While often underestimated, the Department of Labor (DOL) is a very active and powerful federal agency when it comes to investigating health care fraud in New Mexico and across the country. Physicians and other health care providers often find themselves unexpectedly facing federal agents and investigators working for the Office of Inspector General (OIG) or the United States Postal Service pursuant to investigations initiated by the DOL. In some cases, health care providers simply receive subpoenas requesting that they deliver their confidential records to the government.
In any case, what you do next could impact the rest of your life.
DOL Fraud Explained
Just like Medicare fraud, DOL fraud can involve violations of one or more of a variety of different federal health care statutes. Some of the most common examples of DOL fraud include:
Services Not Rendered
Two of the most common accusations in DOL fraud investigations are (i) that a particular service that was billed to the government was not actually provided, and (ii) that a health care provider billed the government for medical devices or medications that were given to patients. In more extreme scenarios, the government may allege that a health care provider billed for services, devices, or medications that were supposedly provided to patients who never existed – referred to as “ghost patients.”
Up-Coding, Bundling, and Unbundling
A significant number of DOL fraud investigations involve upcoding and bundling of health care services. Upcoding involves submitting a claim for a procedure that is more expensive than the services that were actually rendered to the patient. Bundling involves lumping rates together in order to obtain a group reimbursement rate, while unbundling is characterized by splitting services into multiple billing codes that are then billed separately in order to receive a higher overall rate.
Under federal law, seeking reimbursement of funds used for any direct or indirect payment to entice or reward a patient referral is illegal. Receiving government funds for a patient referral is a violation of federal law as well. These “kickbacks” are often the subject of DOL fraud investigations. Additionally, the federal courts consider even the smallest attempt to bribe a referral to be a violation of the federal Anti-Kickback Statute, 42 U.S.C. § 1328-7b(b), and the Federal False Claims Act.
Who Is Targeted by DOL Investigations?
There are a number of reasons why the federal authorities may choose to open an investigation into a particular provider for possible DOL fraud. Some of the most common reasons include the following:
- Complaints by former employees
- Connection to another DOL investigation
- Excessive billing or other suspicious billing practices
- Patient complaints
What Are the Penalties for DOL Program Fraud?
DOL program fraud is a serious federal offense that can be charged in one of two ways:
Civil Charges and Penalties
The government can request recoupment of funds paid as a result of fraud, and often does so under the False Claims Act. In civil cases, the government will ask for the difference between what was actually paid and what should have been paid to the provider. In addition to this recoupment, the government will typically impose a civil fine calculated as a percentage of the total damage caused by the billing fraud. In many cases, this can easily amount to millions of dollars.
Criminal Charges and Penalties
DOL program fraud can also be charged as a felony. In criminal cases, federal prosecutors will typically attempt to indict the responsible owners and staff of the health care company for health care fraud under 18 U.S.C. § 1347. Each count under 18 U.S.C. § 1347 carries a maximum sentence of 10 years imprisonment. Individuals and businesses convicted of DOL fraud can face criminal fines and other penalties as well.
Is My Case Civil or Criminal?
One of the most important issues in any DOL investigation is to find out whether the case is civil or criminal. Our trained and experienced defense attorneys will be able to quickly determine why the government is interested in your practice. Figuring out the context and the objectives of the investigation is critical to formulating a sound defense strategy, and is a crucial first step for protecting you and your business.
What is the “Emergency Defense Package”?
Targets often learn about their alleged involvement in DOL fraud when federal agents show up at their door to serve a subpoena or inspect the premises with a search warrant. In either case, time is of the essence, and you need to speak with a qualified defense attorney right away.
Over the years, Dr. Nick Oberheiden and the former federal prosecutors at the Oberheiden & McMurrey, LLP have developed certain protocols that allow their clients to take immediate action to protect themselves. Case after case, these protocols have proven to work because they allow clients to take important steps that can make a huge difference in the outcome of their case. We call this our “Emergency Defense Package.”
The “Emergency Defense Package” contains:
- General Protocols: What to Do
- Instructions for Management: How to Deal with Agents
- Instructions for Management: How to Deal with Employees
- Instructions for Employees
- Document Retention Forms
- Compliance Examination Instructions
- Important Contact Information
DOL Cases and Experience
At Oberheiden & McMurrey, LLP, we know how to protect you, your livelihood, and your family. Health care fraud and DOL program fraud are serious accusations, and you can expect us to take a serious approach to your defense.
Our team of experienced attorneys has successfully handled a wide variety of health care fraud cases, including specifically cases involving accusations of DOL fraud. We are regularly retained to defend physicians, health care business owners, and patients against health care fraud, bribery, and anti-kickback violations in New Mexico and nationwide. We have concluded dozens of federal, civil, and criminal health care fraud investigations with the result that our clients faced no civil or criminal liability.
FAQs about DOL Fraud Investigations
Which agencies are involved in DOL health care investigations?
Most DOL health care investigations are led by agents and special agents of the OIG and the U.S. Postal Service.
How long does it take to resolve the investigation?
The answer depends on the seriousness of the charges, whether the case is civil or criminal, and the role of the client in the case.
What experience do you have with DOL cases?
The attorneys at Oberheiden & McMurrey, LLP have been involved in some of the largest and most complex DOL investigations in the country. Read more in our success stories.
Who will handle my case at Oberheiden & McMurrey, LLP?
We value personal attention and communication with our clients. All cases will be handled by senior attorneys. We do not use paralegals or junior lawyers, and all clients are represented by a team effort, led by former federal prosecutors and experienced health care attorneys.
Defending Clients in DOL Fraud Investigations throughout New Mexico
Oberheiden & McMurrey, LLP has successfully represented clients in some of the largest DOL investigations in the country. If you are being investigated for DOL fraud in New Mexico, we encourage you to contact us immediately for a free, confidential consultation. Call (800) 801-7249 or contact us online now to speak with an experienced attorney about your case.