We are a team of
former federal prosecutors


Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense for all 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 Missouri as well as surrounding areas.

In Missouri, health care executives, providers, lawyers, businesses, organizations, and facilities are at a high risk of being placed under investigation for being in violation of Medicare fraud law. Indeed, health care entities in Missouri are at a disproportionately larger risk to be declared in violation than the national average. If you are currently under investigation for Medicare fraud, you are in need of the advocacy of attorneys in Medicare fraud who operate in Missouri and its surrounding area. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and managing partner of Oberheiden & McMurrey, LLP.

Defining Medicare Fraud

Medicare fraud is an extraordinarily serious federal offense. These charges bring with them both civil and criminal penalties and repercussions. It should be observed, however, that Medicare fraud is not confined to Medicare exclusively. It involves the submission of false claims from any and all federal government health care programs. It includes, but is not limited to, Tricare, Medicaid, and federal workers’ compensation. It can possibly include a violation of one or more of the following federal statutes:

  • Physician Self-Referral Law (also known as Stark Law)
  • False Claims Act
  • Anti-Kickback Statute
  • U.S. Criminal Code
  • Social Security Act

Medicare fraud occurs upon an illegal payment being made by the federal government to a provider, facility, or business after a false claim is filed.

Missouri and the areas that it is surrounded by are faced with a much higher risk of investigation due to the fact that Missouri is one out of only nine locations in the United States that is heavily surveilled by the Medicare Fraud Strike Force. This rigorous surveillance is thanks to the fact that Missouri has an impressive number of federal health care program beneficiaries. By default, this increases the number of claims that are filed through CMS. This remarkable number of claims is the primary reason that the government maintains such a close watch over the area. The goal of the Medicare Fraud Strike Force is to watch for, investigate, and prosecute occurrences of Medicare fraud.

The Medicare Fraud Strike Force is a combined team of investigators and prosecutors who come from a multitude of federal agencies such as the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. You need to keep in mind that there are more agencies in the Medicare Fraud Strike Force than simply those that were previously listed. During the course of an investigation, it is likely that you will come into contact with one or more representatives from each agency.

Billing Mistakes in Missouri: The Main Cause of Medicare Fraud Investigations

Most of the investigations into Medicare fraud that are started in Missouri happen because the federal government has reason to believe that a specific business or individual is practicing fraudulent billing practices or reimbursement requests. This can possibly include fraudulent charges, unauthorized charges, and excessive charges. The most common issues in Missouri include:

  • Phantom billing (billing for services that weren’t performed)
  • Billing for medically unnecessary services or equipment
  • Billing for equipment or services that weren’t ordered
  • Certifications for medically unnecessary supplies or services (such as medical devices or hospice care)
  • Charge inflation
  • Double billing for equipment, services, or treatment
  • Upcoding for equipment, services, disorders, or treatment
  • Overuse of services
  • Overuse of equipment
  • Providing or accepting kickbacks

In Missouri, doctors, nurses, health care services, nursing homes, registered care facilities, clinics, hospitals, DME providers, pharmacies, labs, DNA centers, and cancer treatment centers are some of the most commonly investigated for Medicare Fraud.

Potential Civil and Criminal Penalties for Medicare Fraud

Medicare fraud allegations are notorious for wreaking serious civil and criminal penalties. If you are currently under investigation for Medicare fraud, you should make it your top priority to call Oberheiden & McMurrey, LLP as soon as possible. Civil penalties can include one or more of the following:

  • Assessment of treble damages
  • Civil fines of up to $11,000 per false claim
  • Recoupment requests
  • Non-payment of future claims
  • Exclusion from federal health care programs
  • Assessment of attorney fees

Criminal penalties are also very serious. They may include one or more of the following:

  • A criminal record
  • Fines that cost you hundreds of thousands of dollars
  • 10 years in federal prison for each count of Medicare fraud for which you are convicted
  • 20 years for each count of Medicare fraud if it resulted in serious bodily injury to the patient
  • A life sentence if the Medicare fraud resulted in the death of the patient

Planning Your Strategic Defense

Medicare fraud allegations are able to permanently affect your professional life in a decidedly negative way. In addition to all other previously mentioned penalties, you are also at a high risk of having your license revoked. You could be faced with disciplinary proceedings. You are even in danger of potentially losing your hospital privileges. Thanks to all of the possible consequences, it is absolutely vital that you hire a skilled and experienced Missouri defense attorney. As you begin to carry out your research, you should look for a defense attorney who has the skills and the experience that you are going to need for proper assistance during either a civil or criminal investigation and prosecution.

