We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Legal Defense for Health CareFraud in Chicago, Illinois

Chicago, Illinois and the surrounding areas have a higher risk of health care fraud allegations for providers, businesses, and entities. The Oberheiden Law Group, PLLC has substantial experience in health care fraud defense, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG and grand jury subpoenas, criminal defense, and internal investigations. Our Health Care Fraud Defense Team includes such talent as a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office, several former health care fraud prosecutors,  and elite former lead prosecutors of the Medicare Fraud Strike Force. Our attorneys offer our services to clients in Chicago as well as throughout Illinois state.

An allegation of this nature in Chicago, Illinois or in the surrounding areas is extremely detrimental. Call the Oberheiden Law Group right away if you’re being investigated. Ask to speak with a member of our Health Care Fraud Defense Team. This call is free and confidential.

Chicago, Illinois Is Constantly Monitored for Health Care Fraud

In the United States, there are nine regions that are constantly monitored by the federal government for instances of health care fraud. Chicago is one of those regions. It is directly monitored by the Medicare Fraud Strike Force. This team of federal prosecutors and investigators from several federal agencies, including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. Other federal agencies often have members who are part of this team.

Chicago, Illinois and the surrounding areas face this constant monitoring because of the number of beneficiaries of a federal health care program who live in the area. This means that there are more claims filed with the federal government health care program for reimbursement. Since there are more claims filed for reimbursement in Chicago, Illinois and the surrounding areas, the federal government believes that more health care fraud also occurs.

In 2016, the Department of Justice released a statement that revealed that they had investigated around 300 cases of health care fraud. Individual health care providers were the center of 80 of those investigations. The rest of the cases centered on a health care entity or business. The agency stated that they recovered more than $900 million in fraudulently paid out claims.

What Is Health Care Fraud?

Health care fraud is when one or more claims are fraudulently filed through federal health care programs like Medicaid, Medicare, Tricare, or federal workers’ compensation for reimbursement. These claims are filed for medical services or equipment. Health care fraud includes a violation of at least one of the following:

  • The Anti-Kickback Statute. Federal health care law outright prohibits kickbacks in exchange for referrals. Any individual (including doctors, marketing representatives, and business owners) is subject to prosecution for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
  • Stark Law. Stark Law, also known as the Self-Referral Law, prohibits doctors from referring patients to specific health care service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest or if there is a compensation arrangement. Note, however, that there are statutory exceptions to this law.
  • False Claims Act. If you submit a claim to Medicare or any other federal health care program, you are required by law to abide by the False Claims Act. If the claim submitted to the federal government is discovered to be inaccurate, the federal government will likely launch an investigation into your billing practices under the criminal provisions of the False Claims Act.
  • Prescription Fraud. The federal government pays special attention to health care practices that have an unusually high number of narcotic prescriptions. If you are suspected of running a “pill mill,” you are at a high risk of being investigated for insurance fraud and for violating DEA dispensing rules.
  • Billing Fraud. The federal government is persistent about investigating the up-coding of claims. Up-coding means that the next higher code is used for a service when the billing is done. The federal government is also prone to investigating phantom billing (billing for services that were not provided), billing for patients who do not exist (referred to as ghost patients), and billing for equipment or services that are deemed not medically necessary.
  • Certification Errors. The home health care and hospice industry is frequently a practice that the federal government chooses to maintain a close eye on. The most common accusations include fraudulent certification for home health care and hospice care.

The Oberheiden Law Group strives to help our clients avoid the possibility of criminal charges when health care fraud allegations are levied. If you’re being investigated for health care fraud in Chicago, Illinois or in the surrounding areas, call us now. Initial calls are free and confidential.

Civil and criminal Penalties of Health Care Fraud

Health care fraud may result in civil or criminal penalties. In civil court, you could be ordered to repay the federal claims in question, lose the ability to be reimbursed for future claims, and you could be barred from participating in federal health care programs.

