Protecting Professionals and Businesses in Southern California from Healthcare Fraud Allegations
Our team of former federal prosecutors provides over a hundred years of collective experience when representing physicians, pharmacies, and healthcare businesses facing an audit, federal investigation, civil penalty, or criminal liability. Federal agencies like the Office of Inspector General (OIG), Drug Enforcement Agency (DEA), Department of Justice (DOJ), Department of Health and Human Services (HHS), or the Department of Defense (DOD) could target your person, profession, and business with the full power of the government and almost limitless financial resources. When facing this daunting prospect, you need proven federal criminal defense attorneys with extensive experience handling fraud allegations.
What Makes Oberheiden, P.C. Unique?
Oberheiden, P.C. has developed a reputation defending individuals and businesses under the cloud of suspicion for healthcare fraud in Los Angeles and throughout the U.S. Healthcare professionals and businesses seek out our law fim because they understand that they can rely on our broad experience when it comes to government investigation, criminal defense work, and trial record.
Our trial experience and thorough understanding of federal agency investigations explain why we are able to routinely guide clients through an audit or federal investigation without the case proceeding to an indictment. Some of the reasons our Southern California clients trust Oberheiden, P.C. with healthcare fraud and other federal regulatory and criminal issues include:
Our Experience Includes:
- More than 1,000 healthcare fraud investigations
- More than 1,000 grand jury investigations
- More than 500 criminal trials
- Dismissal of state and federal indictments
- Avoiding criminal charges in many federal investigations
- More than 70 years of Department of Justice experience
These are just a few of the reasons that physicians, pharmacies, and healthcare companies trust our experienced attorneys with their federal regulatory compliance, investigations, audits, and defense against civil and criminal fraud allegations. Our Firm has successfully represented clients throughout the U.S. against federal regulatory audits, government investigations, criminal prosecutions, and civil liability involving the following:
- Health Care Fraud
- Federal Investigations (DEA, FBI, IRS, OIG)
- Major Federal Conspiracy Cases
- Wire Fraud
- Public Corruption Charges
- Tax Fraud
- Mail Fraud
- Money Laundering
- Bribery Charges
Feds Intensify Scrutiny on Doctors and Pharmacies to Combat the Opioid Crisis
The scope of the opioid overdose crisis has reached epidemic dimensions, so the federal government is cracking down on individuals and entities in the health field that it contends are facilitating easy access to prescription pain medications. When U.S. Attorney General Jeff Sessions recently announced the creation of a new Opioid Fraud and Abuse Detection Unit, he emphasized the law enforcement entity would be used to intensify investigations and pursue prosecutions against healthcare provides engaged in healthcare fraud involving prescription opioid drugs.
Under the auspices of this new program, twelve new Assistant United States Attorneys will focus 100% of their efforts on analyzing data to identify and prosecute healthcare professionals and companies facilitating opioid-related healthcare fraud. This new policy is driven by concerns regarding the human costs associated with the opioid crisis, as well as a desire to curb the drain on public funds. A few statistics explain the reason for the government’s retrenchment in pursuing professionals and businesses that permit improper access to opioids:
- 8 in 10 new heroin users started by abusing prescription pain medications.
- Nearly 60,000 people died of drug overdoses last year.
- An estimated 2 million people are addicted to opioids.
- Overdoses kill more people each year than auto accidents, firearms, or HIV at the height of the AIDS crisis.
- The number of deaths is rising at an exponential rate primarily because of the impact of opioid addiction.
- Twelve million people took opioids without being under the care of supervision of a physician in 2015.
Public Health Costs
The Centers for Disease Control and Prevention (CDC) estimates that opioid addiction and abuse costs about $78.4 billion annually. The CDC broke down these costs as follows:
- Lost Productivity – $42 billion
- Health Insurance – $26.1 billion
- Criminal Prosecutions – $7.6 billion
- Treatment for Substance Abuse – $2.8 billion
The influence of financial factors in driving this crackdown on healthcare fraud can be seen in the many lawsuits filed by municipality, county, and state governments seeking reimbursement for these costs from pharmaceutical manufacturers, drug distributors (e.g. pharmacies), and healthcare professionals.
