We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense for all of Ohio

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 serve clients in Ohio and surrounding areas.

Ohio health care providers, executives, lawyers, facilities, and related businesses are at serious risk. They’re at risk of facing an allegation of Medicare fraud. In fact, Ohio is one of the few areas in the United States that has more investigations performed by the federal government. If you’re being investigated for Medicare fraud, you need an experienced team of legal advocates to work on your behalf. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and managing partner of the Oberheiden Law Group.

What You Need to Know About Medicare Fraud in Ohio

Medicare fraud is a federal offense with civil and criminal penalties. It occurs when a false claim is submitted to the government for illegal reimbursement. However, Medicare fraud includes more than just Medicare. It also includes Medicaid, Tricare, and federal workers’ compensation. If you have been accused of Medicare fraud, you’re being accused of breaking at least one of these federal laws:

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

Ohio has more Medicare fraud investigations than the majority of the United States. This is because Ohio is one of nine locations in the US that is closely monitored by the Medicare Fraud Strike Force. The reason for such close monitoring is because Ohio has a large population that receives benefits from a federal health care program. In areas where there is a large amount of beneficiaries, there are more claims filed. More claims filed leads the federal government to believe that it is more likely to see higher instances of Medicare fraud. The Medicare Fraud Strike Force watches these areas closely to identify, investigate, and prosecute Medicare fraud.

The Medicare Fraud Strike Force is a federal team of prosecutors and investigators from multiple federal agencies. If you’re being investigated for Medicare fraud in Ohio, you may come into contact with representatives of the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. However, those aren’t the only involved agencies. There are other federal agencies that also routinely get involved.

What Causes Most Medicare Fraud Investigations in Ohio?

One of the most commonly asked questions that we hear is what causes Medicare fraud investigations in Ohio. Billing mistakes cause most of the Medicare fraud investigations that occur. These mistakes are noticed by the government and labeled as fraudulent billing practices or reimbursement requests. They often include what the government believes to be fraudulent, unauthorized, or excessive charges. These billing issues are often caused by:

  • 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 or equipment
  • Providing or accepting kickbacks

The next question that we are usually asked is who is most likely to be investigated in Ohio. This list certainly isn’t meant to be all-inclusive. Some of the most common Medicare fraud investigation targets in Ohio include doctors, nurses, hospice providers, nursing and registered care facilities, clinics, hospitals, medical device companies, pharmacies, laboratories, cancer treatment centers, and DNA centers.

Serious Civil and Criminal Liabilities

Medicare fraud in Ohio is extremely serious. You can face civil or criminal penalties. In some cases, you may face both. If you’re in Ohio and you’re being investigated for Medicare fraud, call the Oberheiden Group right away.

Civil penalties may 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
  • State disciplinary action
  • Loss of professional license
  • Loss of hospital privileges

Criminal penalties can change your entire life. You may face 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

Ohio Medicare Fraud Defense Requires the Right Defense Attorney

Medicare fraud allegations are serious matters. You need the right Ohio defense attorney who can plan and execute the right defense related to the facts involved in your case. It is imperative that you choose the right Ohio defense attorney with the necessary skills and experience to help you – regardless of whether your case is civil or criminal.

Medicare fraud allegations lead many to believe that the best legal choice is an Ohio health care lawyer. Although health care attorneys have intimate knowledge of the laws surrounding the health care industry, they may not be prepared to handle the federal criminal charges that are often included. Charges such as wire fraud, mail fraud, tax evasion, and money laundering require specific experience and knowledge. An Ohio health care attorney also may not have the negotiation and defense skills that you need to settle or face federal prosecutors in court.

The mention of criminal charges leads many people to hire an Ohio criminal defense attorney. However, most criminal defense attorneys don’t have experience handling federal criminal charges. It is also unlikely that they will not have the necessary education and understanding of health care laws, billing, coding, and medical utilization rules.

You need someone who can handle both the health care and federal criminal issues at stake. You need an Ohio health care fraud defense attorney. As you look for an attorney to help you, watch 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

After you’ve collected a list of potential lawyers, you should look closely at their experience. To determine whether they can help you, ask the following three questions about Medicare fraud:

  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?

Medicare Fraud Defenses for Ohio

The Oberheiden Law Group uses proven and strategic Medicare fraud defenses for our Ohio clients. Because many of our Health Care Fraud Defense Team members are former senior prosecutors from the Department of Justice, we’ve developed three guiding principles that we use in every case. The goal behind these principles is to reduce the risk of criminal charges.

Contact with investigators happens early. During our legal careers, we’ve learned that contacting the federal investigators early on behalf of our clients is one of the best ways by which we can advocate on their behalf. If investigators have too much uninterrupted time to investigate, it is likely that you’ll face criminal charges. We get into contact with the federal government early to get answers to the important questions like:

  • 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 are often able to get the answers to these essential questions within a few hours of our engagement. It also helps us determine what needs to be done to best help our clients.

Addressing a lack of evidence. In any case, evidence must be presented to show that a crime was committed. The federal government must prove beyond a reasonable doubt that you committed a crime. We analyze the evidence presented by the federal government for each of our Ohio clients to determine whether or not the government is able to reach this Constitutional standard. Because we use this strategy, we regularly get the following results:

  • 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

No criminal intent. In addition to showing that you’ve committed a crime, the federal government must also show that you acted with criminal intent. This is hard to prove, as very few Ohio Medicare fraud cases begin because someone had the intention of defrauding the government. Rather, these cases often start because of an honest mistake. The most common mistakes that often result in Medicare fraud cases in Ohio 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

Ohio health care providers and others who are accused of committing Medicare fraud often accept the penalties, and assume that they must have committed a crime because they don’t realize that the government must prove that they acted with criminal intent. Although the mistakes you made that led to the investigation may ultimately need to be corrected, they are not criminal acts and shouldn’t be treated as such.

The Oberheiden Law Group strives to show the government that our clients did not act with criminal intent.

Developing and using applicable defenses for each Ohio client. Each Medicare fraud case is different because they include different facts. The Oberheiden Law Group examines each case to determine the best strategic defenses available for our clients. 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.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides zealous Medicare fraud defense for Ohio 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, and 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

The Oberheiden Law Group provides legal representation of providers, businesses, and facilities in the State of Ohio. If you’re being investigated by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, or Ohio State law enforcement, call us immediately. Initial consultations are free of charge and are 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.

Ohio Medicare Fraud Defense Attorneys

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated 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 email us directly.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
Serving the State of Ohio 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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