Washington D.C. Healthcare Fraud Attorneys

Respected Washington D.C. Healthcare Attorneys

The nation’s capital is at the center of the government’s fight against health hcare fraud in more ways than one. Our firm brings more than 100 years combined of experience in representing Washington D.C. health care organizations and providers in civil and criminal enforcement matters. If you need representation, contact the proven Washington D.C. healthcare fraud defense attorneys at Oberheiden, P.C.

For Washington D.C. health care industry, the risks of being a target in federal investigations are very real. Over the past few years, we have seen several high-profile instances in the National Capital Region. With the focus on certain sectors, more providers are targets for civil and criminal prosecution.

As a health care provider facing a federal fraud investigation, there are some important questions you need to have answered as soon as possible. These include:

• Why is the government looking into your business or practice? Are you being targeted by government agencies for alleged coding violations, conspiracy to commit health care fraud, prescription drug fraud, offering or accepting kickbacks, or some other form of suspected fraud?
• What is your obligation to respond? Were you served with an OIG or grand jury subpoena? Have you received a civil investigative demand (CID)? The nature of the government’s inquiry will determine your obligation to respond.
• Is the government’s inquiry civil or criminal in nature? In a civil case, you can face substantial monetary penalties, program exclusion, and other consequences. In a criminal case, long-term imprisonment will also be on the table.
• How long has your business or practice been under investigation? The longer you’ve been the subject of a federal inquiry, the more aggressive you may need to be to defend yourself.
• What is the scope of the allegations against you, and what are the potential implications? What statute(s) are you alleged to have violated? How far back do the government’s allegations go?

Click image
to see larger version.

When our healthcare law firm represents providers in federal healthcare fraud investigations, our Washington D.C. healthcare attorneys focus on getting answers to these questions right away. Once we’ve been engaged, we make contact with the agents and prosecutors involved as soon as possible. We then use our backgrounds as healthcare fraud defense attorneys and former federal prosecutors to build a defense. At this stage, our Washington D.C. healthcare attorneys also work closely with our clients to identify potential problems and guide through health care regulatory compliance and HIPAA compliance. The attorneys on our health care fraud defense team strive to provide the best possible chance for a favorable outcome.

Potential Outcomes in Washington D.C. Healthcare Fraud Investigations

In most cases, securing a favorable outcome means ending the government’s investigation before charges. However, in some cases, the factors are such that further action is necessary. Potential outcomes of being targeted by authorities such as the U.S. Department of Justice (DOJ), U.S. Department of Health and Human Services Office of Inspector General (OIG), Drug Enforcement Administration (DEA), Medicaid Fraud Control Unit, and Federal Bureau of Investigation (FBI) include:

• Termination of the investigation without civil or criminal charges
• Civil charges under the False Claims Act, Anti-Kickback Statute, Stark Law, and/or other federal healthcare fraud statutes
• Grand jury indictment and criminal prosecution

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)

Aggressive Legal Defense for Healthcare Fraud Investigations in Washington D.C.

Avoiding charges is the best-case scenario, and it’s an outcome we pursue in every health care law case we handle. No matter the facts and details involved, there are a variety of defenses to challenge the government’s case. Our Washington D.C. healthcare lawyers work diligently to present overwhelming evidence that the U.S. Attorney’s Office does not have a case to prosecute. This approach allows us to avoid criminal indictments in a significant percentage of cases we handle. It has also been used in False Claims Act investigations. In every case, we achieved an ending with no civil or criminal penalty for our client.

“[Oberheiden, P.C.] is unlike your stereotypical law firm. Their level of professionalism, dedication, and sensitivity to me and my situation made me feel comfortable and confident I was in the right hands. Hopefully, I won’t find myself in a situation where I’d need law services again but if I did they would be the first I’d call.” – Healthcare Provider, Previous Client

“Dr. Oberheiden has successfully represented our company in various federal health matters involving the OIG, the Department of Labor, and the Department of Health and Human Services. Dr. Oberheiden quickly understands all issues and is able to convincingly present the client’s side of the story. From my experience with other lawyers, I consider Dr. Oberheiden to be among the best attorneys we have ever used. Should we ever need legal help, the first thing our company will do is to call Dr. Oberheiden.” – Healthcare Provider, Previous Client

Our Areas of Practice – Healthcare Fraud Defense

The Oberheiden, P.C. team brings over 100 years of collective experience representing Washington D.C. healthcare providers. Whether as defense lawyers or attorneys for the government, our Washington D.C. healthcare lawyers have handled more than 2,000 investigations involving a wide range of allegations.

Billing and Coding Violations

Coding is a headache at best. At its worst, it can trigger federal investigations that lead to civil and criminal prosecutions. Billing and coding violations are among the most common allegations in healthcare fraud cases. Providers accused of submitting false claims for payment, even unwittingly, can face:

• Fines,
• Recoupments,
• Treble (triple) damages,
• Program exclusion,
• and other penalties.

