Legal Help for California Diabetes and Obesity Doctors Charged with Medicare Fraud
Diabetes and obesity doctors play a critical role in improving their patient’s lives and preserving the health of our society as a whole. Unfortunately, this does not protect them from the scrutiny of the federal government. Increasingly, diabetes and obesity doctors in California are being forced to defend themselves in unjustified Medicare fraud investigations
Recent advancements in government technology have led to a new approach in the federal government’s fight against Medicare fraud. The Medicare Fraud Strike Force is increasingly relying upon data analytics to identify targets for its Medicare fraud investigations. Unfortunately, while this approach has proven to be effective in some cases, it is also leading to many misdirected investigations targeting innocent diabetes and obesity doctors in California.
The Medicare Fraud Strike Force’s data-driven approach focuses on anomalies in Medicare reimbursement claims. Does your practice submit more reimbursement claims than others This alone can make you a potential target? Do you serve a particular population whose needs are unique from those of patients in other parts of the state or country? On a computer screen, this “discrepancy” can look like a fraud when, in reality, it reflects careful attention to your patient’s individual conditions.
In other words, the fact that you maintain a compliant practice does not mean that you will escape government scrutiny. By the same token, the fact that you are facing an investigation does not mean that you are guilty of Medicare fraud. At the The Criminal Defense Firm, we defend diabetes and obesity doctors in Medicare fraud investigations throughout California. If you are under investigation, we can take swift and aggressive action to protect your practice.
How Our Attorneys Can Help with Your Medicare Fraud Investigation
The Criminal Defense Firm is a team of healthcare fraud defense lawyers who have decades of combined experience in Medicare fraud investigations. This includes not only defending physicians but also representing the government. Several of our senior attorneys are former federal prosecutors who bring inside knowledge and deep insights to helping our clients avoid civil and criminal charges.
Our approach to defending diabetes and obesity doctors in Medicare fraud investigations includes:
1. Identifying the Agency (or Agencies) Involved
In order to develop a strategic defense, we first need to identify the agency (or agencies) involved in your investigation. We can use our experience and government contacts to quickly determine the agency(ies) investigating your case, which may include:
- Centers for Medicare and Medicaid Services (CMS)
- Department of Defense (DOD)
- Department of Justice (DOJ)
- Federal Bureau of Investigation (FBI)
- Office of Inspector General (OIG) of the Department of Health and Human Services (HHS)
- The Medicare Fraud Strike Force
2. Understanding the Grounds for the Investigation
Once we determine who is investigating your case, we will then determine why you are being investigated. Some of the most common allegations leading to Medicare fraud investigations involving diabetes and obesity practices include:
- Billing for services, supplies, or equipment not actually performed or purchased (phantom billing)
- Billing for medically unnecessary services, supplies, or equipment
- Double-billing, up-coding, unbundling, and other forms of coding fraud
- Falsifying patient records
- Offering and accepting kickbacks from pharmaceutical companies, durable medical equipment (DME) companies, and other healthcare providers
Keep in mind, you do not need to have actually committed any of these violations in order to face an investigation. If the government’s data suggest that your practice may be involved in a fraudulent scheme (based upon statistics and general billing trends), this can be enough for the Medicare Fraud Strike Force and other agencies to start looking into your practice.
3. Determining Whether the Investigation is Civil or Criminal in Nature
We will also seek to quickly determine whether your investigation is civil or criminal in nature. This is critical because there are different strategies for defending against civil and criminal investigations. If it is not too late, we want to make sure that your case remains civil and does not lead to criminal charges. While civil charges can lead to monetary penalties, criminal charges for Medicare fraud can lead to years or even decades behind bars.
4. Helping You Protect Your Rights
You have fundamental legal and Constitutional rights that apply during your Medicare fraud investigation, and you need to protect these rights in order to avoid inadvertently helping the government build its case against you. We can represent you in all communications with the federal investigators and prosecutors assigned to your case, and we can assess the validity of any subpoenas, warrants, searches, or seizures.
5. Helping You Avoid Potentially Costly Mistakes
Too often, doctors and other healthcare providers who do not seek legal representation during their investigations make honest mistakes that end up having drastic consequences. We can help you avoid these mistakes, which include things like:
- Allowing investigators to question your employees without legal representation
- Making statements that prosecutors will be able to use against you
- Voluntarily disclosing potentially incriminating records without a legal obligation to do so
6. Quickly Assessing Your Defenses and Building a Comprehensive Defense Strategy
Once we have gathered the information we need to assess the government’s investigation, the healthcare fraud attorneys in our legal defense Group will quickly develop a case strategy designed to prevent the investigation from leading to charges. The sooner you get us involved, the more opportunities we will have to intervene in the investigation, help you avoid unnecessarily disclosing information, and poke holes in the government’s case against you. Remember, the government has the burden of proof, and if it cannot prove every element of the charges it intends to bring, you deserve to have the investigation closed without the threat of civil or criminal liability.
The Keys to a Successful Medicare Fraud Defense
With each aspect of this comprehensive approach in mind, there are three keys to building a successful defense strategy for a Medicare fraud investigation involving diabetes or obesity medicine practice. When you choose The Criminal Defense Firm for your Medicare fraud investigation, the experienced attorneys in our Healthcare Fraud Defense Group will:
- Intervene Early We want to make contact with the investigators and prosecutors involved in your case as soon as possible. We want to let them know that they need to deal with us (not you), and we want to quickly gather the information we need to protect you.
- Assert Statutory Defenses Under many of the laws that the government uses to prosecute Medicare fraud, there are specific provisions that are designed to protect providers who do not deserve to be dragged into court. If a safe harbor or other exception applies in your case, we will use it to protect you.
- Challenge the Prosecutors Evidence In order to obtain a conviction, the prosecutors assigned to your case will need to be able to prove beyond a reasonable doubt that you “intentionally” participated in a fraudulent scheme or submitted false claims. If you or someone in your practice made honest mistakes that resulted in the submission of false claims, this is not enough for the government to convict you of Medicare fraud.
Put Experience On Your Side with Our Nationally Recognized Healthcare Fraud Defense Group
At The Criminal Defense Firm, all Medicare fraud cases are handled by our Healthcare Fraud Defense Group. The Healthcare Fraud Defense Group is a team of nationally recognized lawyers who have decades of experience in Medicare fraud investigations. The team includes several former federal prosecutors who previously worked with the Medicare Fraud Strike Force, DOD, DOJ, FBI, and numerous other federal law enforcement agencies.
Defend Your Practice Schedule a Free Defense Evaluation at The Criminal Defense Firm
If you are diabetes or obesity doctor in California and you are facing a Medicare fraud investigation, contact us now to schedule a free, confidential defense evaluation. You can call us 24/7 at (714) 602-4316, or submit our online request form and a member of our Healthcare Fraud Defense Group will respond as soon as possible.
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.