We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Medicare Fraud Legal Defense Team Serving California

The Oberheiden Law Group is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our attorneys are the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and education from the country’s best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in California and surrounding areas.

California health care providers, clinics, hospitals, other facilities, and related health care businesses in California face an enormous chance of being investigated for Medicare fraud. If you have been notified that you’re being investigated for Medicare fraud, you need legal help. The Oberheiden Law Group, PLLC serves California health care providers, facilities, and businesses. Harvard-trained health care fraud defense attorney Dr. Nick Oberheiden is the managing partner.

What Is Medicare Fraud?

Medicare fraud is a federal offense with both civil and criminal penalties. It can involve more than just the Medicare program. It includes any federal health care program: Medicaid, Tricare, and federal workers’ compensation, too. Medicare fraud is defined as the submission of a false claim or claims to any federal government health care program in order to receive an illegal payment. If you are being investigated for Medicare fraud, you’re being investigated for violating at least one of the following statutes:

  • Stark Law (Physician Self-Referral Law)
  • Anti-Kickback Statute
  • False Claims Act
  • Social Security Act
  • U.S. criminal law

Medicare fraud is incredibly serious. California area health care providers, facilities, and businesses have a much higher risk of being accused of it. This is because the State of California has a huge population of citizens who are beneficiaries of federal health care programs. In fact, California is one of nine areas in the United States that is closely watched by the Medicare Fraud Strike Force. More claims are filed in California because of the number of federal health care program recipients. The federal government believes that this increase in claims may also lead to an increase in fraudulent activity. The job of the Medicare Fraud Strike Force is to monitor, investigate, and prosecute instances of Medicare fraud.

The Medicare Fraud Strike Force is a federal investigative body that is comprised of prosecutors and investigators from several federal agencies including including the DEA, DOJ, DOD, FBI, IRS, the Office of Inspector General, and Department of Human Services. This list isn’t all-inclusive. There are often other federal agencies involved.

What Is the Most Common Reason for Medicare Fraud Investigations in California?

One of the questions we are asked most often is what is the most common reason Medicare fraud investigations in California begin. It begins because the federal government is alerted to billing errors that are deemed as fraudulent billing practices and reimbursement requests. This can include unauthorized, excessive, or false charges. These are commonly caused in California by:

  • Billing for medically unnecessary supplies
  • Billing for unnecessary services
  • Billing for services that were never performed (referred to as phantom billing)
  • Billing for equipment or services that were never ordered
  • Certification for medically unnecessary supplies or services (including hospice care and medical devices)
  • Inflating charges
  • Double billing
  • Upcoding
  • Overuse of services or equipment
  • Providing kickbacks
  • Accepting kickbacks

Another question that we are routinely asked is who is most likely to be investigated in California. The most commonly investigated entities include doctors, nurses, other health care professionals health care executives, health care services, hospice care, registered care, nursing homes, hospitals, clinics, pharmacies, DME providers, labs, cancer treatment centers, and DNA centers. However, keep in mind that any person, facility, or business that files claims for reimbursement from federal health care programs can be investigated for Medicare fraud.

A Look at the Civil and Criminal Penalties

Medicare fraud investigations can involve both civil and criminal penalties. You, your practice, or your business may face these penalties. You may face one or more of the following civil penalties:

  • Treble damages
  • Payment of civil fines of up to $11,000 per false claim
  • Recoupment requests
  • Non-payment of future federal health care program claims
  • Federal health care program exclusion
  • Attorney fees

In addition to civil penalties, you could face criminal penalties. You may face one or more of the following criminal penalties for Medicare fraud in California:

  • Criminal record
  • Fines in the hundreds of thousands of dollars
  • 10 years in federal prison for each count of Medicare fraud
  • 20 years in federal prison if the Medicare fraud resulted in serious bodily injury
  • A life sentence in federal prison if the Medicare fraud resulted in the patient’s death

You could also face state disciplinary measures, lose your license, and lose your hospital privileges.

You Must Choose the Right California Defense Attorney

When you discover that you’re being investigated for Medicare fraud, it is critical that you choose the right California defense attorney. The attorney must have the needed experience and the right skills to go up against the federal government on your behalf in both negotiation and, if necessary, trial.

Many California health care practitioners, businesses, and facilities immediately default to searching for the services of a health care attorney. Although this may make a lot of sense to many people, it’s important for you to understand that Medicare fraud is often charged in conjunction with federal criminal matters such as tax evasion, mail fraud, wire fraud, and money laundering. A health care attorney may not have the training or experience to truly assist you with these life-altering charges. They may not have the negotiation skills needed to help you.

