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 Defense Attorneys Serving the Los Angeles Area

Los Angeles Office
12400 Wilshire Blvd #1180
Los Angeles, CA 90025
310-873-8140
(Meeting location by appointment only)

Medicare fraud allegations are serious. If you’re a health care provider, entity, or business in Los Angeles, California or the surrounding area, you now have the Oberheiden Law Group, PLLC on your side. We are a law firm with skills in Medicare and Tricare audits and health care fraud defense strategies, and that helps our clients protect their assets through compliance programs, jury trials, defense against allegations of fraud, qui tam lawsuit defense, grand jury and OIG subpoenas, criminal defense, and internal investigations. Our team includes a former Chief Health Care Fraud Coordinator from the U.S. Attorney’s Office, former federal health care prosecutors from the Department of Justice and the Medicare Fraud Strike Force, and highly accomplished and educated attorneys.

What Is Medicare Fraud?

Medicare fraud occurs when one or more false claims are filed with a federal health care program by a health care provider, business, or entity for reimbursement for services or medical equipment. This is a federal offense that can include civil and criminal penalties. Medicare fraud includes false claims filed with any federal health care program: Medicare, Medicaid, Tricare, and federal workers’ compensation. When you’re accused of committing Medicare fraud, you’re under investigation for violating at least one of the following statutes:

  • Anti-Kickback Statute;
  • False Claims Act;
  • Stark Law;
  • Social Security Act;
  • S. Criminal Code

health care providers, businesses, pharmacies, and other entities in Los Angeles and the surrounding areas are investigated for Medicare fraud more often than in other areas within the United States. This is because there are more claims filed with federal health care programs in this area than in other areas in the nation. Los Angeles, California is one of nine locations in the United States that is constantly watched by the Medicare Fraud Strike Force. This is because the federal government believes that in areas that have more claims filed for reimbursement, there are more instances of Medicare fraud.

The Medicare Fraud Strike Force watches for, investigates, and prosecutes Medicare fraud. This is an investigative team of federal investigators and prosecutors from several federal agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. If you’re contacted by the federal government, call the Oberheiden Law Group immediately to learn about your potential defense options.

Medicare Fraud Investigations in Los Angeles, California

Medicare fraud investigations in Los Angeles, California and in the surrounding areas often start when a health care provider, business, or other entity files an inaccurate claim with a federal health care program. Then, the federal government reviews the claim and determines that you’ve either given them a fraudulent reimbursement request. These claims often include charges that were not authorized by the federal health care program, have a false charge, or have excessive charges. In Los Angeles, the most common billing inaccuracies are from:

  • Billing for services that weren’t performed (commonly referred to as phantom billing)
  • Submitting a claim for services or equipment that are medically unnecessary
  • Submitting a claim for supplies, such as DME, that are medically unnecessary
  • Submitting a claim for certification, such as for hospice or home health care , that is medically unnecessary
  • Double billing items or services
  • Up-coding
  • Charge inflation
  • Overuse of medical equipment or services
  • Providing or accepting kickbacks

In Los Angeles, California most of the Medicare fraud investigations that start are against doctors, nurses, other health care service providers, physician-owned businesses, nursing and registered care facilities, clinics, hospitals, pharmacies, labs, DNA centers, cancer centers, and DME providers. However, Medicare fraud allegations can be faced by anyone who files claims with a federal health care program.

The Civil and Criminal Penalties of Medicare Fraud

Medicare fraud allegations can have civil or criminal penalties. Civil penalties in Los Angeles may include one or more of the following:

  • Repayment of claims
  • Non-payment of future claims
  • Up to $11,000 in fines for each false claim
  • Exclusion from federal health care programs
  • Payment of treble damages
  • Attorney fees

You could also be called before the state disciplinary or licensing board. You may lose your professional license or your hospital privileges.

Criminal penalties for Medicare fraud may include:

  • Hundreds of thousands of dollars in fines
  • Criminal indictment
  • Federal prison sentence of up to 10 years for each count of Medicare fraud for which you are convicted
  • Federal prison sentence of up to 20 years for each count of Medicare fraud that resulted in serious bodily harm to the patient
  • Life sentence if the Medicare fraud resulted in the death of the patient

Hire the Right Los Angeles Defense Attorney

Because of the serious nature of the penalties associated with Medicare fraud, you must choose the right type of attorney so that you’re well protected against federal criminal charges. Medicare fraud allegations often include charges like mail fraud, wire fraud, money laundering, or tax fraud. You need a Los Angeles health care fraud defense attorney to help you.

