We are a team of
former federal prosecutors


Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense Lawyers Serving all of New York

New York Office
30 Wall Street, 8th Floor
New York, NY 10005
1-800-810-0259
(Meeting location by appointment only)

Oberheiden & McMurrey, LLP is a Medicare fraud defense law firm serving New York, New York and the surrounding areas. We provide legal defense for individuals, businesses, and entities that are under investigation by the federal government, named in a qui tam lawsuit, involved in a jury trial, and that are undergoing a federal audit. Our lawyers can also assist you by planning and implementing a federal compliance program. Oberheiden & McMurrey, LLP’s defense team includes a former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, Department of Justice trial attorneys, and former lead prosecutors for the Medicare Fraud Strike Force. We serve clients in New York as well as the rest of the state.

What Is Medicare Fraud?

Medicare fraud is a violation of federal law. It happens when at least one mistake is made on a claim that is filed with a federal health care program. Despite the name, it isn’t just Medicare. These claims can also be filed with Medicaid, Tricare, or federal workers’ compensation. If you’re being accused of Medicare fraud, you’re being accused of violating at least one of the following laws or statutes:

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

New York is one of nine areas in the nation that is continually monitored by the Medicare Fraud Strike Force because of the number of residents in the area who rely on a federal health care program. This means that there is an increase in the number of claims that are filed with the federal health care programs. The federal government believes that the increase in claims means an increase in Medicare fraud will also surface.

The Medicare Fraud Strike Force monitors, investigates, and prosecutes Medicare fraud. This is a team of federal agencies who work together. Representatives include members of the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. That list is not all-inclusive. Other federal agencies can be involved. If you’re under investigation by the Medicare Fraud Strike Force or if you’ve been contacted by a federal agency, call Oberheiden & McMurrey, LLP immediately. The call is free and confidential.

Medicare Fraud Investigations in New York

New York Medicare fraud investigations often start because of a mistake made when filing a claim with a federal health care program. The mistake is often either in the coding or the billing. The most common billing mistakes are unauthorized charges, incorrect charges, or excessive charges. Other common mistakes are:

  • Phantom billing – billing for services that were never performed;
  • Double billing for medical equipment or services;
  • Submitting a claim for medically unnecessary medical services or equipment;
  • Submitting a claim for medically unnecessary medical supplies;
  • Submitting a claim for a medically unnecessary certification (including a claim for hospice or home health care);
  • Inflating charges;
  • Up-coding;
  • The overuse of medical equipment of services;
  • Providing or accepting kickbacks.

The most common individuals and business in New York that face a Medicare fraud investigation are physicians, nurses, pharmacists, hospitals, and nursing homes. However, any person, business, or facility that files claims with federal health care programs can be investigated for Medicare fraud.

Medicare Fraud Has Civil and Criminal Penalties

Medicare fraud can result in civil or criminal charges. Federal civil penalties may include:

  • Repayment of claims in questions;
  • Future claims aren’t paid;
  • A fine of up to $11,000 per false claim;
  • Exclusion from federal health care programs;
  • Assignment of treble damages;
  • Attorney fees

You could also lose your hospital privileges and your professional license.

Federal criminal penalties include:

  • Fines that cost you hundreds of thousands of dollars, even for a misdemeanor;
  • A criminal record;
  • A 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 or patients;
  • A life sentence in federal prison for Medicare fraud that results in the death of a patient.

Finding a Medicare Fraud Defense Attorney Serving New York

In New York, a Medicare fraud investigation can ruin your professional reputation. You need to hire a health care fraud defense attorney serving New York. This type of lawyer can help you with any violations of health care law and with any federal criminal charges that may be levied against you. Look for these traits in an attorney:

  1. A successful record when handling Medicare fraud cases;
  2. Knowledge of the Medicare fraud and health care fraud laws and regulations;
  3. Knowledge of statutory exceptions;
  4. Both litigation and jury trial experience.

You should then ask the health care fraud defense attorney the following questions:

  1. How many Medicare fraud cases have you handled throughout your career?
  2. How many of those 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 Strategies for New York Clients

We contact the federal government. We immediately contact the federal government. Our objective is to help clients avoid criminal charges. To start, we ask the important questions:

  • 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?

Getting answers to these questions can help us to plan your defense, and it can make the difference between a civil settlement and criminal charges. Often, we get answers to those questions in just a few hours.

Analyzing the evidence presented. We analyze and question the federal evidence that is used by the federal government. This one strategy often results in:

  • Dismissal of charges;
  • No criminal charges;
  • Client retains professional license;
  • Civil fine with no criminal plea;
  • Reducing a felony to a misdemeanor;
  • No federal prison sentence.

Lack of criminal intent. Additionally, the federal government must prove that you acted with criminal intent. This is hard for them to prove since most Medicare fraud cases start because of a mistake. The most common mistakes in New York are:

  • Using unqualified staff;
  • Inadequate supervision;
  • Inappropriate delegation and outsourcing;
  • Structural errors;
  • Human errors;
  • Oversight;
  • Employees who are overwhelmed;
  • No Medicare compliance program in place;
  • The changing health care laws and rules.

Our objective is to show that you admit you made a mistake and you are willing to correct it.

Using the right defense strategies. Our defense team takes the time to analyze the facts involved in each case. This enables us to use custom Medicare fraud defense strategies. One of our recent clients was accused of providing a fraudulent certification for home health care services. We were able to prove that our client was protected by a recognized delegation exception and that the certification was compliant within the law. In another recent case, we refused to admit liability on behalf of our client. Instead, we proved to the federal prosecutor that our client acted within a safe harbor exception.

Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP serves New York, New York and the surrounding areas. We provide legal advocacy for individual providers, business owners, entire entities, attorneys, executives, hospitals, pharmacists, and pharmacies that are being investigated 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

Oberheiden & McMurrey, LLP provides legal advocacy for individuals, entire health care systems, or businesses in New York if they’re contacted by the DOJ, Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Control Unit, the IRS, New York City or New York law enforcement.

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 New York, New York

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 New York, New York  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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