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Oberheiden Attorneys

Legal Defense for Health Care Fraud Charges in Jacksonville, Florida

Jacksonville, Florida and the surrounding areas have a higher risk of health care fraud allegations directed toward health care providers, entities, and businesses. The Oberheiden & McMurrey, LLP has immense 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. We proudly offer our services to clients in Jacksonville as well as the rest of the state of Florida.

An allegation of health care fraud in Jacksonville, Florida or in the surrounding areas is extremely serious. Call Oberheiden & McMurrey, LLP if you are being investigated. Ask to speak with a member of our Health Care Fraud Defense Team. Initial calls are free and confidential.

Jacksonville, Florida Is Watched by the Federal Government

The United States has nine locations that are constantly watched by the federal government for instances of health care fraud. Jacksonville, Florida is one of those locations. In fact, it is directly monitored by the Medicare Fraud Strike Force. This is a 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.

Jacksonville, Florida and the surrounding areas face this constant scrutiny because of the number of federal health care program beneficiaries that live in the area. The number of beneficiaries means that there are more claims filed with the federal government for reimbursement. Because there are more claims filed for reimbursement, the federal government believes that there is also more health care fraud.

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.

Defining Health Care Fraud

Health care fraud happens when one or more claims are fraudulently filed for reimbursement through federal health care programs like Medicaid, Medicare, Tricare, or federal workers’ compensation. These claims are filed for the use or delivery of medical services or equipment. Health care fraud often 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.

Oberheiden & McMurrey, LLP 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 Jacksonville, Florida or the surrounding areas, call us immediately. Initial calls are free and confidential.

The Civil and Criminal Penalties of Health Care Fraud

Health care fraud can 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

During initial phone calls, one of the most common questions that we are asked by clients in Jacksonville, Florida is what the worst-case scenario of this allegation could be. Facing criminal charges or receiving a federal prison sentence are the worst-case scenarios for this allegation. There are factors that are considered to determine if you may be at risk of 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.

Oberheiden & McMurrey, LLP serves Jacksonville, Florida health care providers, businesses, and entities facing the allegation of health care fraud. Our previous experience as 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.

Determining If the Investigation Is Criminal

Health care fraud allegations that occur in Jacksonville, Florida or the surrounding areas can be civil or criminal. These investigations start out as civil most of the time. Then, they turn into a criminal investigation. This is why it is important to contact Oberheiden & McMurrey, LLP as soon as you’re aware that 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.

Crucial Health Care Fraud Defenses

Oberheiden & McMurrey, LLP is a health care fraud defense firm. We develop crucial health care defense strategies for our Jacksonville, Florida clients. We’ve defended hundreds of people facing this allegation. 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 prosecutor. 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 our clients did not commit a crime. 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 defenses for each client. Oberheiden & McMurrey, LLP 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. Oberheiden & McMurrey, LLP 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 accused of health care fraud in Jacksonville, Florida or the surrounding areas, call Oberheiden & McMurrey, LLP right away. The call is free and confidential.

Our Track Record

The commitment of Oberheiden & McMurrey, LLP 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 Jacksonville, Florida

Nick OberheidenNick Oberheiden is 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 & McMurrey, LLP
Serving Jacksonville, Florida 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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