If you face criminal charges, you could end up with a criminal record, expensive fines, or even a federal prison sentence:

  • Up to 10 years for each count of health care fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
  • Life sentence if the health care fraud resulted in the death of a patient

One of the most common questions we are asked during initial phone calls that occur in Chicago is what the worst-case scenario is for health care fraud. The answer is facing criminal charges or receiving a federal prison sentence. However, there are factors that will be considered to determine whether you are at risk for either of those penalties: The severity of any injury to the patient, if the prosecutor wants to pursue criminal charges, and why the investigation started.

The Oberheiden Law Group provides legal defense in Chicago. Illinois and the surrounding areas for health care providers, businesses, and entities being investigated for health care fraud. Our experience as former health care prosecutors for the federal government, in addition to our experience as defense attorneys, gives us a unique understanding of how these cases should be handled.

Is the Health Care Fraud Investigation Criminal?

Health care fraud allegations in Chicago, Illinois often start off as civil. They can turn into a criminal investigation. This is why you must contact the Oberheiden Law Group if you’re being investigated.

Being contacted by a prosecutor is not an indicator to determine if the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor as an indicator. Rather, signs of a criminal investigation may include search warrants, seizure warrants, arrest warrants, target letters, contact from a federal criminal prosecutor, involvement from the IRS, or the receipt of a grand jury subpoena.

Important Health Care Fraud Defenses

The Oberheiden Law Group is a health care fraud defense firm. We develop individualized strategies for our Chicago clients. We’ve defended hundreds of people. Several of our attorneys have experience as former health care auditors and as health care fraud prosecutors with both the Department of Justice and the Medicare Fraud Strike Force. We use this experience to develop strategic defenses for each of our clients.

Contacting the federal investigator. The main priority of our firm is to help our clients avoid criminal charges. Once retained, we immediately contact the federal prosecutor. This lessens the time that the federal government has to investigate you without an interruption. This is important. If the federal government has too much time to investigate you, you could face criminal charges. Our goal is to get answers to the most important questions within hours:

  • What is the investigation about?
  • What is the purpose of it?
  • How long will the investigation take?
  • What is the most likely outcome?

Proving a mistake was made. The federal government must meet a high burden of proof to show that you committed a crime and acted with criminal intent. We evaluate the evidence given by the federal government to determine if they are able to meet that burden of proof. Often, the federal government will point to billing inaccuracies to say that you committed a crime. Yet, we’ve found that these inaccuracies occur not because of fraud, but because of a mistake. While these mistakes should certainly be addressed and corrected, they shouldn’t cause you to face criminal penalties. Mistakes often occur when health care practices or businesses grow quickly or because someone makes a mistake. The most common mistakes that cause these allegations include the use of unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care.

Developing individualized defenses for each client. The Oberheiden Law Group examines the facts in each case to develop the right defenses for each client. Often, this includes the use of statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a health care fraud case.

Preserving your professional reputation. One of the most common concerns of our clients is how their professional reputation will be affected by this allegation. The Oberheiden Law Group works to preserve your professional reputation. Our lawyers will watch for opportunities to correct misinformation, and we also address slanderous commentary from the media.

If you’re under investigation for health care fraud in Chicago, Illinois, call us at  the Oberheiden Law Group. This call is free and confidential.

Our Track Record

The commitment of the Oberheiden Law Group is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former health care prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home health care entities, and many other health care organizations against any form of alleged health care fraud. Here are some recent examples of our case outcomes.

  • Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation 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.
  • Representation of a Health Care Marketing Group Against an Investigation by the Office of Inspector General for Alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation of Health Care Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
    Result: No civil or criminal liability.

Health Care Fraud Defense Lawyers Serving Chicago, Illinois

Nick OberheidenNick Oberheidenis a 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. You can call us directly or complete our contact form or by emailing us directly.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
Serving Chicago, Illinois 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.

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