Due to the complexity of Medicare, Medicaid, and Tricare rules, billing and coding errors are common. But, they are frequently the result of honest human error. Few providers seek to run the risk of federal prosecution. In fact, most go to great lengths to maintain compliance as best they can. Sadly, even this is not enough to protect their healthcare finance and business transactions from legal issues. We represent providers across the healthcare industry who face accusations of:

• Billing for non-allowable costs or excluded services (such as operational expenses, medical procedures, or services rendered by an unlicensed practitioner)
• Double-billing (either to the same program, to multiple programs, or to a program and a private insurance company)
• Phantom billing (billing for services, supplies, or equipment not actually provided to patients)
• Unbundling (billing at the stand-alone rates for services, supplies, and/or equipment that are supposed to be billed at bundled rates)
• Up-coding (billing at a higher reimbursement rate than the one applicable to the billed health care services or item)

Anti-Kickback Statute and Stark Law Violations

The Anti-Kickback Statute and Stark Law make it illegal for providers to use funds from federal programs to pay kickbacks, referral fees, and other forms of compensation. The Anti-Kickback Statute applies to all health care providers. The Stark Law applies in particular to physicians and entities with which they have direct or indirect financial connections. These laws are also different in that the Anti-Kickback Statute applies to transactions involving funds from all healthcare benefit programs. This statute has provisions for both civil and criminal penalties. The Stark Law, however, applies only to Medicare and Medicaid reimbursed funds. Stark only carries civil penalties.

As summarized by the OIG, the Anti-Kickback Statute, “[p]rohibits offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate Federal healthcare program business.” The Stark Law, “[p]rohibits a physician from referring Medicare [or Medicaid] patients for designated health services to an entity with which the physician (or immediate family member) has a financial relationship unless an exception applies . . . [and p]rohibits the designated health services entity from submitting claims to Medicare [or Medicaid] for those services resulting from the prohibited referral.” Designated health services under the Stark Law include:

• Clinical laboratory services
• DME and medical supplies
• Home health services
• Imaging
• Inpatient and outpatient hospital services
• Outpatient pathology
• Outpatient prescriptions
• Parenteral and enteral nutrients, equipment, and supplies
• Physical therapy
• Prosthetics, orthotics, and related supplies
• Radiology and radiological therapy

We have extensive experience on both sides of Anti-Kickback and Stark Law investigations. To defend against such health law allegations, a useful strategy is showing the transaction falls within one of the statutes’ safe harbors. The broad language in both statutes is subject to an array of exceptions. These exceptions can apply even in situations where providers haven’t designed the business with compliance in mind. We are familiar with the various safe harbors available under the Anti-Kickback Statute and Stark Law. We can examine your compensation arrangement or investment to see if a safe harbor applies.

False Claims Act Violations

The False Claims Act (FCA) prohibits any “false and fraudulent” claims submitted for federal program payment. This includes bills submitted for Medicare, Tricare, and Medicaid services. Improper billing is judged a false and fraudulent claim under the FCA. Such charges can potentially subject a provider to civil or criminal penalties. Civil penalties under the False Claims Act include:

• Fines of approximately $21,000 per false claim
• Recoupments
• Treble damages (three times the government’s actual losses)
• Program exclusion

Criminal penalties under the False Claims Act include:

• Fines of up to $250,000 for individuals and $500,000 for businesses
• Five years of federal imprisonment

As with other healthcare fraud investigations, investigations under the False Claims Act can result in loss of hospital privileges, professional license suspension or revocation, and other consequences as well.

Prescription Drug Fraud

Many cases involve allegations of improper prescription and dispensing of opioid medications. Investigations involving non-opioid medications are common as well. Those targeted in prescription drug fraud investigations include:

• Pharmacists,
• Physicians,
• Clinics,
• Home health agencies,
• Hospices, and
• Other providers.

Along with kickbacks and various forms of billing fraud, a common allegation in prescription fraud investigations is the practice of drug diversion. That is providing medications to individuals other than the patients for whom they are intended. Drug shorting and refill schemes are common methods of diverting medications. Forging prescriptions, selling prescriptions, and dispensing more pills than were prescribed are involved as well. When investigating providers for suspected involvement in prescription drug fraud, some things federal agents look for include:

• Prescribing medications without a physical exam
• Limited patient interaction
• Lack of psychological counseling
• Lack of interdisciplinary approach
• Insufficient medical justification for prescriptions
• Financial arrangements with local pharmacies
• Failure to enforce office prescription policies
• High volume of prescriptions for certain medications
• Insufficient triage
• Routine prescription of Schedule II controlled substances

Home Health and Hospice Fraud

Home health agencies and hospices have additional restrictions with regard to federal healthcare benefit program qualification. To bill the government for services provided to program beneficiaries, home health agencies and hospices must first obtain physician certifications. Hospices must also obtain election statements from their patients. Federal authorities routinely inspect home health agencies’ and hospices’ physician certification and election statement practices. Providers can face prosecution under the False Claims Act and Anti-Kickback Statute for violations such as:

• Commencing treatment without a valid physician certification or election statement
• Obtaining fraudulent physician certifications or election statements
• Forging physician certifications and election statements
• Offering and paying referral fees to physicians who provide certifications and recertifications
• Backdating physician certifications and election statements
• Failing to keep adequate documentation of patients’ certifications and elections

Our Washington D.C. Healthcare Fraud Defense Lawyers Answer Providers’ Questions about Investigations

Contact Us for a Free Initial Case Assessment

If you are facing a federal healthcare fraud investigation, we encourage you to contact us promptly for a free initial case assessment. Our Washington, DC healthcare fraud defense attorneys can help you understand your situation and formulate a strategic plan to respond to the government’s inquiry. To request an appointment with the healthcare fraud defense team at Oberheiden, P.C., please call 202-933-9438 or submit our consultation request form now.