Violations of the False Claims Act can turn your medical practice, facility, or business upside down. These allegations of medical fraud can cause you to pay expensive fines, face prison time, cause the loss of your professional license, and can even shut down your business. The Oberheiden, P.C. provides healthcare fraud defense for doctors, nurses, licensed medical professionals, pharmacies, hospice centers, nursing homes, hospitals, other medical facilities, and health-related businesses in the Miami, Florida area. Because an allegation of this nature is extremely serious, you should call Oberheiden, P.C. right away. You can call us 24 hours a day, 7 days a week. Our Healthcare Fraud Defense attorneys can get you the answers that you need and may also be able to help you avoid criminal charges.
Miami, Florida False Claims Act Investigations
Miami, Florida is one of nine areas in the United States the federal government closely watches for False Claims Act violations. This is because they believe that the area has a higher instance of medical fraud and False Claims Act violations. The federal government uses two special task forces in the area to investigation and prosecute violators. The Medicare Fraud Strike Force and Healthcare Fraud Prevention and Enforcement Action Team (HEAT). These investigative bodies are hybrids. They include prosecutors and investigators from multiple federal agencies. These agencies include the FBI, IRS, Office of the Inspector General (OIG), Department of Health and Human Services (HHS), Department of Defense (DOD), Department of Justice (DOJ), and other agencies.
Despite the fact that the Medicare Fraud Strike Force is only about a year old, the government has investigated a record breaking number of alleged violations since its inception. Out of the more than 300 cases, 60 involved doctors, nurses, and other licensed medical professionals. More than 200 involved healthcare facilities and businesses. The federal government totaled the missing claims at more than $900 million.
If you’re facing an allegation involving a violation of the False Claims Act, you must understand that this is an extremely serious matter. Please contact Oberheiden, P.C. right away.
What You Must Know About the False Claims Act
The False Claims Act is a federal law that covers individuals and businesses. It aims to bring accountability to those who have direct or indirect contact with and who receive payment from federal government healthcare programs. These healthcare programs can be Medicaid, Tricare, Medicare, or any other federal government program available in Miami, Florida. If an individual, business, organization, or government contractor knowingly submits or is the cause of a submission of a fraudulent or fictitious claim to one a federal healthcare program, they can be held legally liable.
Understand that the word “knowingly” doesn’t mean that you needed actual knowledge of the submission of the false claim. As a healthcare professional in Miami, Florida, you must perform due diligence to ensure that you and anyone working for you is up-to-date on all aspects of filing government claims. “Knowingly” means that you know or should have known that what was happening would result in a violation of the False Claims Act.
Take the recent updates to the ICD-10 as an example. Even if you didn’t know that someone used an obsolete code while filing a claim for your office, you can still be held liable because you should have known whether or not your staff used the appropriate billing codes.
Civil and Criminal Liability in Miami
Although the majority of violations of the False Claims Act do not occur because of criminal intent, human error can still make you responsible for civil or criminal legal liabilities. At the beginning of the investigation, you may now know whether you’re facing a civil or criminal investigation. Oberheiden, P.C. can contact the investigating task forces on your behalf and help you get the answers that you need.
Civil and criminal liability are two separate issues. You could face civil, criminal, or both types of legal liability. Civil liabilities are heard by the civil federal court. You may receive a judgment that requires you to pay treble damages (that is, three times the amount that federal government paid out on each false claim). You may also face a fine of up to $11,000 per false claim.
Criminal liability is heard in the federal criminal court. If you face criminal liability, you could be sentenced to five-years in prison. You may also be ordered to pay fines based on whether you’re charged with a misdemeanor or a felony. Keep in mind that the fine amounts are based on each claim. So, if you are found criminally guilty of two false claims, you would pay two fines. Misdemeanors can carry charges of up to $100,000 per claim for an individual and up to $200,000 per claim for businesses. Felonies can leave you with charges of up to $250,000 per claim for individuals and up to $500,000 per claim for companies.
In addition to possibly facing both civil and criminal charges, you are also at risk of being stripped of your professional license or being forced to shut down your practice, facility, or business.
Miami, Florida Qui Tam Lawsuits
Although Miami, Florida is one of nine areas that the federal government closely watches for medical fraud, the special task forces involved generally don’t decide to start a random investigation of a healthcare professional or facility. What causes many of these investigations is an unhappy former employee or competitor who chooses to file a certain type of lawsuit in the federal district court. This type of lawsuit is known as a qui tam lawsuit.
