Knowledgeable Disability Fraud Attorneys Serving Ohio Clients
The Social Security Administration (SSA), the U.S. Department of Affairs (VA), the Centers for Medicare and Medicaid Services (CMS), and various other government agencies provide financial assistance to individuals who are unable to work due to disabling injuries. In order to claim disability benefits, a patient must meet the standards for qualification, and he or she must submit a successful application to the appropriate government agency. Once approved for disability benefits, a patient can receive much-needed financial help not only for his or her medical bills, but for loss of income and daily living expenses as well.
For health care providers, dealing with the substantial red tape involved in treating patients who receive disability benefits can be a challenge. There are limits on the benefits that are available for medical treatment, and providers must strictly adhere to the applicable billing standards in order to receive program reimbursements. Ohio providers and patients alike can face significant liability for engaging in medical disability fraud, and the list of mistakes that are considered “fraudulent” is far longer than most people realize.
Experienced Defense Attorneys for Health Care Providers in Ohio
At Oberheiden, P.C., we bring decades of experience to representing clients accused of medical disability fraud. We are former federal prosecutors who spent years pursuing cases against individuals and entities suspected of defrauding health care benefit programs including Social Security Disability (SSD or SSDI), Supplemental Security Income (SSI), Medicare, Medicaid, and others. With our extensive health care law background, we can address complex issues involved in medical disability fraud investigations, and our litigation experience allows us to execute effective strategies for protecting our clients against civil and criminal responsibility.
In recent years, Ohio has been on the short list of states at the center of the federal government’s crackdown on medical disability fraud. Providers in major cities such as Cleveland, Cincinnati, and Columbus, those in smaller urban centers like Canton and Youngstown, and even those in the state’s rural areas are under close and constant scrutiny, and medical disability fraud investigations have become increasingly common. If your practice or facility is being targeted in a medical disability fraud investigation, it is important that you seek legal representation promptly. While these investigations can have severe consequences, it is also possible to resolve them favorably without charges being filed. We can help you, but only if you put us on your side.
How We Can Help
Our experienced federal law health care fraud defense attorneys represent health care providers, medical facilities, durable medical equipment (DME) companies, and other individuals and entities at all stages of medical disability fraud investigations and prosecutions. Regardless of whether someone within your business or practice has recently been contacted by investigators, you are concerned that you may potentially be targeted in a federal investigation, or you are facing civil or criminal charges for medical disability fraud, we can take action quickly to mitigate any potential consequences as much as possible. Our services include:
- Conducting an internal assessment to determine the scope of any potential liability
- Developing remedial compliance programs
- Complying with any applicable self-reporting obligations
- Intervening in medical disability fraud investigations
- Working with investigators and prosecutors to understand the nature of the charges and the alleged fraudulent activity
- Using the facts and any available common law or statutory defenses to challenge the government’s assumptions and evidence
- Negotiating favorable resolutions that avoid civil and criminal charges
- Defending clients in civil and criminal federal medical disability fraud cases
In all circumstances, taking action promptly is critical to building and executing an effective defense strategy. We are available 24/7, and our attorneys can take action immediately if it is necessary to protect your rights.
FAQs: Civil and Criminal Medical Disability Fraud Investigations
Q: What are some examples of medical disability fraud for which health care providers can face civil or criminal liability?
Like other forms of health care fraud, medical disability fraud can take a variety of different forms. In our experience, some of the most-common allegations in medical disability fraud investigations include:
- Submitting “false and fraudulent” claims to Medicare, Medicaid, SSD or SSDI, SSI, or the VA
- Billing government benefit programs for non-qualifying services, equipment, or supplies
- Billing for medical services provided by an unlicensed or excluded health care provider
- Billing for services that are not medically-necessary
- Billing for services or supplies that were not actually provided
- Double-billing Medicare, Medicaid, SSD or SSDI, SSI, the VA, and/or private health care insurers
- Failing to comply with the terms and conditions for federal disability program reimbursement
- Falsifying patient records or test results in order to preserve medical disability benefit eligibility
- Unbundling, upcoding, and other intentional and unintentional billing errors
- Assisting patients with filing fraudulent disability benefit applications
Q: Can I be penalized for paying or receiving compensation for referrals of patients with disabilities?
Potentially, yes. The federal Anti-Kickback Statute, the Stark Law, and various Ohio laws that apply to health care providers make it illegal to receive compensation for referrals when that compensation comes – either directly or indirectly – from a medical disability benefit program. These “kickbacks” can lead to severe penalties, and providers in all sectors of the health care industry must exercise extreme caution to avoid entering into unlawful compensation arrangements.
All of that said, in Anti-Kickback Statute and Stark Law investigations, there are numerous potential defenses available. Various exceptions and safe harbors apply under each statute, and it is possible to structure a variety of different types of compensation arrangements that do not run afoul of the law.
Q: What agencies investigate cases of suspected medical disability fraud?
Several different federal agencies investigate cases of suspected medical disability fraud. When facing a federal investigation, one of the first critical steps is to determine which agency (or agencies) are involved. This may include:
- Centers for Medicare and Medicaid Services (CMS)
- Drug Enforcement Administration (DEA)
- Federal Bureau of Investigation (FBI)
- Social Security Administration (SSA) Office of Inspector General (OIG)
- U.S. Department of Justice (DOJ)
- U.S. Department of Veterans Affairs (VA)
Q: What do I need to do if I am being investigated for medical disability fraud?
If you are being investigated for medical disability fraud, you should contact an attorney immediately. An experienced health care fraud defense attorney will be able to advise you of what it is okay for you to say (and what you should not say), and will be able to communicate with the investigators and prosecutors on your behalf. At Oberheiden, P.C., we will also help you take the affirmative steps necessary to address the risk of an unfavorable outcome, and we will assist you in all aspects of responding to the government’s investigation.
Contact Skilled Legal Representatives for Health Care Providers in Ohio
At Oberheiden, P.C., our defense strategies are based on the insights many of our attorneys gained as health care fraud prosecutors with the DOJ. When you are the target of a federal investigation, experience matters. We have the experience required to defend health care providers against the government; and, if your business or practice is under investigation, we have the experience to help you secure the best possible outcome in light of the facts at hand.
When you choose our health care fraud defense team, you can expect us to:
- take immediate action to protect you and your business or practice as the law and facts allow.
- promptly intervene in the investigation and deal with the investigators on your behalf.
- provide insights gained from prosecuting health care fraud at the federal level.
- use our decades of experience to pursue our goal of a successful result and as quickly as possible.
- execute a comprehensive defense strategy that puts the law on your side.
If you need a medical disability fraud defense attorney in Ohio, we encourage you to get in touch. To get started with a free and confidential case assessment, please call (888) 356-4634 or contact us online now.