We are a team of
former federal prosecutors


Meet the Team
Oberheiden Attorneys

Medicare Fraud Legal Defense Serving Detroit and the Surrounding Areas

Michigan Office
615 Griswold Street, Suite 700
Detroit, MI 48226
313-888-8807
(Meeting location by appointment only)

Our Detroit Health Care Fraud Defense Group is headed by Dr. Nick Oberheiden. Dr. Nick Oberheiden is a nationally recognized health care fraud defense attorney and managing principal of the Oberheiden & McMurrey, LLP.

Medicare Fraud in Detroit

Medicare fraud refers to the submission of false or fictitious claims to a governmental health care program such as Medicare, Medicaid, Tricare, or federal workers’ compensation. As such, Medicare Fraud encompasses wrongdoing that falls under the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Laws (Stark Law), the Social Security Act, or the U.S. Criminal Code. While Medicare Fraud has many facets, all definitions have in common that a health care provider or entity illegally received money from a federal health care program.

Detroit plays a central role in Medicare investigations. Detroit is home to many retirees and the city has some of the largest number of Medicare beneficiaries nationwide. Due to the sheer volume of Medicare services in Detroit, the Centers for Medicare and Medicaid Services (CMS) is keeping a close eye on utilization of Medicare benefits in Detroit. In fact, Detroit is one of only nine U.S. cities in which the federal government has established special task forces to monitor, investigate, and prosecute Medicare Fraud.

Health care practitioners and businesses in Detroit must understand that government prosecutions in Detroit are more aggressive and significantly more frequent than in other communities and spearheaded by the elite Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and others.

Forms of Medicare Fraud

Medicare Fraud refers to the submission of false or fictitious claims to a governmental health care program. Specifically, Medicare Fraud cases allege fraudulent billing practices and reimbursement requests for false, excessive, or unauthorized services and may involve one of the following acts.

  • Billing for Services Never Performed (Phantom Billing)
  • Billing for Services that Were Medically Unnecessary
  • Billing for Supplies and Equipment that Were Never Ordered
  • Billing for Supplies and Equipment that Were Medically Unnecessary
  • Certification for Services that Were Medically Unnecessary (e.g. Home Health or Hospice Fraud)
  • Certification for Supplies that Were Medically Unnecessary (e.g. DME)
  • Double Billing, Up-Coding, Inflating Bills
  • Overutilization of Services or Equipment
  • Offering or Accepting Kickbacks

Physicians, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, DME companies, and other health care service providers are among the most common targets of Medicare Fraud investigations.

What Are the Penalties?

Targets of investigations are exposed to recoupment requests, non-payment of future claims, civil fines of up to $ 11,000 per false claim, exclusion from federal health care programs, treble damages, attorney fees, criminal fines, criminal indictment, or incarceration in a federal prison.

  • Up to 10 years in prison for each count of fraud
  • Up to 20 years in prison if the fraud resulted in serious bodily injury (commonly through counterfeit or excessive medication)
  • A life sentence if the fraudulent Medicare practice resulted in the patient’s death.

Medical professionals are at risk of being excluded from all federal health care programs, prohibited from receiving reimbursement from any federal health care program and could face licensing actions and loss of hospital privileges.

Choosing the Right Defense Lawyer

In light of these penalties, it is critical for clients to select a lawyer that has the skillset and experience to prevail against the government. Because so much can be at stake, health care fraud defense strategies are not for beginners and not an area of law with which to experiment.

Health care Lawyers. Some people believe that a health care lawyer is the right choice to defeat government investigations. Our experience tells us otherwise. Medicare Fraud is often charged jointly with mail fraud, wire fraud, tax evasion, or money laundering, and an effective defense requires an adequate understanding of criminal procedure. health care lawyers do not practice this type of law and they are not trained to negotiate with federal agents, nor do they have the experience to battle against federal prosecutors in court.

Criminal Lawyers. Although hiring a criminal defense lawyer may sound like the natural thing to do to defend against charges from the government, targets of health care fraud prosecutions simply don’t have the time to explain the nuances of health care law to a lawyer in a time of crisis. The best criminal defense attorney with a practice centering on DWI, rape, and drug offenses may not have the track record needed to instantly handle complex health care fraud matters and may lack familiarity with billing, coding, and medical utilization rules.

Health Care Fraud Defense Lawyer. The ideal lawyer that clients in Detroit should look for when they are accused of Medicare Fraud and other health care offenses should meet the following four criteria.

