North Dakota Healthcare Fraud Attorneys
North Dakota Healthcare Defense
Team Lead
Contact Nick1630 1st Ave N
Fargo, ND 58102
888-680-1745
Oberheiden, P.C.’s federal defense attorneys represent North Dakota healthcare providers in False Claims Act, Stark Law, Anti-Kickback Statute, and other federal healthcare industry fraud investigations. If you have received a subpoena or been contacted by federal agents, call 888-680-1745 for a free consultation.
For healthcare professionals and providers targeted by the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Department of Health and Human Services Office of Inspector General (HHS-OIG), and other federal agencies and task forces, avoiding the potential for severe penalties requires prompt action and experienced legal representation. These authorities have a mandate to aggressively pursue healthcare providers suspected of improperly dispensing opioid medications and overbilling Medicare, Medicaid, Tricare, and the Department of Labor (DOL), and providers accused of fraud can face recoupments, fines, program exclusion, prison time, and other costly consequences.
Federal Healthcare Fraud Defense Attorneys Representing Providers in North Dakota
Our federal defense attorneys have extensive experience representing healthcare providers in federal fraud investigations in North Dakota. We have secured favorable results for clients being targeted for prosecution by the DEA, DOJ, HHS-OIG, and other agencies, often with the result that our client is never formally charged. Many of our attorneys served as healthcare fraud prosecutors with the DOJ prior to joining Oberheiden, P.C., and our team also includes the Honorable Joe Kendall – the only former federal trial judge in private practice.
If your healthcare business or medical practice is under investigation for prescription drug fraud or for overbilling Medicare, Medicaid, Tricare, other healthcare benefit program, or the DOL, this is the type of experience you need on your side. When you engage Oberheiden, P.C. to represent you, our North Dakota healthcare fraud attorneys will use their experience to quickly intervene in the government’s investigation and gather the information necessary to execute a strategic defense. We will work to keep your case civil in nature (which will keep prison time off of the table), and we will use the available evidence (or lack thereof) to seek to obtain a favorable result as efficiently and cost-effectively as possible.
Meet the federal healthcare defense lawyers at Oberheiden, P.C.
Cases We Handle
Our healthcare fraud attorneys represent healthcare providers charged with fraud and related offenses under the False Claims Act, Stark Law, Anti-Kickback Statute, healthcare fraud statute (18 U.S.C. § 1347), and all other federal laws. We have successfully represented numerous providers in civil and criminal cases, securing favorable results during our clients’ investigations, following grand jury indictments, and during the trial at state and federal courts. This includes protecting healthcare providers against financial penalties, prison time, and other potential penalties in cases involving allegations of:
1. Billing and Coding Errors
Billing and coding errors include submission of improper billing codes, upcoding, unbundling, and double-billing the federal government and/or a private insurer. Healthcare providers can face prosecution for both intentional and unintentional billing and coding errors, with intentional billing fraud carrying the potential for criminal penalties under the False Claims Act and the federal healthcare fraud statute.
2. Kickbacks, Bribes, and Rebates
Kickbacks, bribes, and rebates are prohibited under the Anti-Kickback Statute. This federal statute prohibits the offer, payment, solicitation, or receipt of any form of “remuneration” in exchange for referrals for program-reimbursed services, equipment, or supplies (and if these actions are legitimized, they become a violation of money laundering regulations). Similar to billing and coding errors, healthcare providers can face civil penalties for unintentional violations, and they can face criminal prosecution if federal agents find evidence of intent. In many cases, one of the strongest defenses to an alleged Anti-Kickback Statute violation will be to demonstrate that one of the statute’s many “safe harbor” provisions applies.
3. Physician Self-Referrals
The concept of “physician self-referrals” is established in the federal statute commonly known as the Stark Law. Under this law, physicians and their related entities can face civil penalties for paying or receiving compensation for Medicare or Medicaid-reimbursed “designated health services.” These services include:
- Clinical laboratory service
- 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
Similar to the Anti-Kickback Statute, the Stark Law contains a number of safe harbors and exceptions as well.
4. False and Fraudulent Claims
The False Claims Act prohibits the submission of any “false or fraudulent” claim for Medicare, Medicaid, Tricare, or DOL reimbursement. This includes all types of billing and coding errors (both intentional and unintentional), program billings related to unlawful referral relationships, and billings that violate other laws or program billing regulations. False Claims Act violations are among the most common allegations in federal healthcare fraud investigations, and our North Dakota healthcare fraud attorneys have successfully defended numerous providers against accusations of submitting “false or fraudulent” claims.
