Experienced Ohio Health Care Fraud Defense Attorneys
With significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense, The Criminal Defense Firm is a health care law defense firm dedicated to your case. Our team includes well-educated and respected attorneys, such as the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force. Many of our firm’s lawyers received law degrees from the country’s best schools, such as Harvard Law School and Yale Law School. Our firm serves clients around the state of Ohio and its surrounding areas.
In Ohio, violating the False Claims Act can bring criminal and civil charges against you and your business. These investigations can be levied against health care providers, facilities, organizations, and businesses. The Criminal Defense Firm provides strategic defenses for Ohio health care clients who are facing these investigations.
The State of Ohio Is Closely Monitored By the Federal Government
The federal government monitors the entire nation for a fraudulent activity involving federal health care programs. However, the State of Ohio is one of nine locations in the United States that is more closely monitored by the Medicare Fraud Strike Force. This occurs because Ohio has a large number of federal health care program beneficiaries. Because of this, more claims are filed in Ohio than in other areas. The federal government believes that there is a higher statistical rate of False Claims Act violations because of the increase in claims. The Department of Justice investigated more than 300 allegations and recovered more than $900 million in fraudulent claims in 2016.
The Medicare Fraud Strike Force is a federal group that is made up of investigators and prosecutors from different federal agencies. You may come into contact with the Department of Health and Human Services, the Department of Justice, the DEA, the Department of Defense, the FBI, and even the IRS. Often, other federal agencies are also involved. If you find out that you’re being investigated by the Medicare Fraud Strike Force, immediately contact The Criminal Defense Firm
What Is the False Claims Act?
The False Claims Act is a federal statute that affects any person or business that has direct or indirect contracts with and who will be paid by the federal government for federal health care claims. This statute creates criminal and civil liability if you knowingly submit or cause the submission of a false claim that is approved and paid by the federal government. This statute is applied to individuals, contractors, businesses, facilities, and organizations in Ohio.
Although the federal statute explains what does and doesn’t constitute a violation of the False Claims Act, it’s important that you understand the meaning of the word “knowingly.” It means that if you didn’t know that something was a violation of the law, you should have known. It makes it your responsibility to know that the claims that are filed are compliant with federal law. Medical coding is a good example. If you don’t do your own coding, you’re still ultimately responsible to make sure that the right codes are used. This is particularly important since the ICD recently updated from 9 to 10.
Civil and Criminal Penalties Created by the False Claims Act
Whether you are an Ohio health care provider, facility, or business, you can face serious civil and criminal liabilities if you’re accused of violating the False Claims Act. If you learn that you’re being charged with violating the False Claims Act, call The Criminal Defense Firm right away. Once our Health Care Fraud Defense Team is retained by you, we can help you by contacting the federal government and ascertaining the charges you may face.
Civil penalties may include one or more of the following:
- Treble damages paying the government three times the amount of the original claim
- Payment of civil fines of up to $11,000 per false claim
- Recoupment requests
- Non-payment of future submitted claims
- Future exclusion from federal health care programs
- State licensure or disciplinary proceedings
- Loss of hospital privileges
Criminal penalties may include one or more of the following:
- Claims that cost you hundreds of thousands of dollars
- Criminal charges
- Up to five years in federal prison
Ohio Qui Tam Lawsuits Often Result in False Claims Act Investigations
In Ohio, there is a large number of False Claims Act investigations that begin as a result of a qui tam lawsuit. These lawsuits are filed in federal court. The federal court will depend on where in Ohio you operate your practice or business in. “Qui tam” is Latin and means “he who sues for the king and himself.” Qui tam lawsuits are incentivized because the initial goal was to encourage private clients to report others who are defrauding the government. However, this is now abused in Ohio. These lawsuits are often filed by vengeful former employees or unscrupulous competitors who are simply out to destroy you.
