If you’re a healthcare provider, clinic, hospital, or healthcare business in Detroit, Michigan and you’re being investigated for violating the False Claims Act, you need the assistance of an experienced and dedicated team of legal professionals. The Oberheiden, P.C. has taken hundreds of cases to trial and stands ready to advise, represent, and defend you against the federal government. Our Healthcare Fraud Defense Group is nationally recognized. It’s managed by Dr. Nick Oberheiden, a well-respected healthcare fraud defense attorney. Many of the fraud defense lawyers on this elite team previously held senior positions within the Department of Justice. We understand just how serious these allegations can be.
Detroit and False Claims Act Violations
There are nine specific locations within the United States that are closely watched by the federal government. Detroit is one of those nine areas. Because there are a large number of Medicare/Medicaid beneficiaries in Detroit, there are more claims filed with the federal government by healthcare providers and businesses for reimbursement. This large number of claims leads the federal government to believe that Detroit has a higher than average risk of fraudulent activity. In fact, in 2016, the DOJ announced that it had investigated more than 300 alleged fraudulent practices and recovered more than $900 million.
Detroit is monitored by the Medicare Fraud Strike Force. Their goal is to assess the potential for fraud or violations of the False Claims Act, investigate those occurrences, and prosecute where necessary. This team is made up of federal agents and government prosecutors from several federal agencies including the Department of Justice, the Department of Health and Human Services, Office of Inspector General, the FBI, and the IRS. If you’re being investigated for violating the False Claims Act, you may come into contact with one or more agents, investigators, and prosecutors from these federal agencies.
What Is the False Claims Act?
The False Claims Act is a federal statute that applies to any individual or business that has direct or indirect contracts with and is paid for services by the United States government. The statute creates liability for contractors, individuals, organizations, or corporations who knowingly submit or causes the submission of a false claim to get approval and payment from the federal government.
However, the word “knowingly” is extremely important because it doesn’t mean that you necessarily had actual knowledge of the false claim. It means that if you didn’t know, you should have known about it. It’s a matter of due diligence. Here’s a simple example:
If you outsource your ICD coding and the company uses an outdated or obsolete code, you should know known. It is seen as your responsibility to ensure that the organization that you contract with for billing uses the appropriate codes.
Looking at Criminal and Civil Liability
Detroit providers and businesses that are charged with violating the False Claims Act face serious civil and criminal penalties. You may not know whether you’re facing criminal charges when you find out that you’re being investigated. In fact, you could face both criminal and civil charges. Oberheiden, P.C. can get the answers that you need about the investigation.
Civil liabilities include paying treble damages, fines of up to $11,000 per claim, recoupment requests, and you could also be barred from future participating in federal healthcare programs. You could also lose your license and your hospital privileges.
Criminal liability is extremely serious. Individuals can face up to $250,000 in fines for felony convictions and $100,000 per claim for misdemeanor convictions. Businesses can face up to $500,000 for each claim in fines for felonies and up to $200,000 for misdemeanors. In addition to hundreds of thousands of dollars in fines, you could also face federal imprisonment of up to five years for a False Claims Act violation.
Qui Tam Lawsuit Basics
In Detroit, Michigan, most False Claims Act investigations start because of a qui tam lawsuit. These lawsuits are designed for whistleblowers who are reporting legitimate wrongdoing, but unfortunately most qui tam lawsuits in Detroit are filed by angry former employees and competitors who are just looking to shut down your business.
In a qui tam lawsuit, the plaintiff is known as a qui tam relator. Private citizens are allowed to file qui tam lawsuits. The Latin phrase “qui tam” means “he who sues for the king and himself.” If successful, the plaintiff receives monetary compensation of either 25 or 30 percent. The initial goal of protecting the government seems to have fallen by the wayside because of the number of people who abuse the system.
First, the qui tam relator files the complaint either against an individual or the business. They can even file it against both the individual and the business. They would file the complaint with the Eastern Michigan District federal court. These complaints are sealed to protect the identity of the plaintiff(s). Unsealed copies are provided only to the presiding judge and the involved federal prosecutors.