5. Billing for Medically-Unnecessary Services, Supplies, or Equipment
Under all federal healthcare benefit programs, providers may only bill for services, supplies, and equipment that meet the applicable program guidelines regarding “medical necessity.” Billing for services that are deemed medically unnecessary can lead to civil or criminal prosecution; and, in order to avoid steep penalties, providers targeted in these types of investigations must be prepared to justify their care-related decision-making.
6. Billing for Services, Supplies, or Equipment Not Provided
Billing for services, supplies, or equipment not provided is commonly known as “phantom billing;” and, while it may sound like one of the more egregious forms of healthcare fraud, there are actually a variety of reasons why a phantom billing investigation may be misguided. We routinely handle cases involving allegations of phantom billing; and, if this is an issue in your case, we can use our experience reviewing countless billing records to assert an appropriate defense.
7. Prescription Drug Fraud
Prescription drug fraud allegations range from prescribing medically-unnecessary opioid medications to diverting medications and selling forged prescriptions. The DOJ’s Justice Prescription Interdiction & Litigation (PIL) Task Force, the DEA, and other authorities are vigorously pursuing providers in prescription drug fraud cases, and providers who are indicted for prescription-related offenses are facing substantial fines and long-term imprisonment.
8. Falsifying Patient Records and Inaccurately Reporting Test Results
Falsifying patient records and inaccurately reporting test results are additional serious allegations that often have a much more mundane explanation. From simple recordkeeping mistakes and other human errors by practice personnel to faulty assumptions made by federal agents during healthcare fraud investigations, our North Dakota healthcare fraud lawyers can get to the bottom of the government’s allegations and protect you from unwarranted consequences.
9. Fraudulent Physician Certifications and Election Statements for Hospice Care
With the rapid growth of the hospice care industry, federal authorities are increasingly focusing their sights on hospices and the physicians who certify patients for palliative care. Our North Dakota healthcare fraud defense lawyers are increasingly seeing investigations in which healthcare providers in North Dakota and other states are facing allegations related to physician certifications and patient election statements, with both civil and criminal penalties on the table.
10. Healthcare Fraud Attempt and Conspiracy
Under the federal attempt and conspiracy statutes, in order to face federal prosecution, it is not necessary to “successfully” defraud Medicare, Medicaid, Tricare, or the DOL. These statutes are some of the federal prosecutors’ most potent tools in healthcare fraud investigations. In order to protect themselves, providers must focus their defense strategies not only on overcoming any allegations of fraudulent billing practices, but on overcoming allegations of attempting or conspiring to engage in fraudulent practices as well.
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)
5 Reasons to Choose Oberheiden, P.C. in North Dakota
If your business or practice is under investigation for healthcare fraud in North Dakota, it is important that you engage experienced legal representation as soon as possible. Here are five reasons why healthcare providers nationwide trust the North Dakota healthcare fraud defense attorneys at Oberheiden, P.C.:
- Experience – Our attorneys are highly experienced on both sides of healthcare fraud investigations. This includes civil and criminal investigations involving allegations of prescription drug fraud; illegal kickbacks and self-referrals; and Medicare, Medicaid, Tricare, and DOL billing fraud.
- Results – We have a greater than 90% success rate in helping our clients avoid criminal charges. To date, not a single client has been forced to close its business or practice as a result of an investigation in which our firm has provided representation.
- Focus – We focus our practice on federal defense, with particular emphasis on defending providers, executives, and other clients accused of healthcare fraud and related civil and criminal offenses.
- Reputation – Our North Dakota healthcare fraud attorneys are recognized nationwide for their experience in federal health care fraud investigations.
- Client Focus – We tailor our representation to the unique circumstances of each individual client’s case. As our client, you will have constant direct access to our senior attorneys, and we will work closely with you every step of the way.
Frequently Asked Questions
What is the difference between the Anti-Kickback Statute and the Stark Law?