The name of this type of suit is from a Latin phrase that means “he who sues for the king and himself.” This is where a private citizen sues on behalf the federal government. It essentially alleges that the plaintiff knows of fraud that was committed against the federal government. The original goal of this type of lawsuit is to help the government recover money that it paid on fraudulent or false claims. In legitimate instances, one could liken it to whistleblowing. If the plaintiff is successful, with or without the involvement of the federal government, he or she can receive a monetary reward of either 25 or 30 percent. However, because qui tam lawsuits are routinely filed by former employees and competitors, they are often abused and used as mechanisms to punish or sabotage others.
Plaintiffs in qui tam lawsuits are referred to as “qui tam relators.” The complaints seal the identity of the plaintiff in order to protect individuals who truly are trying to report fraudulent claims. Complaints are filed in the Southern District of Florida. Copies of the unsealed complaint are given only to the presiding judge and the appropriate government officials.
Investigations of alleged violations involving the False Claims Act can take months. Extensions are filed and granted in the qui tam case to give the government the time that it needs to conduct its investigation to determine if it will decline or support the qui tam lawsuit. During the investigation, you will receive subpoenas for your communication, financial, billing, and corporate records. Subpoenas may come from the FBI, DEA, IRS, OIG, DOJ, DOD, HHS, or other government agencies.
During the investigation, your healthcare fraud defense lawyer can be in contact with the task forces. If the government decides to reject the qui tam lawsuit, it won’t necessarily be over. The plaintiff can still choose to pursue the case. If the government chooses to support the lawsuit, it is known as intervening. If intervention occurs, you may face additional charges such as violating the Truth in Negotiation Act and the Anti-Kickback Act.
Guiding Principles of Oberheiden, P.C.’s Strategic Defense Plan
Each case involving an allegation of medical fraud is different. Oberheiden, P.C. has a proven track record of negotiating with the federal government and defending our clients in False Claims Act cases throughout the United States. Our Healthcare Fraud Defense Team uses a core set of guiding principles to develop and implement a strategic plan of defense.
- Early contact with investigating task forces. Oberheiden, P.C. will establish and maintain contact with the investigating task forces involved in the investigation. We will help you determine the type of charges you may be facing, what the government’s ultimate goal is, and what can be done to resolve these allegations. We can usually get answers to these questions within a couple of days. We’ve discovered that early intervention is one of the best ways to protect your professional license and reduce the risk of criminal charges.
- Vigorous qui tam defense. Since most qui tam lawsuits in Miami, Florida originate because of a former employee or competitor, Oberheiden, P.C. works to provide a vigorous defense. We will challenge the evidence and discredit the source. Our goal is to show the federal government that the claims against you are unfounded. The federal government is less likely to intervene if the claims are shown to be unfounded.
- Settlement. In most of our former False Claims Act cases involving civil liability, we’ve negotiated damage amounts to a small portion of the federal government’s original demand. To date, none of our former clients were forced to shut down their practice or their business because of one of these allegations.
False Claims Act investigations can be stressful and time-consuming. They’re also extremely serious. Oberheiden, P.C. can help. Call us right away to discuss the facts in your case. Your initial consultation is free and confidential. Call us anytime. We’re available 24 hours a day, 7 days a week. You can also use our online contact form or send us an email to learn more.
Oberheiden, P.C.
The attorneys of Oberheiden, P.C. have successfully defended physicians, practice owners, physician-owned entities, toxicology laboratories, device companies, pharmacies, service management organizations, healthcare marketing companies, hospitals, and many others in False Claims Act, qui tam lawsuits, Stark Law, Anti-Kickback, Medicare, Medicaid, Tricare, and DOL investigations.
- 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 today and speak with former federal prosecutors and established defense counsel about your case. All initial consultations are free and confidential.
False Claims Act Defense Attorneys in Miami, Florida
Dr. Nick Oberheiden has represented clients in Qui Tam, False Claims Act, Medicare/Medicaid Fraud, Tricare Fraud, Stark Law, 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). Clients greatly benefit from Lynette’s experience from the Department of Justice, where she prosecuted healthcare fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Lynette 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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