Federal Agencies Use Sophisticated Law Enforcement Tactics to Target So-Called “Pill Mills”
Our Los Angeles healthcare fraud attorneys have extensive federal court experience as former DOJ lawyers. Our law firm provides valuable knowledge of the practices and strategies of law enforcement agents associated with federal agencies and federal prosecutors. Generally, the DEA and other federal agencies will receive information from a monitoring program to select a target for investigation. These targets typically are physicians with unusual patterns of opioid prescriptions or pharmacies that let prescription painkillers “walk out the door” despite obvious red flags associated with the order.
Our federal healthcare fraud attorneys have consistently guided targets of investigations through the process without civil or criminal prosecutions. For example, we can provide a distinct advantage if the investigating agency decides to initiate an “administrative inspection.” Based on our existing attorney-client relationship, the target of the investigation can deny the DEA permission to conduct the inspection unless a search warrant has been issued.
Defending Healthcare Professionals Facing “Pill Mill” Allegations (Regulatory Compliance – Investigations – Prosecutions)
Our Los Angeles healthcare fraud lawyers represent medical professionals, pharmacists, and healthcare entrepreneurs embroiled in federal investigations and prosecutions for the unlawful prescription and dispensation of controlled substances. Because our law firm is staffed by attorneys formerly with the DOJ, they have the knowledge and expertise to assist our clients in compliance with regulations regarding proper prescription and distribution of opioids and other controlled substances. Our experienced former government lawyers can review intake practices and documentation, prescription procedures, and other aspects of medical practices or a pharmacy to avoid compliance issues. If we are representing a client already facing an indictment or conviction, our trial and appellate practice divisions are ready to tenaciously challenge the government and fight for your reputation, professional license, and liberty.
Defense of Compounding Pharmacies Facing an Onslaught of Expansive Federal Investigations and Takedowns
Federal investigations focused on illegal kickback arrangements and fraudulent claims have targeted a growing number of compound pharmacies. The DOJ, OIG, DOD, and HHS have been pursuing claims against compounding pharmacies that bill TRICARE (military health insurance payor), the Department of Labor (DOL), and private insurance plans. In this context, “compounding” is defined by the FDA as a doctor, pharmacy, or their agent mixing, modifying, or combining the constituents of a drug for the specific needs of a patient.
Fraud allegations and kickback schemes alleged against compound pharmacies have particularly focused on TRICARE billing. Drugs created by a compounding pharmacy do not need to meet FDA approval, so the agency does not affirm their effectiveness or safety. While fraudulent billings reach beyond TRICARE, the military insurance program has received the bulk of attention because compounding pharmacy reimbursements rose from $5 million in 2014 to $514 million in 2014. Reports indicate TRICARE paid $10,000 to $20,000 for individual prescriptions despite the actual cost being only a small fraction of that amount.
Allegations in TRICARE prosecutions allege that the lack of FDA regulation and high TRICARE reimbursement rates resulted in aggressive marketing and unlawful kickbacks arrangements. The Anti-Kickback Statute (AKS) prohibits paying, receiving, offering, or soliciting compensation for referring federal healthcare patients or business. Since a violation of the AKS can serve as a basis for imposing liability under the False Claims Act, compounding pharmacies under investigation for failing to comply with the AKS can mean exposure to per claim penalties, program exclusion, treble damages, or even criminal liability. Although these alleged fraud schemes can take many forms, most cases involve a lack of necessity for the compound drug for the specific patient or an insufficient physician-patient relationship. The compensation in these cases frequently involves a thinly veiled kickback arrangement, such as bogus speaking fees or paying doctors a portion of the TRICARE reimbursement for prescribing the drug.
Our Los Angeles federal healthcare fraud lawyers defend each case based on the specific facts and circumstances, but we might use safe harbor provisions, challenge the evidence of a quid pro quo relationship, or dispute whether our client had the requisite intent under the AKS. If no “one purpose” of the compensation is to obtain referrals, the payment of a benefit does not constitute a violation of the statute. For example, a genuine speaker program where a doctor is paid to speak at conferences and other functions about the company’s drugs would not constitute a violation. Our law firm explores defenses based on safe harbor provisions, lack of intent, and other relevant factors.