When a qui tam lawsuit is filed in Ohio federal court, it is sealed. The assigned judge and the federal agencies involved are the only ones who will receive an unsealed copy. The purpose of this is to protect the identity of plaintiffs who truly are whistleblowers. The plaintiff is listed simply as the “qui tam realtor.” In Ohio, False Claims Act investigations can take a long time. Extensions are routinely filed and granted by the court. This ensures that the federal government has the time it needs to complete the investigation.
During the federal government’s investigation, you’ll receive subpoenas for different records. This can include your financial, billing, and communication records. Subpoenas can come from the DOJ, DEA, DOD, IRS, FBI, OIG, or any number of federal agencies. The government will review your records and determine whether it will support or decline the lawsuit. If the government declines to get involved, the lawsuit isn’t over. The plaintiff can pursue the lawsuit. If they win, they will be rewarded with 30 percent of the recovered funds. If the government elects to support the qui tam lawsuit, you will likely face additional charges. If the qui tam suit is successful against you, the plaintiff who initiated it will receive 25 percent of the recovered funds as a reward.
If you are notified that you’re a qui tam defendant, contact The Criminal Defense Firm. Once retained, we can help you by establishing an applicable defense or work to settle on your behalf.
Principle Strategies for Ohio Clients
The Criminal Defense Firm has developed principle defense strategies for Ohio clients. Our main three strategies were developed by relying on our combined experiences as former federal health care prosecutors and defense attorneys.
- The first principle is to contact the federal investigators right away. The goal is to get answers to your questions and to minimize the likelihood that you’ll face criminal charges. We will find out the purpose of the investigation, the potential charges, and what can be done to resolve the investigation. We’re usually able to get answers within days of our engagement. We’ve learned that this early involvement is one of the best ways that we can advocate on behalf of our Ohio clients.
- Qui tam lawsuits in Ohio are very rarely filed because of actual fraudulent behavior. As such, we mount an aggressive defense for our Ohio clients by working to discredit the allegations and evidence of the case. Our goal is to show the federal government that the qui tam lawsuit doesn’t deserve its support.
- Where civil liability is indicated by the federal government against our Ohio clients, we negotiate on their behalf with the federal government to reduce the amount of damages owed. To date, none of our clients have been forced to shut down their practice, facility, or their business.
The Criminal Defense Firm
The Criminal Defense Firm provides Ohio ARNPs, doctors, nurses, hospitals, clinics, practice owners, physician-owned businesses, hospice centers, labs, pharmacies, and other health care businesses accused of False Claims Act violations and named qui tam defendants. We also assist those being investigated for violating Stark Law or the Anti-Kickback Statute, or those involved in Medicare, Medicaid, Tricare, or Department of Labor investigations.
Our Track Record
- False Claims Act Investigation (Pharmacy)
Result: No Liability.
- False Claims Act Investigation (Pharmacy)
Result: No Liability.
- False Claims Act Investigation (Laboratory Group)
Result: No Liability.
- False Claims Act Investigation (Laboratory Group)
Result: No Liability.
- False Claims Act Investigation (Laboratory Group)
Result: No Liability.
- False Claims Act Investigation (Physician)
Result: No Liability.
- False Claims Act Investigation (Physician)
Result: No Liability.
- False Claims Act Investigation (DME Company)
Result: No Liability.
- False Claims Act Investigation (MSO)
Result: No Liability.
- False Claims Act Investigation (MSO)
Result: No Liability.
- False Claims Act Investigation (Physician Syndication)
Result: No Liability.
- False Claims Act Investigation (Physician Syndication)
Result: No Liability.
- False Claims Act Investigation (Physician Syndication)
Result: No Liability.
- False Claims Act Investigation (Device Company)
Result: No Liability.
- False Claims Act Investigation (Health Care Service Provider)
Result: No Liability.
If you’re in Ohio and if you’re being investigated by the federal government for violating the False Claims Act, you should call The Criminal Defense Firm Initial consultations are free and totally confidential.
We are available to discuss your case. You can call us directly, use our contact form, or send us an email.
The Criminal Defense Firm
Serving the State of Ohio and Surrounding Areas
CriminalDefense.com