A health care fraud defense attorney understands the intricacies of health care law and is also skilled in federal criminal defense. As you look for the right attorney, watch for these four traits:

  1. A track record of success with Medicare fraud cases
  2. Industry knowledge
  3. Intimate familiarity with health care laws and the associated exceptions
  4. Litigation and trial practices

You should also ask these three questions to learn more about the skills of the health care fraud defense attorney.

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

Medicare Fraud Defense Strategies

The Oberheiden Law group looks at each Medicare fraud case on an individual basis to determine the right defense strategies to use. While we do look to settle cases when possible, we also have practice as federal trial lawyers. We have represented hundreds of people. Several members of our health care Fraud Defense Team lawyers have practice as senior federal health care fraud prosecutors with the DOP and the Medicare Fraud Strike Force. We use the following strategies that we developed to assist our clients in Los Angeles:

We contact the federal government immediately on behalf of our clients. Our main priority is to resolve the allegation and protect our clients from federal criminal charges. We immediately contact the federal government. We have found that this immediate contact is key to a successful resolution. This immediate contact gives us the opportunity to get the answers to the most important questions, usually within hours:

  • What is the investigation about?
  • What prompted the investigation?
  • Is the investigation civil or criminal?
  • Which federal agencies are involved?
  • What is the ultimate goal of the government?
  • How can this matter be resolved?

If you’re under investigation for Medicare fraud, call the Oberheiden Law Group right away. Do not give the federal government uninterrupted time to investigation you or your business.

We evaluate the evidence against you. The federal government must use evidence to prove that you are guilty of Medicare fraud. Their evidence must meet a Constitutional standard known as “beyond a reasonable doubt.” We look at the evidence against our clients to determine if it meets this high standard. This strategy has provided the following results on a regular basis:

  • Case dismissal
  • No criminal charges
  • Clients keep their professional license
  • Civil fine and no criminal plea
  • Reduction of a felony to a misdemeanor
  • No prison sentence

Lack of criminal intent. The federal government also has to prove that you acted with criminal intent. Criminal intent means that you made the active decision to try and defraud the government. This is often difficult for the federal government to prove because intentional Medicare fraud in Los Angeles is actually quite rare. Medicare fraud investigations in the areas usually start because a health care provider, facility, or a business make a big mistake in their billing or coding. The most common mistakes that result in an allegation of Medicare fraud include:

  • The use of unqualified staff
  • Lack of adequate supervision
  • Delegation and outsourcing
  • Structural or organizational mistakes
  • Human errors
  • Oversight
  • Overwhelmed employees
  • No Medicare compliance program
  • Quickly changing health care laws and rules

While these mistakes should certainly be corrected, they shouldn’t be treated as a crime. Our priority is to prove to the federal government that you did not commit a crime. You made a mistake.

The use of strategic Medicare fraud defenses for each case. Medicare fraud cases can be quite similar in nature since they all involve the same main issue. However, each case will not have the same defense since they all have their own facts. The Oberheiden Law Group looks at each case to develop the right Medicare fraud defense strategies for each client. Recently, one of our clients was accused of fraudulently certifying home health care services. We proved to the federal government that our client was legally protected by a recognized delegation exception that made their certification fully compliant within the law. In another case, we did not admit liability on behalf of our client. We proved to the prosecutor that our client acted within a safe harbor exception.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides Medicare fraud defense for Los Angeles, California health care providers, entities, and related businesses. We’ve helped business owners, executives, lawyers, individual health care providers, hospitals, clinics, pharmacies, labs, and others under investigation for fraudulent billing, illegal kickbacks, and allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. We can help you in many areas, including:

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

The Oberheiden Law Group represents both individuals and entire health care systems or businesses in Los Angeles, California and the surrounding areas. If you’re under investigation by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, DEA, the Office of Inspector General, Medicare Fraud Control Unit, the IRS, Los Angeles or California state law enforcement, contact us right away. Initial consultations are free and confidential.

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 Lawyers Serving Los Angeles, California

Nick OberheidenNick 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 knowledge 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 skills 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.

310-873-8140
Including Weekends
Oberheiden Law Group, PLLC
Serving Los Angeles, CA 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
×