Nevada Healthcare Fraud Attorneys
Nevada Healthcare Defense
Team Lead
625 S. 6th Street, Suite #301
Las Vegas, NV 89101
702-213-9490
Oberheiden, P.C. is a team of experienced Nevada healthcare fraud attorneys representing physicians, pharmacists, health care company executives, and other clients in audits, investigations, and trials. If your Nevada healthcare business or medical practice is being targeted for health care fraud, call 702-213-9490 for a confidential consultation.
For many healthcare providers in Nevada, the risk of being targeted in a federal healthcare fraud investigation is one of the biggest threats to the long-term stability of their business or practice. Federal agents and prosecutors with the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other agencies and task forces are aggressively targeting providers in Las Vegas, Reno, and other parts of Nevada, and many providers are facing the potential for hundreds of millions of dollars in financial penalties and years or decades of federal imprisonment.
5 Key Facts About Federal Healthcare Fraud Investigations
1. All Healthcare Providers are at Risk for Prosecution.
Due to the methods by which federal authorities and federal prosecutors identify healthcare providers to target in Medicare, Medicaid, Tricare, and Department of Labor (DOL) investigations, no provider is immune from the risk of being targeted in health care fraud allegations and investigations. In Nevada, the Medicaid Fraud Control Unit is responsible for the investigations regarding the Medicaid program. In most cases, investigations result from automated reviews of providers’ billing data, with any apparent “anomalies” serving as potential triggers for further inquiry. For example, a provider who routinely bills Medicare for a particular service or supply may stand out as a Nevada Medicare fraud risk if no other providers in the same part of Nevada have similar billing patterns. While this alone certainly does not indicate Medicare fraud or Medicaid fraud crimes, under state and federal law, it is enough to trigger a federal investigation.
2. Allegations of Healthcare Fraud Can Take Many Forms.
Most people think of “fraud” as an intentional act. But, while intentionally overbilling Medicare or Medicaid is one form of federal health care fraud and insurance fraud, various unintentional billing violations can lead to federal prosecution as well. Generally speaking, evidence of intent (or the lack of such evidence) is the distinguishing factor between a provider facing civil and criminal charges – not the distinguishing factor between prosecution under federal law and avoiding the potential for federal penalties.
Healthcare fraud investigations can involve allegations under the False Claims Act, the Anti-Kickback Statute, the Stark Law, the federal healthcare statute, and various other federal laws. Some of the most common allegations under these statutes include:
- Billing and coding errors
- Kickbacks, bribes, and rebates
- Physician self-referrals
- False and fraudulent claims
- Billing for medically-unnecessary services, supplies, or equipment
- Billing for services, supplies, or equipment not provided
- Prescription drug fraud
- Falsifying patient records and inaccurately reporting test results
- Fraudulent physician certifications and election statements
- Tax evasion and other related federal offenses
When facing a federal investigation, determining exactly why you are being targeted is the first step toward building an effective defense strategy. Once you engage with our team to represent you, an experienced Nevada healthcare fraud defense lawyer will quickly intervene in the investigation to determine the nature and extent of the allegations against you.
3. The Penalties for Healthcare Fraud are Severe.
In both civil and criminal healthcare fraud cases, the penalties for fraud conviction can be severe. Providers targeted for civil and criminal violations can face substantial financial penalties, and those targeted for alleged fraud crimes can face long-term imprisonment. Along with fines and prison time, potential consequences of a federal healthcare fraud investigation also include:
- Recoupments
- Treble damages
- Fees and costs
- Denial of pending claims
- Pre-payment review (which can delay payment by up to six months)
- Medicare, Medicaid, Tricare, and DOL exclusion
- Loss of DEA registration
- State board licensing action
While these are all potential penalties, the outcome of any particular investigation for a healthcare fraud crime will depend heavily on the scope and severity of the allegations involved, whether the investigation is civil or criminal in nature and the strength of the provider’s defence. Our Nevada healthcare fraud attorneys have helped clients avoid fraud charges and penalties altogether during the investigative process. We have negotiated plea deals and obtained dismissals before trial, and we have used strategic trial representation to mitigate our clients’ sentences in federal courts substantially.
