Federal Health Care Fraud Defense Attorney South Dakota
If you seek lawyers for federal health care fraud defense in South Dakota then call us or e-mail us today. The attorneys at our firm have years of experience successfully defending those being facing charges on or being investigated for:
- OIG and HHS subpoenas
- Qui Tam and other whistle blower situations
- Department of Labor health care fraud situations
- Medicare and TRICARE fraud audits
- False Claims Act investigations
- CLIA violations
- Anti-Kickback Statute and Stark Law violations
- Other federal health care fraud charges requiring an experienced, competent criminal defense law firm
Government Health Care Fraud Strike Force Unit
According to the OIG HHS website:
Medicare Fraud Strike Force Teams harness data analytics and the combined resources of Federal, State, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse. First established in March 2007, Strike Force teams currently operate in nine areas: Miami, Florida; Los Angeles, California; Detroit, Michigan; southern Texas; Brooklyn, New York; southern Louisiana; Tampa, Florida; Chicago, Illinois; and Dallas, Texas.
Strike Force teams bring together the efforts of the Office of Inspector General, the Department of Justice, Offices of the United States Attorneys, the Federal Bureau of Investigation, local law enforcement, and others.
These teams have a proven record of success in analyzing data and investigative intelligence to quickly identify fraud and bring prosecutions. The interagency collaboration also OIG Agentsenhances the effectiveness of the Strike Force model. For example, OIG refers credible allegations of fraud to the Centers for Medicare & Medicaid Services (CMS) so that it can suspend payments to the suspected perpetrators, thereby immediately preventing losses from claims submitted by Strike Force targets.
Strike Force teams have shut down health care fraud schemes around the country, arrested more than a thousand criminals, and recovered millions of taxpayer dollars.
What Is Health Care Fraud All About?
This is when one or more fraudulent claims like Medicare, federal workers’ compensation for reimbursement, Tricare and Medicaid are filed with a federal health care program. These claims get filed with the government for medical services or equipment including violation of one or more of the following laws:
The Anti-Kickback Statute
Federal government health care law forbids kickbacks in exchange for referrals. Everybody, be it business owner, doctor or marketing representative is subject to prosecution for not complying with the Anti-Kickback statue for offering payment or any other valuable in exchange for patient referrals.
This is also called the Self-Referral law. This law prevents doctors from referring patients to particular health care service entities most especially if the doctor or any of his family has an investment interest or ownership although there are some statutory clauses to this law.
False Claims Act
If a claim is submitted to Medicare or other health programs, it is deemed fit by the law to abide by the False Claims Act. And in a case where the submitted claim is found inaccurate, an investigation by the federal government will be launched into your billing practices under the False Claims Act.
The federal government decides to keep a close eye on hospice industry and as well the home health care. The commonly found fraudulent accusations are hospice care and fraudulent certification for home health care.
When it comes to the investigation of the up-coding of claims, the federal government is very persistent. What does up-coding mean? This implies the following higher code is used for a service after the billing has been done. Phantom billing such as patients who do not exist, services that were not offered, unnecessary medical services will also be investigated by the federal government.
Special attention is given to health care practices that have high amount of narcotic description by the federal government. You are likely to be investigated for insurance fraud and as well violating the dispensing rules of DEA if you are suspected of running a pill mill.
Our aim is to protect our clients from any form of criminal charges. Call us today if you are in South Dakota and you are under investigation for health care fraud.
Important Legal Defenses To Health Care Fraud
Our firm is a health care fraud defense firm offering services to those in South Dakota. We scrutinize the facts in every case to select the effective defenses for our several clients the past years. We have the experience to develop fundamental legal defenses for the health care of our clients going through health care fraud allegations.
Proving A Lack Of Criminal Intent
Proof must be presented by the federal government to confirm you truly committed a crime and that you had criminal intent. We will evaluate the evidence presented by the federal government to decide if you committed the crime. At times, the federal government is likely to point out inaccuracies in billing to proof that you committed a crime.
However, we have discovered that these inaccuracies happen not necessarily because of fraud, at times they are mistakes. Although these mistakes should be addressed and rectified, it should not lead to you facing criminal penalties. Mistakes happen when business or health care practices grow rapidly or perhaps a mistake is made by someone. The common triggers of these mistakes are outsourcing errors, the use of unqualified workers, insufficient supervision, delegation errors, frequent change of rules and laws of health care.
Federal Health Care Fraud Announcements In South Dakota
Here are some announcements from the Department of Justice and/or other federal government agencies about specific health care fraud situations in South Dakota. We also may include video news clips about investigations or convictions on various federal health care fraud charges in South Dakota: