We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

New York and New Jersey Hospice & Home Health Care Fraud Defense Attorneys

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

If you have been charged with either home health care fraud or hospice fraud, you need a team of attorneys with years of experience in representing clients in similar situations.  You need the Oberheiden Law Group.  Our team includes former federal prosecutors as well as renowned criminal defense attorneys, and our experience in the arena of health care fraud is both deep and wide.  The team is led by Dr. Nick Oberheiden, a health care fraud defense attorney and managing principal of the Oberheiden Law Group.

Medicare Fraud Investigations in New York and New Jersey

In an effort to crack down on the perceived amount of health care fraud in the country, the United States government has recently established nine specialized task forces to monitor, investigate, and prosecute Medicare fraud in cities across the country.  One of those nine task forces is located in Brooklyn.  If you own a health care business or are a medical provider in New York or New Jersey, you should know that the presence of this task force in close proximity to you means that health care fraud prosecutions here will be more aggressive and more frequent than in other cities without the presence of such task forces.  The fraud investigations are overseen by the Health Care Fraud Prevention and Enforcement Action Team, or HEAT, an elite group of federal investigators and attorneys from agencies including the DOJ, OIG, DHHS, FBI, and others.

Hospice & Home Health Care Fraud

At the Oberheiden Law Group, we routinely represent hospice and home health care providers as well as business owners and other professionals in every aspect of health care law, including internal investigations, corporate compliance, Medicare audits, and reimbursement or recoupment requests to defense of civil or criminal cases brought by the federal government.  Among other matters, we provide services covering:

  • Medicare and Medicaid Fraud allegations
  • Violations of Anti-kickback laws
  • Issues with the DEA, including Prescription Fraud
  • Grand Jury Subpoenas
  • OIG Subpoenas
  • ZPIC & RAC Audits
  • IRS Audits
  • Accusations of False Claims Act Violations
  • Overutilization Claims, for Equipment and/or Services
  • Qui Tam cases
  • Stark Law Violations
  • Compliance Issues, including HIPAA
  • Overbilling Accusations or Billing Errors
  • Fraudulent or Incorrect Certificates of Medical Necessity

Our attorneys are familiar and experienced in all aspects of home health and hospice care including medical necessity, conditions of coverage, plan of care requirements, clinical status determinations, initial certification requirements, re-certification, homebound evaluations, and respite care.  We frequently work in conjunction with the National Association for Home Care & Hospice (NAHC), the National Center for Assisted Living (NCAL), and the National Hospice and Palliative Care Organization (NHPCO).

What Are the Penalties?

If a health care fraud case is brought against you in relation to home health care or hospice, you could be facing recoupment or repayment requests, non-payment of any future claims, and exclusion from federal health care programs such as Medicare and Medicaid.  Moreover, you could have to pay a fine of up to $11,000 per false claim, as well as treble damages and attorneys’ fees.  Even worse, a criminal charge could bring additional fines, indictment, and/or imprisonment.  Criminal sentences of incarceration may be up to ten years in prison for each count of Medicare fraud, which may be increased up to twenty years if a patient suffered serious injury as a result of the fraud, or up to life in prison if the fraud caused a patient’s death.

If you are a medical professional, charges of incorrectly prescribing, certifying, or supervising may also lead to your exclusion from participation in federal programs or suspension or revocation of your professional license.

Choosing the Right Defense Lawyer

Obviously, due to the potential consequences if you are found guilty of or liable for health care fraud, you must hire an experienced, knowledgeable attorney to represent your interests against the government.  Health care fraud allegations threaten your livelihood, your business, your reputation, and even your freedom.  You need lawyers who are knowledgeable in health care law as well as in the courtroom to convince the prosecutors, your clients, the public, and the media that you are not guilty of the fraud of which you have been accused.

In order to choose a lawyer to represent them against allegations of health care fraud, home health care and hospice service providers and business owners should judge the attorneys they are considering based on these three criteria: 

  • First, the attorney you select should be extremely knowledgeable about the statutes and regulations surrounding the home health care and hospice business.  You simply cannot take the time to explain billing, coding, and certification requirements to lawyers unfamiliar with these concepts when you are fighting the government.
  • Second, determine whether or not the attorney you are considering hiring has successfully resolved health care fraud cases and health care audits.  An attorney may claim that he is an aggressive, experienced trial lawyer, but having a criminal defense lawyer who specializes in drug cases, DWI, or assault will do you little good in the specialized arena of health care fraud.
  • Third, but far from least important, your attorney must be a talented litigator who is comfortable and experienced in front of judges and juries.  Ask the attorney how many trials they have conducted.  The government prosecutors are well aware of which defense attorneys are not afraid to go to trial.

