We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Your New York & New Jersey Medicare 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)

The Oberheiden Law Group 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 are licensed in New York and New Jersey as well as authorized to appear in New York and New Jersey federal courts.

We recognize the importance of each matter and we dedicate our fullest attention to each client. All clients of the Oberheiden Law Group are represented by senior attorneys only. We are available for free and confidential consultations.

Medicare Fraud in New York and New Jersey

Health care fraud is committed every time someone submits a false claim to any government health car program, including Medicaid, Tricare, and federal workers’ compensation programs managed by the Department of Labor.  Medicare fraud, then, is any such false claim submitted to Medicare.  Medicare fraud includes violations of the Stark Act, the Anti-Kickback Statue, the False Claims Act, and various sections of the Criminal Code.  The common denominator among all Medicare fraud cases is that a business or medical provider illegally received money from Medicare.

As two of the most populated states in the country, New York and New Jersey contain a large number of Medicare beneficiaries and thus are a primary focus of Medicare fraud investigations.  The CMS keeps a careful watch over Medicare providers in this region due to the large number of retirees and senior citizens who benefit from Medicare.  In fact, a few years ago, the federal government set up special task forces to monitor, investigate, and prosecute Medicare fraud in nine “hot spot” locations.  One of those locations is Brooklyn, bringing even more law enforcement attention to the NY/NJ area.

This elite, specially skilled task force in Brooklyn is called HEAT, which stands for the Health Care Fraud Prevention and Enforcement Action Team.  Their presence means that Medicare fraud prosecutions, and in fact, all federal health care fraud prosecutions, will be more aggressive and more common in this area than in other parts of the county.  You must be aware of the presence and effectiveness of HEAT as a medical business owner or services provider.  The task force is made up of agents, prosecutors, and investigators from a number of federal agencies, including the FBI, the DOJ, the OIG, DHHS, and others.

Forms of Medicare Fraud

As noted previously, Medicare fraud occurs when a person submits false, fictitious, and/or fraudulent claims to the government health care program of Medicare.  Common allegations of Medicare fraud include requests for reimbursements for services that are unauthorized, unnecessary, excessive, or simply made up, as well as incorrect billing practices.  The following allegations are among the most common:

  • Offering or Accepting Kickbacks
  • Up-Coding or mis-coding
  • Bundling or unbundling
  • Double Billing
  • Inflating Bills
  • Billing for Services that Were Medically Unnecessary
  • Billing for Services Never Performed, also called Phantom Billing
  • Billing for Supplies and Equipment that Were Medically Unnecessary
  • Billing for Supplies and Equipment that Were Never Ordered
  • Overutilization of Services or Equipment
  • Certification for Supplies that Were Medically Unnecessary, particularly DME
  • Certification for Services that Were Medically Unnecessary, Especially in Home Health or Hospice areas

Medicare Fraud investigations target every type of health care business and each type of medical service provider, including physicians, nurses, cancer treatment centers, DNA testing centers, pharmacies, hospitals, DME companies, toxicology laboratories, home health care agencies, hospice providers, medical device companies, physician syndications, rehabilitation centers, and nursing homes.

What Are the Penalties?

Medicare fraud is a serious offense and, if charged criminally, is a felony.  Under civil charges, persons found liable for the fraud will face demands of recoupment, refusal to pay future claims, exclusion from all federal health care programs, fines of up to $11,000 per false claim, treble damages, and attorney’s fees. Criminal penalties are even more serious – in addition to fines and indictment, criminal conviction can result in the following sentences in federal prison:

  • 10 years in prison for each count of fraud
  • 20 years in prison if the fraud resulted in serious bodily injury
  • A life sentence if the fraud resulted in the patient’s death.

In addition to the above penalties, civil liability or criminal conviction could lead to suspension or loss of licenses and hospital privileges for medical professionals.

Choosing the Right Defense Lawyer

Obviously, being investigated for Medicare fraud can have serious consequences.  If you are in this situation, you need attorneys with the experience and the skills to win such a case against the federal government.  With your business and freedom at stake, this is no time to choose an attorney who does not have any experience in health care fraud, no matter how eager he may be to learn, or one who works in an entirely different area.  The question remains:  what type of attorney should you select?

Criminal Lawyers. Your first instinct to respond to a government investigation might be to hire a criminal defense attorney.  But while such attorneys do have experience in New York and New Jersey courts, they are likely to spend most of their time defending violent crimes, DWIs, or drug offenses.  And while their courtroom expertise is valuable, you simply can’t spare the time to explain the complicated health care regulations to your attorney – such as utilization, billing, and coding rules – while the federal government is attacking you.

Health Care Lawyers.  If a criminal attorney is not the right choice, then many people turn to a health care specialist. In our experience, such a choice is usually a mistake.  To be sure, Medicare fraud allegations do require knowledge of complex health care regulations, but they also usually involve other criminal accusations, such as mail and wire fraud, tax evasion, or money laundering.  It is important that the lawyer you choose has courtroom experience and is familiar with the criminal process.  Health care lawyers are usually not trial lawyers, are certainly not criminal defense lawyers, and are not trained to and experienced in fighting the federal government.

Health Care Fraud Defense Lawyer.  There is a third option in New York and New Jersey. If you have been accused of Medicare fraud, you should seek an attorney with the following qualifications:

  • Knowledge of the health care industry
  • A proven record of success
  • Trial and litigation experience, including in federal court and in criminal cases
  • Solid understanding of health care laws and regulations

Before investing your hard-earned money in legal representation, you should ask any potential attorney pointed and detailed questions about their resume.  We suggest that you include at least these three questions:

  • How many Medicare Fraud cases have you handled?
  • How many of those Medicare cases resulted in no civil liability, no criminal charges, or outright dismissals, for your clients?
  • How many Medicare fraud trials have you handled?

Proven Defense Strategies

Our firm has years of experience in health care fraud cases and a proven track record across the country, including in New Jersey and New York.  In their careers, our attorneys have handled over 1000 health care fraud cases and conducted more than 200 criminal trials, in front of both judges and juries.  In fact, many of our lawyers joined our firm directly from senior positions as Assistant U.S. Attorneys in the Department of Justice who specialized in health care fraud prosecutions.  Now they share their experience, contacts, and insight with our clients and us.  And while every case is different, we have found that many Medicare fraud investigations can be resolved without any criminal charges being filed when the following strategies are employed:

  • Early Intervention
  • Demonstrating Lack of Evidence
  • Showing Lack of Intent
  • Including Relevant Defenses

Early Intervention. If you have been accused of Medicare fraud, you have no time to waste:  you must find a good attorney to represent you and get involved in the case as soon as possible.  Without involvement by defense counsel early on during the government’s investigation, criminal charges are likely to be brought. Once that happens, you may be a day late and a dollar short.  Don’t give the government ample, uninterrupted time to attempt to build a case against you.  Quickly hire attorneys who know enough to ask – and get answers to – the important questions early, such as:  Why is this investigation taking place?  What is it about?  Does it appear to be civil or criminal in nature? Which agencies are participating?  What does the government want? Is there a way to resolve this quickly?  Our law firm can get you answers to these questions within hours of our retention.

Demonstrating Lack of Evidence. As in every criminal case, criminal Medicare Fraud must be proven by the government beyond a reasonable doubt.  The government must prove both that the act in question was committed and that the person who committed the act had the required criminal intent.  At the Oberheiden Law Group, we know how to hold the government to their burden in every case, meaning we routinely free our clients from accusations of health care fraud.  Our goal is to obtain the best possible result for you in every case, whether that means outright dismissal, maintenance of your license, no criminal charges, civil fines only, no jail time, or reducing the charge to a misdemeanor instead of a felony. 

In our experience, Medicare fraud investigations usually occur because of simple mistakes or organizational failure, not from criminal intent.  Health care providers are naturally focused on treating patients, not billing or business issues, which may allow mistakes to go unnoticed.  Also, the government’s attention is drawn to health care businesses that are growing and expanding quickly.  These two factors combined can explain most mistakes by negligent oversight or organizational deficit.  In our experience, most mistakes are caused by:

  • Structural Deficits
  • Organizational Mistakes
  • Human Error
  • Lack of Oversight
  • Overwhelmed Employees
  • Improperly Supervised Staff
  • Unqualified or Untrained Staff
  • No Compliance Program
  • Delegation & Outsourcing of billing
  • Constantly Changing Regulations

Showing Lack of Intent.  Intentional Medicare fraud is rare; most errors truly are the result of a simple error. However, being investigated by the government is frightening, and honest people often agreed to accept fines and penalties even when they are guilty of nothing more than a mistake or oversight in supervision.  Common mistakes in a busy health care practice should not lead to a conviction or civil liability for health care fraud.  We insist that the government prove the level of intent required by the statute under which they are proceeding.

Including Relevant Defenses. Many of the cases brought against our clients by the federal government are defensible once you know the limits of the law.  This was true in two of our recent cases.  In the first, we were able to show that our client acted within a safe harbor exception and thus did not commit Medicare fraud. In the other, we proved that a recognized delegation exception authorized a certification for home health care services that the government had claimed was fraudulent.

The Oberheiden Law Group, PLLC

Here at the Oberheiden Law Group, we take on the government for many types of health care entities as well as individuals. Our clients include doctors, nurses, business owners, lawyers, health care executives, toxicology laboratories, pharmacies, hospitals, hospices, and home health care providers.  We have and do represent clients in all aspects of health care law and Medicare fraud, including accusations of illegal kickbacks, fraudulent billing, unlawful joint ventures, medically unnecessary services, and services not provided.  We have experience in jury trials, non-jury trials, health care fraud defense, and licensure and disciplinary proceedings as well as in asset protection, qui tam defense, internal investigations, and compliance programs.

No client is too small or too big; we have represented entire health care systems as well as individual providers. In New York and New Jersey, we represent clients who are under investigation by any of a number of government agencies, including state or federal law enforcement, the IRS, the FBI, the DOD, the DOJ, the DEA, the OIG, and the Medicare Fraud Control Unit.  Just a few of our recent successes are outlined below.

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.

Our Attorneys Serving New York & New Jersey

Nick OberheidenNick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney, who is licensed in New York and Washington D.C. and routinely appears in federal courts across the country. 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. 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 year. You can call us directly or complete our contact form or email us directly.

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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