Protecting Medical Professionals and Businesses in Scottsdale & Phoenix from Health Care Fraud Allegations
When medical professionals, health care businesses, and pharmacies retain our team made up of former federal prosecutors, they want the advantage of courtroom dominance and trial expertise garnered by litigating hundreds of trials. Although other firms might have a former federal trial attorney in their firm, our firm is made up of several attorneys who had distinguished careers within the Department of Justice (DOJ). We utilize this experience of the practices and strategies employed by federal agencies like the Department of Defense (DOD), Drug Enforcement Agency (DEA), Federal Bureau of Investigation (FBI), Office of Inspector General (OIG), and the Department of Health and Human Service (DHH).
Whether you need assistance with regulatory compliance, an audit, a federal investigation, or a federal indictment, The Criminal Defense Firm offers the advantages of attorneys with unique insight and experience with the investigative strategies and litigation approach of federal regulatory agencies.
The Criminal Defense Firm Making a Difference in Federal Health Care Cases
Our federal health care fraud defense attorneys and federal criminal defense lawyers have developed a national reputation, and we have successfully represented clients in Arizona as well as in twenty-four other states. Medical providers, pharmacies, and health care businesses all over the U.S. seek out our law firm because we do not wait to defend our clients until after they are facing a federal indictment. We take an active role in defending our clients subject to an audit or federal investigation to discourage an indictment from being brought against our clients. This proactive approach and the experience of our attorneys working within the Department of Justice (DOJ) explains why our law firm has prevented referrals to the U.S. Attorney’s Office in every one of our client’s Medicare and Medicaid audit cases.
Our law firm has multiple attorneys with former experience in the Department of Justice.
U.S. Attorney General Announces Crackdown on Alleged “Pill-Mills”
The opioid overdose crisis in the U.S. has reached epidemic proportions. The enormous financial costs associated with the prescription painkiller crisis amounts to tens of billions of dollars every day. Governments at the municipal, county and state levels have been filing lawsuits to seek reimbursement for the costs associated with unnecessary prescriptions, opioid overdoses, construction and operation costs for drug treatment facilities, insurance expenditures, emergency responder costs, and hospitalization expenditures.
U.S. Attorney General Jeff Sessions recently articulated the federal government’s commitment to using the power of the DOJ to attack medical practices, pharmacies, and other medical care companies that contribute to the abuse of addictive pain medications. Jeff Sessions explained that the DOJ is launching a new program called the Opioid Fraud and Abuse Detection Unit. The unit will be comprised of a dozen Assistant United State Attorneys who will focus exclusively on conducting the investigation and prosecution of individuals and entities functioning as so-called “pill mills.”
How Federal Law Enforcement Authorities Conduct Investigations of Improper or Excessive Prescription of Opioids
Federal authorities often open an investigation when a monitoring program like PDMP, KASPER, PMP, E-FORCE, OARRS or the like raises red flags with a federal agency. The agency will initiate an investigation that will include an analysis of the provider’s PDMP records, which can be misleading since they do not contain information relevant to a patient’s medical condition. The federal authorities will work with local law enforcement and often send someone into a medical office or pharmacy with pain complaints seeking prescription pain drugs. The informant will be told to drop certain hints that should give rise to warning signs for the health care provider.
Our health care fraud attorneys have established a reputation for discouraging federal authorities from indicting our clients. The best way to mitigate the risk of civil liability or criminal prosecution involves starting to craft a defense long before our client ever faces a federal indictment. When we are retained early in the investigative process, we can protect our client’s legal rights and interests. For example, we instruct our clients about their right to object to an “administrative inspection” of their medical practice if the DEA shows up without a warrant.
Tenacious Defense Against Allegations of Unlawful Prescriptions
We represent clients in the face of allegations they are operating a “pill mill” by illegally prescribing and dispensing opioids. Our clients place faith in the fact that the attorneys in our law firm have over a century of collective legal experience during which we have handled many trials and overseen many others. We even have the rare distinction of successfully pursuing the dismissal of a federal Grand Jury indictment. This is a task that requires extraordinary skill because the indictment is based on the unanimous determination of 16 grand jurors that the government has sufficient evidence to establish “probable cause” the accused has committed a federal crime.