Defense to Healthcare Fraud Audits, Investigation & Indictments in Los Angeles
When you are the object of a federal investigation, compliance audit, or a federal indictment, the outcome can be enormous financial liability or even a criminal sentence. Cases under the False Claims Act (FCA) during the last five years have resulted in in the government recovering billions of dollars from pharmaceutical companies, medical providers, and device manufacturers for healthcare fraud. The greatest portion of recoveries through the FCA in recent years have involved Medicare/Medicaid.
Protecting Healthcare Professionals and Businesses Facing Fraud Investigations
At Oberheiden, P.C., we work diligently to assist our clients in avoiding a fraud indictment for healthcare fraud. Whether you are the subject of an independent audit or a federal fraud investigation, we are prepared to challenge an auditor’s methodology or intervene to prevent the federal investigation from proceeding to a civil or criminal case. Even if a medical provider has absolute confidence regarding compliance with state and federal regulations, private audits authorized by the Centers for Medicare and Medicaid Services (CMS) generally are performed by private contracts on a “fee-for-pay” basis. This means the auditor has a direct financial incentive to find violations. Healthcare providers and medical facilities across the U.S. seek out our services because of our record of ending such scrutiny without the federal investigation or independent audit proceeding to civil or criminal charges.
Our success in federal court also extends to other forms of fraud or misappropriation of public funds, such as Department of Defense (DOD) fraud, Tricare fraud, wire fraud, and tax evasion.
Protecting Your Profession, Reputation, and Business
Our law firm has a well-established history of intervening in cases during an audit or federal investigation to prevent a federal criminal indictment or civil proceedings for qui tam penalties. However, many clients come to us already facing a federal indictment or conviction. Our trial division brings the experience that comes from conducting over 500 trials and supervising many other trials. After a client has retained us, we investigate the government’s evidence and allegations while determining our client’s exposure to civil and criminal liability. When your professional reputation and license, freedom, and financial future hangs in the balance, you will benefit from former Department of Justice trial attorneys, former federal prosecutors, and other distinguished trial lawyers with a proven record of courtroom dominance and trial expertise. Even if you have already been convicted, we have an appellate division to challenge legal errors and to seek a reversal of your adverse judgment.
When taking on skilled federal prosecutors and the immense litigation resources of the government, our clients want the advantage of representation by a law firm with proven success. Our clients know that when they contact us about a compliance audit or federal investigation we go beyond trying to prevent a conviction. We do not want the case to proceed to an indictment. Each of our clients has retained their professional license.
Areas We Serve in Los Angeles and Southern California
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 Oberheiden, P.C. 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.
Areas We Serve in Los Angeles
Alhambra, Azusa, Baldwin Park, Bellflower, Burbank, Beverly Hills, Carson, Compton, Claremont, Culver City, El Monte, Glendale, Hawthorne, Inglewood, Lakewood, Lancaster, Long Beach, Los Angeles, Norwalk, Palmdale, Pasadena, Pomona, Redondo Beach, Santa Clarita, Santa Monica, South Gate, Torrance, West Covina, West Hollywood, and Whittier.
Areas We Serve in Orange County
Santa Ana, Huntington Beach, Aliso Viejo, Anaheim, Brea, Villa Park, Placentia, Tustin, Westminster, Yorba Linda, Stanton, Seal Beach, Orange, Mission Viejo, Los Alamitos, Laguna Beach, Laguna Hills, Laguna Niguel, Laguna Woods, Lake Forest, Buena Park, La Habra, La Palma, Riverside, Ventura County.
Areas We Serve in San Diego
San Diego, La Mesa, La Presa, Spring Valley, Santee, Lakeside, National City, Chula Vista, Lemon Grove, Bonita, Coronado, Rancho San Diego, Bostonia.
We offer a no obligation, free consultations. Call Oberheiden, P.C. at 310-873-8140 or contact us online today to discuss your situation.