auditors and federal agents are working around the clock to fight fraudulent healthcare practices and prosecute healthcare providers who intentionally violate the law. So, as a licensed provider, executive, administrator, or business owner in Hawaii, when is it time for you to be concerned?
- You have Been Contacted by a MAC, RAC, UPIC, or ZPIC – Medicare administrative contractors (MACs), recovery audit contractors (RACs), unified program integrity contractors (UPICs), and zone program integrity contractors (ZPICs) all work with CMS to identify fraudulent overbillings and recoup overpayments on behalf of the federal government. If you have been contacted by one of these contractors, your practice or business is being audited, contact a healthcare fraud defense lawyer and engage a federal healthcare fraud defense counsel promptly.
- You have Been Contacted by Federal Agents Who Want to Conduct “Interviews” – While federal authorities use a number of formal mechanisms to collect evidence during investigations (more on this below), they also frequently seek to informally “interview” practitioners and other individuals. These inquiries may seem non-threatening, but federal agents do not visit healthcare providers’ homes and businesses for no reason. If a federal agent has shown up at your door, it is important that you speak with Hawaii healthcare fraud lawyer right away.
- You have Received a Target Letter or Civil Investigative Demand (CID) – Target letters and civil investigative demands (CIDs) are investigative tools that allow federal authorities to collect an extraordinary amount of information. The grounds for legally challenging the government’s investigative efforts at this stage are extremely limited, and targets must be extremely careful to avoid unnecessarily disclosing information that could expose them to federal prosecution.
- You have Received a Federal Search Warrant or Subpoena – If you have been served with a federal search warrant or subpoena, this means that federal authorities have strong reason to believe that you have committed (or were involved in the commission of) a federal healthcare fraud offense. You are entitled to legal representation during the government’s search and when responding to the subpoena, and it is strongly in your best interests to engage highly-experienced federal defense counsel promptly.
- You are Aware of Intentional or Unintentional Misconduct – If you have not yet been contacted by auditors or federal agents but you are aware of intentional or unintentional misconduct (such as overbilling government or private insurance companies, or improperly prescribing opioid medications), this too is a situation in which experienced legal representation is required. Not only must you come into compliance as quickly as possible, but you may also have an obligation to self-report the violation to the federal government in order to mitigate any potential penalties.
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)
In each of these scenarios, your first step should be to speak with an experienced Hawaii healthcare fraud defense attorney. When dealing with auditors or federal agents, it is absolutely essential to avoid mistakes that could increase your risk of prosecution. At Oberheiden, P.C., we bring centuries of experience to representing healthcare providers in Hawaii, and we can begin working to protect you immediately.
What are Some of the Most-Common Examples of Healthcare Fraud?
Healthcare fraud can take many different forms; and, during audits and investigations, providers must be careful to avoid unnecessarily producing any records or saying anything that could substantiate civil or criminal allegations. For example, while many providers who have committed unintentional billing errors assume that it is in their best interests to be fully transparent and cooperate in the government’s inquiry, the reality is that these efforts can actually increase providers’ risk of penalization for wrongdoing.
All of the following are common examples of allegations against doctors, pharmacists, and other health care providers, along with clinics, testing laboratories, telemedicine companies, durable medical equipment (DME) companies, and other medical facilities in the health care industry found in audits and investigations:
- Intentionally and unintentionally overbilling Medicare, Medicare, Tricare, and the VA, constituting False Claims Act violations
- Billing for health care services not provided (“phantom billing”) or for non-existent patients (“ghost patients”)
- Billing health insurance companies for services that do not quality as “medically necessary” under the applicable program regulations
- Upcoding, unbundling, double-billing, and other billing and coding violations
- Falsifying certifications, test results, and other patient records
- Improperly prescribing or dispensing opioid medications
- Offering, soliciting, paying, and accepting unlawful referral fees, rebates, or kickbacks
- Attempting to commit healthcare fraud
- Violations of the Affordable Care Act
- Participating in a conspiracy to defraud the federal government or unlawfully distribute opioid medications
What are the Potential Penalties for Federal Healthcare Fraud in Hawaii?
The penalties for healthcare fraud under the False Claims Act, the Anti-Kickback Statute, the Stark Law, the Health Insurance Portability and Accountability Act, and other federal statutes are severe. In cases involving civil healthcare fraud allegations, penalties can include:
- Recoupments
- Civil fines
- Treble (triple) damages
- Attorneys’ fees
- Non-payment of pending and future claims
- Loss of Medicare, Medicaid, Tricare, and VA eligibility
When charged criminally under the False Claims Act or the Anti-Kickback Statute, health care providers can face criminal fines and federal imprisonment. In criminal cases, DOJ prosecutors may bring charges for mail fraud, wire fraud, money laundering, and other crimes as well, and these charges can add up to create serious consequences including exposure to millions of dollars in financial penalties and decades behind bars.