Federal Authorities Targeting Compound Pharmacies That Bill Federal Health Programs
Although “compounding pharmacies” do not need the Food and Drug Administration (FDA) to approve the drugs they produce, the federal government has begun pursuing civil and criminal actions for fraudulent billing practices under the Fair Claims Act (FCA), Anti-Kickback Statute, and other federal laws. A compounding pharmacy is unique in designing drugs that are formulated for the needs of a specific patient by combining, mixing, or modifying the components that make up the medication. Several federal agencies, such as the DOD, OIG, HHS, and DOJ have been pursuing legal actions against compounding pharmacies for improper billings.
While billings regarding other government health care insurance plans have been targeted, TRICARE, which is the health care provider for the DOD and the military, has been the primary focus of these legal claims. TRICARE pharmacy reimbursements rose from $5 million in 2004 to $514 million in 2014, which attracted the attention of federal agencies like the DOD.
A couple of factors involving compounding pharmacies have made TRICARE fraud a focus of government investigations. Compounding pharmacies do not have to have their drugs meet FDA approval nor are the businesses closely monitored by the FDA. Additionally, the TRICARE reimbursement rates for compound drugs is much higher than for conventional medications. Reports from parties involved in actions brought against compound pharmacies throughout the U.S. claim certain compound pharmacies billed TRICARE for $10,000 to $20,000 for a single prescription.
Anti-Kickback Statute (AKS) and False Claims Act (FCA) Liability of Compound Pharmacies
In the past, compound pharmacies could not market their products, but these restrictions were struck down as an unconstitutional restriction on free speech. Because of the high rates of reimbursement through TRISTAR, compound pharmacy fraud schemes allegedly involved a range of tactics that includes aggressive marketing campaigns and kickbacks paid to physicians by compound pharmacy companies. The Anti-Kickback Statute (AKS) forbids compensating, receiving, or soliciting financial remuneration to obtain referrals for medical care or products billed to a government health plan like TRISTAR. Since the False Claims Act can be a predicate offense under the False Claims Act (FCA), a compound pharmacy that violates the AKS could be subject to treble damages, per claim penalties, program exclusions, and criminal prosecution.
Persuasive Defense Against Investigations & Prosecutions
Our Scottsdale health care fraud lawyers represent clients in private audits, federal investigations, and federal criminal cases. The federal government has recovered billions of dollars by pursuing False Claims Act lawsuits for false or misleading billings of Medicare or Medicaid against doctors, hospitals, pharmacies, and other health care providers.
Common Basis of Health Care Fraud Allegations
Medical Device/Pharmaceuticals Fraud: The manufacturers of medical devices and pharmaceutical companies frequently face prosecution for unlawful kickbacks, promotion, marketing for off-label (non-FDA approved) uses, and similar unlawful practices. Depending on the circumstances, these investigations and prosecutions can be civil or criminal in nature.
False Statements or Certifications to Health Care Programs: Physicians and other medical service or product providers are routinely required to provide certifications and statements to confirm their compliance with federal regulations. When these documents are related to a payment from a government health care program, the individual or entity can face exposure under the FCA.
Reporting and Pricing Fraud: Pharmaceutical wholesalers and others in the health care industry can be charged with improper purchase arrangements and manipulation of drug prices.
Fraud by Hospitals and Other Medical Facilities: Hospitals, outpatient treatment centers, nursing homes, and hospice centers are required to submit paperwork like cost reports to qualify for Medicare/Medicaid funds. If statements in the reports or supporting documents are false, the institution can face health care fraud exposure.
Trusted Federal Criminal Defense Lawyers
Although our Arizona criminal defense attorneys have special health care fraud expertise, we also routinely represent clients charged with other crimes and forms of fraud in federal courts throughout the U.S. Some of the other types of cases we handle include:
- Federal White-Collar Defense of Individuals and Businesses
- Public Corruption Charges
- Tax Fraud
- False Claims Act & Qui Tam Cases
- Antitrust Investigations
- Internal Investigation and Corporate Compliance
- Business Litigation
- Professional License Defense
Contact Us to Speak with an Experienced Arizona Federal Health Care Fraud Defense Attorney
Our clients seek assistance with compliance audits or federal investigations. Physicians, pharmacists, and other medical professionals also take comfort in the fact that not one of our clients has lost their professional license. We offer a no obligation, free consultation. Call The Criminal Defense Firm at 888-452-2503 or contact us online today to discuss your situation.
Areas We Serve in Phoenix, Arizona
Subject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of The Criminal Defense Firm may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel. Phoenix, Mesa, Tucson, Chandler, Glendale, Scottsdale, Gilbert, Tempe, Surprise, Peoria, and throughout Arizona.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.