There are many in California who will seek out the services of a criminal defense attorney when they realize that they may be facing criminal charges. It’s important to note that not all criminal defense attorneys have experience with federal criminal matters. Also, many won’t have knowledge of health care law and the intricacies in billing, coding, and medical utilization rules.

You should look for the services of a California health care fraud defense attorney who has these four qualifications:

  1. A proven track record of success in Medicare fraud cases
  2. Industry knowledge
  3. Deep familiarity with health care laws and their exceptions
  4. Litigation and trial experience

As you complete your research, you’ll have a list of potential attorneys. You should then ask these three questions to ensure that they have the Medicare fraud experience that you need:

  1. How many Medicare fraud cases have you handled during your career in law?
  2. How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
  3. How many Medicare fraud cases did you try in court?

California Medicare Fraud Defense Strategies

The Oberheiden Law Group serves California health care providers, businesses, and related entities using our three core guidelines. These guidelines help us defend our clients from allegations of Medicare fraud, while also helping us develop the right defenses for their particular facts. Our overall goal is to reduce the likelihood that our clients will face criminal charges.

Early intervention. One of the best Medicare fraud defense strategies is for us to get involved early with the federal government on behalf of our clients. The more uninterrupted time that the government has to investigate you, the more likely it is that you’ll face federal charges. Once retained, we get into contact with the federal investigators as soon as we can to ask:

  • What is the investigation about?
  • What prompted the investigation?
  • Is this civil or criminal?
  • Which federal agencies are involved in the investigation?
  • Who all is being investigated?
  • How can the matter be resolved?

These questions are extremely important in formulating the right defense. We can usually get the answers to these questions within the first few hours after being retained by our clients.

Addressing and testing federal evidence. The federal government must present evidence that proves beyond a reasonable doubt that you committed a crime. This is a Constitutional standard that we test in each and every case. By addressing and testing their evidence, we’ve routinely seen the following results:

  • Dismissal of case
  • No criminal charges
  • Clients maintain their professional license
  • Civil fine without a criminal plea
  • Reducing a felony to a misdemeanor
  • No prison sentence

Lack of criminal intent. The government must do more than prove that you have committed a crime. It must also show that you acted with criminal intent. Yet, there are very few purposeful acts of Medicare fraud that occur in California. The allegation of Medicare fraud usually occurs because of mistakes made. The most common mistakes include:

  • Using unqualified or untrained staff
  • Inadequate supervision of staff
  • Delegation and outsourcing of work to unqualified entities
  • Business errors
  • Human error
  • Oversight
  • Employees who are overwhelmed
  • Lack of a Medicare compliance program
  • Failure to keep up with the quickly changing health care laws and rules

Our goal is to show the federal government that you made a mistake. You did not commit a crime.

Using applicable and strategic defenses. Each Medicare fraud case that we see of course has some similarities, but they can’t all have the same defense because they all have different facts. We take the time to review and analyze each case to develop strategic and applicable defenses. Recently, we handled a case where the government alleged that our client fraudulently certified home health care services. We proved to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant within the law. In another case, we refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides Medicare and health care fraud defenses to California health care businesses, lawyers, executives, providers, clinics, hospitals, labs, pharmacies, and other health care related businesses being investigated for illegal kickbacks and fraudulent billing practices, and allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. We can help you with:

  • Health care fraud defense
  • Compliance program creation and implementation
  • Internal investigations
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

We provide legal advocacy and extensive experience for providers, businesses, and facilities in California. If you’re being investigated by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, or California state law enforcement, call us right away. Our initial consultations are confidential and totally free of charge.

Our Track Record

  • Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of a health care services company against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act and Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.

Medicare Fraud Defense Attorneys Serving California

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. He is most known for stopping federal investigations before criminal charges can be filed. In addition to his health care defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Clients greatly benefit from Ms. Byrd’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she regularly argues federal matters for her clients.

We are available every day of the year. Call us directly, email us, or use our contact form.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
Serving the State of California and Surrounding Areas
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. The Oberheiden Law Group PLLC is a Texas PLLC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

IF YOUR FREEDOM IS AT STAKE

YOU SHOULD CONTACT US TODAY

Contact the Experienced Attorneys of the Oberheiden Law Group Now for a Confidential Consultation

Contact Us Now
×