Federal Defense and Healthcare

Federal Defense and Healthcare: Navigating Complex Legal Challenges

At Spodek Law Group, we understand the intricate web of federal laws and regulations surrounding healthcare. As experienced federal defense attorneys, we’ve seen firsthand how even well-intentioned healthcare providers can find themselves facing serious allegations of fraud or misconduct. If you’re a healthcare professional or organization under federal investigation, you need a skilled legal team in your corner.

The High Stakes of Federal Healthcare Investigations

Healthcare is one of the most heavily regulated industries in the United States. With billions of dollars flowing through Medicare, Medicaid, and other federal healthcare programs each year, the government takes a hard line on suspected fraud and abuse. Even minor billing errors or administrative oversights can trigger invasive audits and investigations.Some of the most common allegations we see in federal healthcare cases include:

• Medicare/Medicaid fraud
• Anti-Kickback Statute violations
• Stark Law (physician self-referral) violations
• False Claims Act violations
• Controlled substance violations
• HIPAA privacy breaches

The penalties for healthcare fraud can be severe, including:

• Massive civil monetary penalties
• Criminal fines in the millions of dollars
• Exclusion from federal healthcare programs
• Prison sentences of 10+ years in serious cases

With your professional reputation and freedom potentially on the line, you can’t afford to face federal investigators and prosecutors alone. You need an experienced healthcare fraud defense team that knows how to protect your rights and interests.

Our Approach to Federal Healthcare Defense

At Spodek Law Group, we take a proactive, strategic approach to defending healthcare providers against federal allegations. Here’s how we tackle these complex cases:

1. Rapid Response: As soon as you contact us, we spring into action to intervene in the investigation and protect your interests. Time is of the essence in federal cases.
2. Thorough Case Assessment: We conduct a deep dive into the allegations, evidence, and applicable laws to determine your potential exposure and develop a tailored defense strategy.
3. Aggressive Defense: We leverage our extensive experience and resources to challenge the government’s case at every turn – from contesting search warrants to filing motions to suppress evidence.
4. Strategic Negotiations: When appropriate, we engage in proactive negotiations with prosecutors to resolve cases favorably before charges are filed.
5. Trial Preparation: If a case proceeds to trial, we assemble a top-notch team of attorneys, experts, and investigators to mount a vigorous defense.

Our goal is always to achieve the best possible outcome for our clients, whether that means getting charges dismissed, negotiating a favorable plea deal, or prevailing at trial.

Common Federal Healthcare Investigations

Let’s take a closer look at some of the most frequent types of federal healthcare investigations we handle:

Medicare/Medicaid Fraud

The federal government aggressively pursues suspected fraud in Medicare, Medicaid, and other taxpayer-funded healthcare programs. Common allegations include:

• Billing for services not rendered
• Upcoding (billing for more expensive services than provided)
• Unbundling (billing separately for bundled services)
• Kickbacks for patient referrals
• Falsifying patient diagnoses to justify services

EXAMPLE SCENARIO: Dr. Smith runs a busy family practice and employs a third-party billing company. An audit reveals numerous instances of “upcoding” where routine office visits were billed at higher levels. While Dr. Smith had no direct involvement in the billing, she now faces potential False Claims Act charges. We would work to demonstrate her lack of intent and implement compliance measures to prevent future issues.

Anti-Kickback Statute Violations

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for services covered by federal healthcare programs. This can include:

• Cash payments for referrals
• Excessive consulting fees
• Below-market rent for medical office space
• Free or discounted equipment/supplies

REAL-WORLD EXAMPLE: A medical device company offers surgeons lavish “training” trips to exotic locales, along with speaking fees for minimal work. While positioned as education, prosecutors view this as unlawful inducement for the surgeons to use the company’s products. We would scrutinize whether the trips/fees were truly fair market compensation for legitimate services.

Stark Law Violations

The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities with which they (or immediate family members) have a financial relationship, unless an exception applies. Common issues include:

• Referrals to facilities where the physician is an investor
• Compensation arrangements exceeding fair market value
• Office space rentals that don’t meet Stark exceptions

HYPOTHETICAL CASE: An orthopedic group has an in-office MRI machine and routinely refers patients for scans. While in-office ancillary services can be permissible, any missteps in the arrangement’s structure could trigger Stark Law violations. We would carefully review the setup to ensure full compliance with applicable exceptions.

False Claims Act Cases

The False Claims Act (FCA) is the government’s primary tool for combating healthcare fraud. It imposes liability for knowingly submitting false claims to government programs. Key aspects include:

• Whistleblower (qui tam) provisions allowing private citizens to file suits
• Potential treble damages and penalties of $11,803 to $23,607 per false claim
• Liability for “deliberate ignorance” or “reckless disregard” of truth/falsity

CASE STUDY: A hospital system faces FCA allegations that it admitted patients for short inpatient stays when observation status was more appropriate. While the hospital argues these were good faith medical judgments, prosecutors allege a pattern of upcoding for financial gain. Our defense would focus on the complexity of admission decisions and lack of clear standards.

Controlled Substance Violations

With the ongoing opioid crisis, federal authorities are cracking down on suspected drug diversion and improper prescribing practices. Issues can include:

• Prescribing without legitimate medical purpose
• Failing to maintain proper records and security measures
• “Pill mill” operations prioritizing profits over patient care

EXAMPLE: A pain management physician faces DEA scrutiny for high-volume opioid prescribing. While she believes her practices are appropriate for her patient population, investigators see red flags like cash-only payments and minimal medical records. We would work to demonstrate legitimate medical decision-making and enhance compliance protocols.