Why Do Hawaii Healthcare Providers and Business Owners Choose Oberheiden, P.C. as Their Hawaii Healthcare Fraud Attorneys?
1. Our Team
Our healthcare fraud defense team is comprised entirely of senior attorneys and senior former federal agents. When you choose Oberheiden, P.C., you will not have paralegals and junior associates working on the defense of you and your health care facility.
2. Our Experience
When facing a federal investigation, who better to have on your side than former federal agents and former DOJ prosecutors? Together, our attorneys have over 70 years of federal prosecutorial experience and centuries of combined experience on both sides of federal healthcare fraud matters.
3. Our Results
We have resolved the majority of our clients’ cases without civil or criminal charges being filed, and to date not a single one of our clients has been penalized under the federal False Claims Act. We are committed to achieving favorable results for our clients, and we are prepared to do whatever it takes to protect you.
Hawaii Healthcare Fraud Defense FAQs
What is the Anti-Kickback Statute?
The Anti-Kickback Statute (AKS), codified in 42 U.S.C. §1320a–7b, is a federal law that places limits on medical providers’ ability to participate in kickback arrangements. More specifically, the statute prohibits a medical provider from offering, paying, soliciting, or receiving money (or anything else of value) in exchange for patient referrals when the patient’s medical bills are paid by any federally funded program. Most violations of the AKS cases involve Medicaid or Medicare. Additionally, while most cases also involve the payment of money for referrals, other kickbacks may include vacations, favors, meals, or even employment opportunities. The AKS is a criminal law, and a conviction carries potential incarceration and other criminal sanctions. However, those in violation may also face civil liability under the False Claims Act. If you are facing a violation under the AKS, it is important for you to protect yourself by contacting a dedicated Hawaii healthcare fraud attorney as soon as possible.
What are the most common examples of Medicare fraud?
Medicare fraud is a broad term used to describe any fraudulent or false medical claims submitted to the Medicare program. While there are many ways a provider or practice can raise the ire of federal investigators, some of the most common examples of Medicare fraud include:
- Billing for services that were not performed or not medically necessary;
- Billing for supplies or equipment that were never ordered;
- Billing for supplies or equipment that were not medically necessary;
- Certification for services or supplies that were not medically necessary;
- Double billing, up-coding, and inflating bills; and
- Overutilization of services or equipment.
If you are facing allegations of federal healthcare fraud, you can be sure that the investigators overseeing your case know just as much—if not more—about your business than you do. Given this reality, you need a Hawaii healthcare fraud lawyer with knowledge and experience handling these complex and high-stakes claims.
Which agencies in the federal government pursue healthcare fraud charges?
Healthcare fraud laws are exceedingly complex. Not only that, but it can even be a challenge to identify the government agency that is investigating a case. Typically, one or more of the following agencies are responsible for investigating claims of healthcare fraud.
- Centers for Medicare and Medicaid Services (CMS)
- Department of Defense (DOD)
- Department of Health and Human Services (HHS)
- Department of Justice (DOJ)
- Department of Labor (DOL)
- Drug Enforcement Administration (DEA)
- Federal Bureau of Investigation (FBI)
- Department of Health and Human Services Office of Inspector General (HHS-OIG)
Regardless of the agency spearheading the case against you, it is imperative that you reach out to a Hawaii federal healthcare fraud defense attorney as soon as possible. An attorney can help you understand the nature of the allegations and how to best defend against them.
Will I face criminal charges if I am under investigation for healthcare fraud?
It depends on the nature and severity of the alleged violations. Many healthcare fraud cases are civil in nature, meaning if the allegations are substantiated, you could face hefty fines and professional sanctions. However, there are also several federal statutes that permit criminal charges, such as the False Claims Act and the Anti-Kickback Statute. For example, a violation of the Anti-Kickback Statute constitutes a federal felony punishable by up to 5 years in prison and up to a $25,000 fine for each violation. However, charges under the False Claims Act may be either civil or criminal. In short, it is not always clear whether you are facing civil or criminal charges, and you cannot be sure of what you are looking at until you reach out to a Hawaii federal healthcare fraud lawyer.
Speak with One of Our Hawaii Healthcare Fraud Lawyers in Confidence
If you are facing a federal healthcare fraud audit or investigation in Hawaii, we encourage you to contact us promptly to discuss how we can help. Our Hawaii health care attorneys are experienced in defending clients dealing with healthcare fraud charges. To speak with a member of our defense team in confidence, call 888-680-1745 or request a free case assessment online now.