A distinctly apparent large number of practitioners in the Missouri area subscribe to the ill-founded impression that they should contract the services of a health care attorney. Once allegations that you have committed Medicare have been levied against you, you are presented with the likely risk of facing extremely serious federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. Though it may be true that a health care attorney can be familiar with and have a deep understanding of health care law, he or she may not have appropriate experience and understanding of federal criminal defense that you are in need of. Furthermore, they might not have the negotiation skills necessary to face the federal government or to deal with federal prosecutors in a court of law, such as in a trial.

Many others choose to search for a Missouri defense attorney; this is because they realize that they run the probability of being faced with criminal charges. However, the majority of Missouri criminal defense attorneys don’t have the experience required to undertake federal criminal matters. Furthermore, they also might not have experience with or knowledge of the intricacies of billing, coding, and medical utilization rules.

You need a health care fraud defense attorney serving Missouri and its surrounding areas. Keep on the lookout for these four traits:

  1.    A proven track record of success in Medicare fraud cases
  2.    Industry knowledge
  3.    Deep familiarity with health care laws and their exceptions
  4.    Litigation and trial experience

Once you’ve thinned out your options, it is very important that you ask three particular questions so that you know whether or not the law firm has the experience in Medicare fraud that you need.

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

Proven Strategic Medicare Fraud Defenses

Oberheiden & McMurrey, LLP formulates proven, forceful defense strategies for our clients in Missouri. Much of our Health Care Fraud Defense Team is comprised of former senior prosecutors for federal health care programs with the Department of Justice. We merge this advantage with our experience as defense attorneys so that we can provide proven defenses. Our first and foremost goal is to reduce the possibility of criminal charges.

Immediate contact with the federal government. From our work in Medicare fraud defense, we have found that one of the most efficient ways in which we can help our clients is to work to get into contact with the federal government as early as we possibly can. If the government is in possession of a copious of time to initiate an investigation into your practice, there is an higher chance that you will be faced with criminal charges. We endeavor to get into contact with all applicable federal agencies in order to get answers to questions, such as:

  • What is the investigation about?
  • What prompted the investigation?
  • Is this civil or criminal?
  • Which federal agencies are involved in the investigation?
  • Who all is being investigated?
  • How can the matter be resolved?

We keep the lines of communication open with the government, meaning that we can usually get answers to these questions within hours.

Lack of evidence.  The federal government is legally required to present evidence in order to prove that you have committed a crime. This evidence must meet a Constitutional standard known as ‘beyond a reasonable doubt.’ We analyze and scrutinize the evidence presented in each case and place its legitimacy into question. Thanks to this potent strategy, we consistently observe the following outcomes:

  • Case dismissal
  • No criminal charges
  • Clients maintain their professional license
  • Civil fine without a criminal plea
  • Reducing a felony to a misdemeanor
  • No prison time

Lack of criminal intent. Moreover, not only is the government required to put forth concrete evidence that you have committed a crime, the government is furthermore required to prove that you acted with criminal intent. This is very often difficult for the government to prove, because the majority of Missouri Medicare fraud investigations that are carried out generally are initiated thanks to an honest mistake. The most commonly made mistakes include:

  • Relying on unqualified or untrained staff
  • Inadequate supervision of staff
  • Delegation and outsourcing of work to unqualified entities
  • Business errors
  • Human error
  • Oversight
  • Employees who are overwhelmed
  • Lack of a Medicare compliance program
  • Failure to keep up with the quickly changing health care laws and rules

In truthfulness, Missouri and its surrounding areas see a small amount of authentic occurrences of Medicare fraud. Despite this, businesses and people that are faced with allegations on because of a mistake will, many times, assume that they must have committed a crime and need to accept the punishment. Due to this, many can no longer work in their profession.

Oberheiden & McMurrey, LLP works to address any obvious lack of criminal intent. We make our best efforts to prove to the federal government that, despite the possibility that you may have made a mistake that very likely should be addressed and rectified, your actions were not done out of criminal intent.

Development of applicable defenses. Every Medicare fraud case has its own unique aspects, despite the cohesions shared between all of them. Oberheiden & McMurrey, LLP carefully analyzes each case with a careful and discerning eye in order to create compelling and deliberate defenses. We recently handled a Medicare fraud case where the government accused our client of fraudulently certifying home health care services. We proved to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant within the law. In another case, we refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP provides aggressive, professional Medicare fraud defense for Missouri health care businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation for illegal kickbacks and fraudulent billing practices. We also those investigated for allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. We can help you with:

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

Oberheiden & McMurrey, LLP provides legal representation of providers, businesses, and facilities in Missouri. If you’re under investigation by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, Missouri law enforcement, call us immediately. Our initial consultations are free of charge 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 Attorneys Serving Missouri

Nick OberheidenDr. Nick 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. Call us directly, email us, or use our contact form.

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.

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