Both the Anti-Kickback Statute (AKS) and the Stark Law limit a medical provider’s ability to refer patients in certain circumstances. The AKS deals with patients whose medical expenses are being paid by a federally funded program, such as Medicare, Medicaid, or Tricare. More specifically, the AKS prohibits any referral fee, monetary or otherwise. The Stark Law prohibits most cases of physician self-referrals, in which a healthcare provider refers a patient to another provider that the referring physician has an economic interest in. The Stark Law applies more broadly to any patient, regardless of whether a federally funded program is footing the bill. The other primary difference between the two laws is that the AKS is a criminal law statute, carrying a maximum penalty of five years in prison and a fine of up to $25,000. The Stark Law is a civil statute, which carries a maximum penalty of $15,000 per violation. If you are under investigation for any type of healthcare fraud, it is imperative you reach out to a dedicated North Dakota healthcare fraud defense lawyer as soon as possible.
What charges might I face if I am alleged to have engaged in healthcare fraud?
Depending on the specific facts and circumstances, there are many federal crimes that healthcare providers and medical businesses in North Dakota could face. The following is a non-comprehensive list of some of the statutes federal prosecutors may use:
- Stark Law: The Stark Law is a civil statute that prohibits doctors from referring Medicare or Medicaid patients to an entity providing designated health services if the physician (or a family member) has a financial relationship with the entity. If a defendant is found civilly liable under this statute, they will be obligated to pay back any amount obtained in violation of this mandate. Penalties as high as $15,000 per service can be imposed as well. Our North Dakota healthcare fraud lawyers have effectively advocated for clients under this law based on several statutory exceptions.
- False Claims Act: Although the DOJ often pursues civil actions under this law that are initiated by “whistleblowers,” this statute also can be the basis for imposing criminal liability. Even if you are facing an action for civil liability under the statute, the financial consequences can be astounding. This statute allows for treble damages and a civil penalty of $21,563 per false claim. The fact that not one of our clients has been subject to civil or criminal liability under the FCA after retaining our law firm is a key reason clients give for retaining our law firm.
- Criminal Healthcare Fraud Statute: Healthcare providers and suppliers can be criminally liable for defrauding a healthcare benefit program or using misrepresentations to obtain this result. Conviction under this statute carries a punishment of up to 10 years in prison and a fine of $500,000 or double the amount that was illegally obtained.
- Anti-Kickback Statute: This federal law prohibits providing or promising any form of compensation for Medicare or Medicaid business. Violation of this law constitutes a felony punishable by up to a five-year period of incarceration and a $25,000 fine. Our law firm might defend against allegations under this statute by arguing the conduct at issue is protected under the statute’s “safe harbor” provisions.
Which providers are most at risk for a healthcare fraud investigation?
The federal government oversees all healthcare providers, and a provider’s specific practice area doesn’t necessarily mean they are subject to additional scrutiny. However, certain types of providers are more likely to fall within an investigation, including those who handle a high volume of claims or bill a significant portion of their business through federally funded programs like Medicaid and Medicare. If you are a practitioner or own or operate any of the following practices, it is imperative that you get in touch with a North Dakota federal healthcare fraud defense attorney as soon as you realize the federal government is looking into your practice:
- DNA testing facilities
- Drug rehabilitation facilities
- Healthcare marketing agencies
- Home healthcare agencies
- Hospice providers
- Hospitals
- Mobile healthcare clinics
- Outpatient surgical centers
- Toxicologists and toxicology laboratories
What should I look for in a North Dakota federal healthcare fraud defense attorney?
If you find yourself under investigation for federal healthcare fraud such as Medicaid, Tricare, or Medicare fraud, your choice of an attorney is one of the most important decisions you will make regarding the case. However, not all North Dakota healthcare fraud defense lawyers are well-suited to handle these complex claims. The most important considerations when selecting a healthcare fraud lawyer are experience and industry knowledge. You want an attorney who is comfortable handling your case no matter where it goes. Too often, practitioners work with an attorney who initially is confident in their ability to resolve the case but loses that confidence when the case suddenly takes an unexpected left turn. Along those lines, due to the inherent complexity of the U.S. healthcare fraud laws, you want to make sure your lawyer commands an in-depth understanding of the underlying healthcare industry. This not only prevents you from needing to explain your business to your lawyer but also enables them to provide valuable input based on their own wealth of knowledge.
Contact a North Dakota Healthcare Fraud Lawyer at Oberheiden, P.C. Today
To discuss your North Dakota healthcare fraud investigation with an attorney on Oberheiden, P.C.’s nationally-recognized federal defense team, contact our experienced criminal defense attorney to arrange your free and confidential initial case assessment. Our team is composed of former federal prosecutors and seasoned litigators who will use their experience to protect our client’s interests. You can reach us by phone or online 24/7, so call 888-680-1745 or send us your information online now.