  • Proven Track Record
  • Industry Knowledge
  • Profound Familiarity with Health Care Laws
  • Extensive Litigation & Trial Experience

Before investing money, clients should test the lawyer’s specific experience in Medicare Fraud cases. Specifically, clients should ask the lawyer candidate the following 3 GOLDEN QUESTIONS:

  • How many Medicare Fraud cases have you handled so far?
  • How many of the health care fraud cases that you handled resulted in no civil and no criminal charges or dismissals for your clients?
  • How many health care fraud cases did you try in court?

Proven Defense Strategies

What makes Oberheiden & McMurrey, LLP different is our experience and our track record. Throughout our careers, our attorneys have handled in excess of 1,000 health care proceedings across the country and conducted more than 200 criminal trials. Many of our attorneys come from senior positions within the Department of Justice and share the experience, insights, and contacts as former federal prosecutors in charge of health care matters. While every case varies, the following defense strategies have proven to be most successful for our clients to resolve health care investigations without recourse to criminal charges.

  • Early Intervention
  • Lack of Evidence
  • Lack of Intent
  • Applicable Defenses

Early Intervention. Early intervention by experienced lawyers is key. Pull the seeds before they grow into a tree. The longer the government investigates uninterruptedly, the higher the chance the case will turn into a criminal matter. Don’t let the government build its case. Hire lawyers with open channels to the government that can immediately initiate a dialogue with their government contacts. Get answers to the most pressing questions: What is the case about? What prompted the investigation? Is the case civil or criminal? What agencies are involved? Who else is under investigation? What is the government’s ultimate goal? How can the issue be resolved? We strive to provide our clients these answers within the first hours of our engagement.

Lack of Evidence. The U.S. justice system places a heavy burden on the government to prove punishable misconduct. In fact, in order to be found guilty of health care fraud, the government must prove beyond a reasonable doubt that an illegal act was committed with criminal intent. Our attorneys put this constitutional standard to the test in every single case and we routinely liberate clients from fraud accusations.

  • Case Dismissed
  • Avoidance of Criminal Charges
  • License Maintained
  • Civil Fine, No Criminal Plea
  • Misdemeanor, No Felony
  • No Jail Time

In our experience, we have observed that most incidents that prompt health care investigations originate from organizational and human errors, not from criminal spite. Mistakes occur because health care providers focus on caring for their patients. Similarly, businesses of interest to the government almost all have rapid growth and fast expansion in common. In either case—patient dedication or business growth—organizational deficits and negligent oversight explain mistakes made. Specifically, we commonly find the following causes for errors:

  • Unqualified Staff
  • Supervision Errors
  • Delegation & Outsourcing
  • Structural Deficits
  • Organizational Mistakes
  • Human Error
  • Oversight and Overwhelmed
  • Lack of Compliance Program
  • Constantly Changing Rules

Lack of Intent. Intentional health care fraud is rare and too many business owners are ready to roll over and accept penalties for mere negligent oversight. In a busy practice, mistakes are common and they should not result in fraud convictions or liabilities.

  Anti-Kickback False Claims Act Stark Law Criminal
Offense Nature Criminal Civil (& Criminal) Civil Criminal
Offense Element Illegal Referrals False Claims Self-Referrals Fraud Scheme
Government Burden Knowing & Willful Reckless Disregard Strict Liability Knowingly

Applicable Defenses. A thorough analysis often reveals favorable defenses for clients under health care investigation. To give you only two recent examples, in a recent Medicare Fraud case that we handled, the government alleged that our client fraudulently certified the need for home health care services. We convinced the government that a recognized delegation exception applied rendering the certification fully compliant with the law. In another Medicare Fraud case, we refused to admit liability and ultimately convinced the prosecutors that our client acted within a safe harbor exception.

Oberheiden & McMurrey, LLP

We represent business owners, health care executives, lawyers, health care providers, hospitals, pharmacies, laboratories, and other health care entities that find themselves under investigation for illegal kickbacks, fraudulent billing practices, and allegations of medically unnecessary services, services not rendered, and unlawful joint ventures between referring physicians and ancillary income businesses.

  • Health Care Fraud Defense
  • Compliance Programs
  • Internal Investigations
  • Qui Tam Defense
  • Asset Protection
  • Licensure & Disciplinary Proceedings
  • Jury Trials

Our clients range from individual providers to entire health care systems. We represent clients in Detroit who are under investigation by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, Drug Enforcement Administration, the Office of Inspector General, the Medicaid Fraud Control Unit, Detroit and Michigan law enforcement, or the Internal Revenue Service.

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.

Defense Attorneys Serving Detroit

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Nick has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, scores of political corruption, government investigations, and 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, Nick 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 Lynette’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. Lynette 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, complete our contact form, or email us directly.

313-888-8807
Including Weekends
Oberheiden & McMurrey, LLP
Serving Detroit, Michigan 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. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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