4. Healthcare Fraud Investigations are Often Misguided.
Although Medicare, Medicaid, Tricare, and DOL fraud cost the federal government billions yearly, many investigations targeting legitimate healthcare providers are misguided. In these cases, it is important for providers to quickly identify the source of the government’s misinformation and assemble the evidence needed to close the investigation promptly. However, due to the breadth of our nation’s healthcare laws, it is also essential for providers targeted in federal investigations to ensure their billings will withstand scrutiny. Even unintentional mistakes have the potential for severe consequences, so providers must conduct prompt and thorough internal assessments to determine the scope of any potential exposure.
5. An Aggressive Defense Strategy is Key to Avoiding Federal Charges.
Regardless of the veracity of the government’s allegations, presenting an aggressive defense strategy is the key to avoiding charges of a federal crime. This starts with intervening during the investigative process and using the information gathered during an internal assessment to respond appropriately. At Oberheiden, P.C., we rely on our Nevada healthcare fraud lawyers’ notable legal experience on both sides of federal healthcare fraud cases to develop and execute comprehensive defense strategies that are tailored specifically to the facts and allegations involved in each individual client’s case.
Who We Represent
In our healthcare fraud defense practice, our Nevada healthcare fraud lawyers represent clients throughout Nevada and nationwide in all facets of the healthcare industry. Our experience includes securing favorable outcomes for clients including:
- Physicians
- Specialists
- Pharmacists
- Compounding pharmacists
- Dentists
- Physician groups
- Hospitals, clinics, and other medical facilities
- Testing laboratories
- Durable medical equipment (DME) companies
- Company owners, board members, and executives
By their nature, many healthcare fraud investigations will involve allegations against multiple related or unrelated parties. For example, an Anti-Kickback Statute investigation may involve allegations against a medical practice and a referral source, or a Stark Law investigation may involve allegations against a physician and one or more “related entities.” Additionally, the federal conspiracy statute gives prosecutors broad authority to pursue cases against multiple providers – even in cases where no healthcare offense has been committed – and, in these cases, we work to ensure that our clients are insulated from liability to the greatest extent possible.
Q&A with Oberheiden, P.C.’s Federal Healthcare Fraud Defense Lawyers
Q: Am I safe if have not intentionally overbilled Medicare, Medicaid, Tricare, or the DOL?
Unfortunately, not necessarily. While lack of intent is a defense to criminal healthcare fraud charges, you could still be charged civilly as a result of the government’s investigation and whether they find false or misleading information in your records. To try to prevent this from happening – and to position yourself to present a strong defense at trial if necessary – it is imperative that you begin working to counter the government’s evidence of Nevada Medicare fraud as soon as possible.
Q: What should I do if I am aware of improper billings being submitted to Medicare, Medicaid, Tricare, or the DOL?
If you are aware that your business or practice has previously submitted improper reimbursement requests to Medicare, Medicaid, Tricare, or the DOL, you need to proceed very cautiously. From how you respond to the investigation to the actions you take independent of the investigation, there are both key steps you need to take and critical mistakes you need to avoid. For more information, you can read:
Q: Should I cooperate with the government’s investigation?
This question does not have a straightforward answer. While it can be beneficial to cooperate (and you may have a legal obligation to cooperate under state and federal law) to a certain extent, being too cooperative can also unnecessarily expose you to prosecution and potential penalties. With our extensive experience in federal healthcare fraud investigations, we can advise you regarding the appropriate steps to take, and we can deal with the federal agents and prosecutors handling your investigation on your behalf.
Q: What do I need to know if I have received a target letter, subpoena, or civil investigative demand?
Target letters, subpoenas, and civil investigative demands are different investigative tools that require different responsive measures. If you have received a target letter or been served with a subpoena or civil investigative demand, we strongly encourage you to contact a healthcare fraud defense lawyer at Oberheiden, P.C. to discuss your options as soon as possible.
Q: Can Oberheiden, P.C. handle my federal healthcare fraud investigation in Nevada?
Yes. Our law firm has a nationwide presence, and our Nevada healthcare fraud lawyers are available to represent healthcare providers and medical businesses in Nevada. We can conduct your initial case assessment over the phone; and, if necessary, we can have attorneys from our defense team on the ground in Nevada at a moment’s notice.
Get Started with a Confidential Initial Case Assessment with our Nevada Healthcare Fraud Lawyer
To speak with our Nevada healthcare fraud defense attorneys about your healthcare fraud investigation, please call 702-213-9490 or contact us online. Federal healthcare fraud investigations require immediate action, and our healthcare fraud defense lawyers can begin working on your case 24/7.
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