Health Care Fraud and Abuse Defense
The health care industry is one of the most heavily regulated and complex industries in America. Health care laws and regulations, as well as the government’s enforcement priorities, change frequently and require constant study and attention. Indeed, the only thing that remains unchanged in the health care industry is the federal government’s intense and unrelenting efforts to combat health care fraud and abuse. The government is now dedicating an unprecedented level of resources to health care fraud initiatives, and is working proactively to bring enforcement actions against all types of health care providers.
When allegations of health care fraud or abuse arise, health care institutions, senior health care executives, and health care professionals should be represented by a health care lawyer with extensive experience defending complex fraud and abuse cases. The statutes and regulations addressing health care fraud and abuse are extraordinarily complex and challenging to navigate without the guidance of a knowledgeable and skilled attorney.
We Know the Health Care Industry
To effectively defend a health care fraud investigation, an attorney needs more than just an understanding of the complex web of health care laws and regulations. Indeed, our attorneys also understand how health care businesses operate and the unique competitive pressures they face, including the need to recruit top medical talent and maintain revenues in a time of increased regulation and decreased reimbursement rates. Our attorneys speak your language and are uniquely suited to help you develop strategies and approaches that meet strict regulatory requirements, while advancing your critical business goals. We have years of experience representing a myriad of health care providers, including:
- Diagnostic Centers
- Comprehensive Outpatient Rehabilitation Facilities
- Nursing Homes
- Physician Group Practices
- Individual Health Care Professionals (Physicians, Physicians’ Assistants, Chiropractors, Nurses)
- Durable Medical Equipment Companies
- Drug & Alcohol Treatment Centers
- Partial Hospitalization Programs / Community Mental Health Centers
We Understand Fraud and Abuse Laws and Government Agencies
At Stumphauzer & Sloman, our attorneys have years of experience handling sophisticated health care fraud and abuse cases. In private practice and previously as federal prosecutors, our lawyers have managed hundreds of health care fraud and abuse cases, from grand jury investigation through jury trial and sentencing, including matters involving:
- Anti-Kickback Statute
- Health Care Fraud Statute
- Stark Law (Physician Self-Referral Law)
- False Claims Act (FCA)
- Civil Monetary Penalty Law
- Exclusion from Federal Health Care Programs
- RAC, MAC and ZPIC Audits
Our attorneys understand the complex interaction between these laws and the multiple government agencies responsible for their enforcement. All of our firm’s principals have worked as federal prosecutors with the U.S. Attorney’s Office, and attorney Ryan Stumphauzer was the Deputy Chief of the Health Care Fraud Unit at the U.S. Attorney’s Office in the Southern District of Florida.
Based on this experience, we have a keen awareness of how parallel investigations and enforcement proceedings against a health care provider may be instituted by different agencies including the U.S. Department of Justice (DOJ), the U.S. Department of Health and Human Services - Office of the Inspector General (HHS-OIG), the Federal Bureau of Investigation (FBI), and the Florida Attorney General’s Medicaid Fraud Control Unit (MFCU).
When parallel proceedings arise, our attorneys know how to guide clients through simultaneous investigations and enforcement actions. We also understand the various types of civil, criminal and administrative sanctions that each of these governmental entities can impose.
We have represented clients in some of the nation’s highest profile health care fraud and abuse investigations. We draw upon our extensive experience and knowledge to design a complete and coordinated defense strategy. Some of our representative engagements include:
- Represented a senior executive of a publicly-traded hospital management corporation in connection with an investigation by the Department of Justice and the Department of Health & Human Services into alleged violations of the Anti-Kickback Statute and Stark Law.
- Represented the Chief Executive Officer of a large Florida hospital in parallel civil and criminal investigations by the Department of Justice, Department of Health & Human Services, and the Federal Bureau of Investigation involving alleged violations of the Anti-Kickback Statute and Stark Law.
- Represented the Compliance Committee of a large Florida hospital in conducting an internal investigation after a Board member raised concerns regarding potential violations of federal health care laws.
- Represented a prominent national health care provider in conducting an internal investigation of alleged violations of the Civil Monetary Penalty Law, and in voluntarily reporting those violations to the Department of Health & Human Services pursuant to the Self-Disclosure Protocol.
- Successfully represented the founder and senior executive officer of one of South Florida’s largest primary care providers, a Medicare Advantage Management Services Organization (MSO), in connection with an investigation alleging violations of the Anti-Kickback Statute, the Medicare Marketing Guidelines, and the Civil Monetary Penalty Law. The firm further assisted the senior executive officer in assessing complex health care compliance issues.
- Represented an array of health care professionals—including physicians, physician assistants, nurses and chiropractors—in defending government investigations and in responding to MAC, RAC and ZPIC audits.