When choosing an attorney, smart clients ask smart questions. We believe that every attorney should freely offer an unconditional answer to the following question:

In your career, how many Medicare Fraud cases have you handled that resulted in no liability for your client, either civilly or criminally? 

Our Proven Defense Strategies

The Oberheiden Law Group is different from other law firms.  We are distinguished by our experience, our competence, and our track record in health care fraud defense.  Together, our team has tried over 200 cases to a judge or a jury and has handled over one thousand health care fraud investigations.  Before they joined our firm, many of our attorneys have headed fraud investigations and health care audits as Assistant United States Attorneys for the Department of Justice.  Our clients now benefit from their unique insights and unparalleled network of contacts.  In every case we handle, we tailor our defense to the specific facts and client, but follow the same general plan to achieve the best possible results.  Our plan consists of the following steps:

  • Put Pressure on the Government. Once you are named as a target in a government investigation, you can be sure that such investigation has been proceeding for a while.  You must respond as soon as possible.  The more time the government has to investigate without facing opposition from a skilled defense attorney, the more likely they will be able to build a case against you.  Don’t let that happen to you.  As soon as you become aware of your involvement in an investigation or potential audit, hire a strong and experienced attorney like those at the Oberheiden Law Group.  We prioritize providing answers to your most important questions within hours of our engagement – questions like, what is the investigation about?  How can I resolve it quickly?  What is the government seeking as a penalty?  Are they considering civil or criminal charges?
  • Showing Lack of Intent. In our experience, many health care providers are investigated for fraud due to simple human error, and not fraudulent or malicious intent. Maybe the staff at your business was overwhelmed and undertrained, or simply unfamiliar with the latest billing rules.  Maybe someone made a simple data entry error.  The hospice and home health care industries have expanded rapidly in recent years with the aging of the American population, and such growth is likely to continue.  Such quick expansion can make it difficult for you and your staff to keep up with the business side of health care.  Fortunately, a criminal case of health care fraud requires a showing of fraudulent intent beyond a reasonable doubt in every case.  The government knows that our attorneys will insist that they meet this stringent standard in every single case.
  • Demonstrating Appropriate Certifications. Commonly, in health care fraud cases involving home health care or hospice agencies, the government allegations center on an accusation that the certification or re-certification of medical necessity for such services was incorrect and therefore in violation of federal law. At the Oberheiden Law Group, our team has the experience to realize that while such a claim is easy to make, it is difficult to prove.  We work with a network of qualified health care experts to disprove the prosecutor’s claims about medical necessity, and explain the certification exceptions and delegation rules that the government typically ignores in their complaint.
  • Media Intervention. Our representation doesn’t stop in the courtroom or the negotiating table.  We know that our clients’ reputation and the public perception of the charges brought against them are just as important as our legal strategies.  It is not uncommon for the media to present stories based on unfounded rumors or biased reporting that presents only one side of the story, ruining someone’s reputation.  Our lawyers know how to stop such media defamation, and we find opportunities to present the other side of the story to educate the media and correct the public record.

Our Track Record

Our clients range from individual health care providers to entire medical systems.  We represent clients in New York, New Jersey, and around the country, in investigations by the FBI, the DEA, the OIG, the Department of Defense, the IRS, and the Medicaid Fraud Control Unit, among others.  Our recent successes include:

  • Defense of Health Care Service Business Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of Health Care Service Business Investigated by the Department of Justice and the FBI for Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of Health Care Service Business Investigated by the Department of Justice and the FBI for Medicare Fraud and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Defense of Health Care Service Business Investigated by the Department of Defense and the FBI for Tricare Fraud.
    Result: No civil or criminal liability.
  • Defense of Health Care Service Business Investigated by the Department of Defense and the OIG for Tricare Fraud.
    Result: No civil or criminal liability.
  • Defense of Physician Syndication Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and Stark Law.
    Result: No civil or criminal liability.
  • Defense of Physician Investigated by the Department of Health and Human Services and the Office of Inspector General for Medicare Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Defense 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.
  • Defense of Health Care Service Business Investigated by the Office of Inspector General for Medicare Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Defense 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.
  • Defense of Health Care Marketing 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.
  • Defense of Health Care Service Business Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of Health Care Service Business Investigated by the Department of Health and Human Services and the Office of Inspector General for Medicare and Tricare Fraud.
    Result: No civil or criminal liability.
  • Defense of Health Care Conglomerate Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.

NY & NJ Defense Attorneys

Nick OberheidenNick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Nick has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, scores of political corruption, government investigations, and 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, Nick 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 Lynette’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. Lynette has immense experience with health care law enforcement and she regularly argues federal matters for her clients.

We are available every day of the week, including weekends. You can call us directly, complete our contact form, or send us an email.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
Serving New York, New Jersey, 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.

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