We are a team of
former federal prosecutors


Meet the Team
Oberheiden Attorneys

Health Care Fraud Defense Legal Team Serving the State of Missouri

The Oberheiden & McMurrey, LLP 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 the state of Missouri as well as surrounding areas.

If your practice serves the State of Missouri and you are facing allegations of health care fraud, make it your priority to call Oberheiden & McMurrey, LLP as soon as you can. Oberheiden & McMurrey, LLP makes use of in-depth legal 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, elite former lead prosecutors of the Medicare Fraud Strike Force, and accomplished lawyers with education from the nation’s best schools of law, including Yale and Harvard.

If you have any interest in learning how we can help, call immediately and request to speak with a member of our Health Care Fraud Defense Team. Initial consultations are free and completely confidential.

Missouri Is Observed with a Close Eye for Medicare Fraud

Missouri is one of nine areas in the United States that is scrutinized by the Medicare Fraud Strike Force in an attempt to weed out health care fraud. The Medicare Fraud Strike Force is an elite team composed of select prosecutors and investigators from a varied array of federal agencies, including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. Note that this list is not a complete or definite compilation of possible federal agencies that could be involved in the investigation of your case. Other agencies may have a presence in the Medicare Fraud Strike Force.

The state of Missouri is observed closely because a sizable amount of its citizens rely on a federal health care program. This naturally increases the number of claims filed with the federal government for reimbursement, leading the government to aggressively monitor, investigate, and prosecute allegations of health care fraud. In 2016 alone, the Department of Justice investigated over 300 cases. Roughly 80 of those investigations centered on individual health care providers. The rest involved a health care entity or business. The agency reported that it recovered more than $900 million in fraudulently paid out claims.

What is Health Care Fraud?

Federal health care fraud is defined as an attempt to obtain reimbursement for medical services or equipment through government health care programs, such as Medicaid, Medicare, Tricare, or federal workers’ compensation by filing one or more bogus claims. It likely 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 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 upcoding of claims. Upcoding 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 has a consistent track record of success in assisting clients in avoiding criminal charges. If you or your health care practice or business are under investigation for health care fraud in Missouri, call Oberheiden & McMurrey, LLP now. Calls are free and confidential.

Health Care Fraud and the Severe Penalties

Health care fraud is an extremely serious matter. You can be subject to civil repayment of claims and non-payment of future claims, and you may be excluded from federal health care programs. In the some of the dire scenarios, you are at risk of facing the state disciplinary board, losing your license, and being stripped of your hospital privileges. Criminal penalties include prosecution, prison time, and fines in the hundreds of thousands of dollars.

If you are found guilty of criminal health care fraud, you could receive one of the following prison sentences:

  • 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

Often, we are asked about the worst-case scenario for health care fraud in Missouri. Whether someone will face criminal prosecution or be sent to prison is incumbent upon several factors, such as the severity of any injury suffered by the patients, whether the prosecutor is interested in criminal prosecution, and the reason the investigation was initiated.

Oberheiden & McMurrey, LLP is well-prepared to handle your Missouri health care fraud defense case, thanks in large part to our dual experience as former health care prosecutors and defense attorneys. If you’ve been alerted that you are under investigation for health care fraud, or if you’d like to discuss your legal options, call us right away. Initial consultations are free of charge and confidential.

Is the Investigation a Criminal Matter?

Health care fraud cases can be either civil or criminal in nature. Through our time-tested method of early intervention and compelling defense strategies, Oberheiden & McMurrey, LLP has an exceptional reputation helping clients avoid criminal charges. Call us as soon as possible if you’ve been put under investigation for health care fraud in Missouri so that we may begin our methods to develop your custom defense strategies.

Receiving contact from a prosecutor is not a certain indicator that you are being investigated for criminal charges. All federal agencies that have prosecutors maintain both a civil and a criminal division. This is why you cannot accurately and precisely determine the nature of the charges based solely on the fact that a prosecutor has contacted you. Determining whether the investigation is criminal in nature can depend on the legal interpretation of many different elements, such as OIG subpoenas, the manner in which the inquiry is made or in the way in which the allegations are made, and other indicators of criminal prosecution. Criminal prosecution may come with search warrants, seizure warrants, arrest warrants, target letters, involvement of federal criminal prosecutors, IRS involvement, or grand jury subpoenas.

If you have questions about whether you are facing civil or criminal charges, make a call to Oberheiden & McMurrey, LLP as soon as you can. We represent a variety of practitioners, including individual providers, entire health care systems, and other related businesses. We provide our health care defense services to individuals, businesses, and entities in and around Missouri that are being investigated by the Department of Justice, the Department of Defense, Office of Inspector General, Drug Enforcement Administration, the Federal Bureau of Investigation, Medicare Fraud Control unit, Missouri state law enforcement, or the IRS.

Health Care Fraud Defense

Oberheiden & McMurrey, LLP is a health care fraud defense law firm providing services in the great state of Missouri. Throughout our careers, we have handled hundreds of health care fraud cases and tried a great number of criminal cases in court. A number of our lawyers have previous experience as health care auditors and health care fraud prosecutors with the Department of Justice. We provide their invaluable insight directly to our clients.

Advocacy begins immediately for our clients. In every case, our primary goal is to help our clients avoid criminal charges. Our extensive experience and impressive track record objectively prove that the absolute best way to defend against criminal prosecution is to intervene early and not allow the government enough uninterrupted time to compile their case against you. We work around the clock to safeguard your freedom and your professional aspirations. We advocate for you as soon as we possibly can by immediately getting into contact with federal prosecutors. Generally speaking, we can get answers to the most important of questions within just a few hours:

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

Testing the standards. The federal government is beholden to the Constitution; they must prove beyond a reasonable doubt that you committed a crime and that you performed your actions with criminal intent. In each case that the government indicates criminal charges to be involved, we put this high standard to the test. Often, prosecutors will cite billing inaccuracies as an example in an attempt to prove criminal intent. In spite of this, we have learned from experience that mistakes happen and that those mistakes do not and should not be equivalent to fraudulent activity. Oberheiden & McMurrey, LLP has provided successful legal defense for clients all across the United States by proving that the inaccuracies in billing are results of organization or human error and did not happen because of intent to defraud the government. In our experience, we’ve learned that unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care are the most frequent errors that cause these investigations. Although these issues should be corrected, they should not lead to criminal liability.

The use of strategic defenses. Oberheiden & McMurrey, LLP has the legal experience that you will need to develop strategic defenses, including locating applicable defenses and statutory loopholes. Many of our cases have largely been successful thanks to our use of legal exceptions. For example, in the context of Stark Law which involves medical necessity certifications, we have been able to point to exceptions to either attenuate or entirely resolve a health care fraud case.

Protecting your professional reputation. We are committed to not only defending you in court, but also to protecting your professional reputation. Accusations of health care fraud can be supremely harmful to your career. Many of our clients are, rightfully, very concerned about how these accusations will affect their future. The media holds and frequently exercises the power to blacken someone’s image or spread vicious rumors. Reports are prone to being biased and are often averse to telling the story in its entirety. Our attorneys routinely address concerns about slander and book news spots and other opportunities to correct misinformation about our clients.

Contact Oberheiden & McMurrey, LLP immediately to discuss the details of your case. Initial calls are 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 Attorneys Serving Missouri

Nick OberheidenNick 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. 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 the State of Missouri 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.

IF YOU ARE UNDER INVESTIGATION

YOU SHOULD CONTACT US TODAY

Contact the Experienced Attorneys of Oberheiden & McMurrey, LLP Now for a Confidential Consultation

Contact Us Now
×