Defending Against Federal Healthcare Charges

When facing a federal healthcare investigation or charges, a strategic, proactive defense is critical. Here are some key elements of our approach:

Early Intervention is Key

The earlier we can get involved in a case, the better. By engaging experienced counsel as soon as you become aware of an investigation, we can:

• Intervene to limit the scope of subpoenas and document requests
• Ensure your rights are protected during interviews and searches
• Conduct an internal investigation to get ahead of issues
• Open a dialogue with prosecutors before positions harden

DON’T WAIT to contact us if you suspect you’re under investigation. Early action can make a huge difference in the outcome of your case.

Challenging the Government’s Evidence

Federal prosecutors often rely on data analytics and statistical sampling to build healthcare fraud cases. We scrutinize their methodologies and conclusions, looking for flaws like:

• Improper extrapolation from limited samples
• Failure to account for legitimate clinical variations
• Misinterpretation of complex billing rules

We work with leading medical and statistical experts to counter the government’s analyses and present alternative explanations for billing patterns.

Asserting Lack of Intent

Many federal healthcare laws require prosecutors to prove willful or knowing violations. We focus on negating intent by demonstrating factors like:

• Good faith efforts to comply with regulations
• Reliance on advice from lawyers or consultants
• Complexity and ambiguity in billing/coding rules
• Delegation of billing to qualified third parties

Even if technical violations occurred, lack of fraudulent intent can be a powerful defense.

Negotiating Favorable Resolutions

In many cases, the best outcome is achieved through skillful negotiation rather than protracted litigation. We leverage our experience and relationships to pursue options like:

• Civil settlements without criminal charges
• Reduced charges or penalties
• Corporate integrity agreements instead of exclusion
• Pretrial diversion programs

Our goal is always to resolve cases on the most favorable terms possible for our clients.

Aggressive Trial Defense

If a case does proceed to trial, we assemble an elite team of attorneys, experts, and investigators to mount a vigorous defense. Our trial strategies may include:

• Challenging the credibility of whistleblowers/cooperating witnesses
• Presenting alternative explanations for billing/prescribing patterns
• Educating jurors on the complexities of healthcare regulations
• Humanizing our clients and their dedication to patient care

With decades of trial experience, we know how to effectively tell our clients’ stories and create reasonable doubt.

Why Choose Spodek Law Group for Federal Healthcare Defense?

When your professional reputation and freedom are on the line, you need a legal team with the experience, resources, and dedication to achieve the best possible outcome. Here’s why healthcare providers nationwide trust Spodek Law Group:

• Unmatched Experience: Our attorneys include former federal prosecutors and veteran defense lawyers who have handled hundreds of healthcare fraud cases.
• Comprehensive Expertise: We understand both the legal and medical aspects of healthcare investigations, allowing us to build stronger defenses.
• Proactive Approach: We don’t just react to government actions – we anticipate their moves and stay one step ahead.
• Nationwide Reach: With a network of local counsel and investigators across the country, we can effectively handle cases in any jurisdiction.
• Dedication to Clients: We treat every case as if our own lives and livelihoods were at stake, fighting tirelessly for the best outcomes.

Don’t gamble with your future. If you’re facing a federal healthcare investigation or charges, contact Spodek Law Group today at 212-300-5196 for a confidential consultation. Let us put our experience and dedication to work for you.

Frequently Asked Questions About Federal Healthcare Defense

Here are answers to some common questions we receive about federal healthcare investigations and defense:Q: I received a subpoena from HHS-OIG. Does this mean I’m under investigation?A: Not necessarily. Subpoenas are often used to gather information in broader investigations. However, it’s crucial to respond appropriately and consider retaining counsel to protect your interests.Q: Can I just explain the billing error/mistake to investigators and resolve this quickly?A: We strongly advise against speaking to investigators without an attorney present. Even innocent explanations can be misconstrued or used against you later. Let us handle communications with the government.Q: What’s the difference between civil and criminal healthcare fraud cases?A: Civil cases typically focus on financial penalties and program exclusion, while criminal cases can result in prison time. However, investigations often start as civil and can escalate to criminal if serious misconduct is uncovered.Q: How long do federal healthcare investigations typically last?A: Timelines vary greatly, from a few months to several years for complex cases. Having experienced counsel can often help expedite resolutions.Q: Will my case definitely go to trial?A: Not necessarily. Many federal healthcare cases are resolved through negotiation or alternative resolutions. However, we always prepare as if a case will go to trial to ensure the strongest possible position.

The Spodek Law Group Difference

At Spodek Law Group, we don’t just practice law – we fight passionately for our clients’ futures. When you choose us to defend you against federal healthcare charges, you get:

• A team of elite attorneys with decades of experience in healthcare fraud cases
• Aggressive, proactive defense strategies tailored to your unique situation
• 24/7 availability to address your concerns and guide you through the process
• A track record of achieving favorable outcomes in high-stakes federal cases

We know how devastating healthcare fraud allegations can be to your professional and personal life. That’s why we pour our hearts and souls into every case, treating our clients’ challenges as our own.Don’t face federal investigators alone. Contact Spodek Law Group today at 212-300-5196 for a confidential consultation. Let us fight to protect your rights, your reputation, and your future.Remember, the earlier you involve experienced counsel in your case, the better your chances of a positive outcome. Don’t wait – call us now to get the aggressive defense you deserve.