Qui tam lawsuits and False Claims Act investigations in Detroit can take a long time. Extensions are often filed in the lawsuit and granted by the court. This enables the federal government to get all of the time that it needs to finish its investigation. The government has two options when considering the qui tam lawsuit. It can either reject it if they believe it is unsubstantiated, or it can support it. If the government thinks that there is something to the complaint, it will begin to investigate you. You may be investigated by the DOJ, DOD, DEA, FBI, OIG, or other agencies. You’ll likely receive subpoenas that require you to submit specific corporate, financial, communication, and billing records.
After the government receives your records, it will review them. This is when the government will decide whether or not it will support the qui tam. If the government rejects the qui tam, the case isn’t completely over. The plaintiff can still choose to keep the case alive. If they win without the government backing them, they can keep up to 30 percent of the recovered monies. If the government backs them, it is called intervening. The federal government will often amend the qui tam lawsuit to include additional charges such as violating the Anti-Kickback Act and the Truth in Negotiation Act. If the qui tam action is successful with the government intervention, the plaintiff will be entitled to keep 25 percent of the recovered monies.
Once you’ve been notified about the qui tam lawsuit, you need to have a False Claims Act defense attorney involved. This is a good time for your attorney to contact the federal investigating agencies and work to negotiate a settlement on your behalf. The length of time that this may take will ultimately depend on the complexity of your case.
Keep in mind that if you’re found liable, you can face serious penalties such as treble damages and expensive fines. It is extremely important that you seek out the services of a Detroit healthcare fraud defense attorney.
Using Proven Defense Strategies
The Healthcare Fraud Defense Team of Oberheiden, P.C. is made up of experienced fraud defense lawyers, many of which have experience as federal prosecutors. We’ve successfully resolved False Claims Act cases across the United States. Our collective experience gives us an edge in helping our Detroit clients through False Claims Act investigations and qui tam lawsuits. We use our demonstrated industry experience and attention to detail to negotiate with the federal government. We’ve developed three core principles:
- We work to reduce the chances of our Detroit clients facing criminal charges. This is our top priority. We use our experience to determine whether your investigation is civil or criminal, find out the objectives of the government, and how this matter can be resolved. Generally, we can get the answers to these questions within the first day or two.
- Since False Claims Act investigations in Detroit often start because of angry former employees and competitors, we work to confront these charges and we will challenge their evidence. The goal is to destroy their credibility and their story. This is a critical component to convince the government that the qui tam lawsuit lacks merit and shouldn’t be supported by the government.
- In cases that indicate civil liability, our goal is to get our Detroit clients the most favorable deal that we can. We’ve negotiated damages to a small fraction of the government’s original demand. None of our clients that have faced a False Claims Act violation investigated had to stop their practice or close their business.
If you’re being investigated by the federal government, call Oberheiden, P.C. now to discuss your case. Initial consultations are confidential and free. You can call us, use our contact form, or send us an email.
Oberheiden, P.C.
Oberheiden, P.C. has successfully represented doctors, nurses, clinics, physician owned entities, practice owners, labs, medical device companies, pharmacies, service management businesses, healthcare marketing companies, hospitals, and other healthcare businesses facing False Claims Act violations, qui tam lawsuits, Stark Law violations, Anti-Kickback Statute violations, and Medicare, Medicaid, Tricare, and Department of Labor investigations.
Here’s a small look at 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 (Healthcare Service Provider)
Result: No Liability.
Call Oberheiden, P.C. right away to speak with our Healthcare Fraud Defense Team about your case. Initial consultations are free and confidential.
False Claims Act Defense Attorneys Serving Detroit, Michigan
Dr. Nick Oberheiden has represented clients in qui tam lawsuits, False Claims Act investigations, Medicare/Medicaid fraud investigations, Tricare fraud investigations, Stark Law violations, and anti-kickback proceedings before virtually all federal agencies including, but not limited to, the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL). Dr. Oberheiden is trained in negotiations by Harvard Law School and holds a Juris Doctor from the University of California, Los Angeles, as well as a Ph.D. in law.
Lynette S. Byrd is a former Assistant United States Attorney (AUSA). Detroit clients greatly benefit from Ms. Byrd’s previous experience with the Department of Justice, where she prosecuted healthcare fraud, Anti-Kickback violations, violations of the False Claims Act, and Stark Law violations on behalf of the United States. Ms. Byrd has immense experience with healthcare law enforcement and she regularly argues federal matters for her clients.
We are available to discuss your case. You can call us directly or complete our contact form or by sending us an email.
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