We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Experienced Legal Defense for Health Care Fraud in Phoenix, Arizona

If you’re a health care provider or if you own a health care practice or business that is active in Phoenix, Arizona or the surrounding areas, you’re at risk for being investigated for health care fraud. If you’re facing an allegation of health care fraud, call the Oberheiden Law Group. We have extensive legal experience in health care fraud defense, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG and grand jury subpoenas, criminal defense, and internal investigations. Our Health Care Fraud Defense Team includes such talent as a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office, several former health care fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. We serve clients in Phoenix as well as the rest of the state of Arizona.

You have legal options. Call the Oberheiden Law Group, PLLC and ask to speak with a member of our Health Care Fraud Defense Team. The call is free and confidential.

Phoenix, Arizona Is Constantly Monitored by the Federal Government

Phoenix, Arizona is one of nine regions in the United States that is constantly monitored by the Medicare Fraud Strike Force, an agency of the federal government. The Medicare Fraud Strike Force is a team of prosecutors and investigators from multiple federal agencies. Often, members of this team work with the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. However, other federal agencies often have representatives who are part of this team.

Phoenix and the surrounding areas are constantly monitored because of the number of citizens in the area who rely on a federal health care program. The large amount of recipients increase the number of claims filed with the federal government by health care providers and businesses for reimbursement. This increase in claims causes the federal government to watch the area closer because they believe that there will be an increase in the number of fraudulent claims filed. During 2016, the Department of Justice released a statement that revealed that they had investigated around 300 cases of health care fraud. Individual health care providers were the center of 80 of those investigations. The rest of the cases centered on a health care entity or business. The agency stated that they recovered more than $900 million in fraudulently paid out claims.

What Is Health Care Fraud?

Federal health care fraud is the attempt to receive reimbursement for medical equipment or services from a federal health care program such as Medicaid, Medicare, Tricare, or federal workers’ compensation. It is the filing of one or more false claims and includes a violation of at least one of the following laws:

  • The Anti-Kickback Statute. Federal health care law outright prohibits kickbacks in exchange for referrals. Any individual (including doctors, marketing representatives, and business owners) is subject to prosecution for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
  • Stark Law. Stark Law, also known as the Self-Referral Law, prohibits doctors from referring patients to specific health care service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest or if there is a compensation arrangement. Note, however, that there are statutory exceptions to this law.
  • False Claims Act. If you submit a claim to Medicare or any other federal health care program, you are required by law to abide by the False Claims Act. If the claim submitted to the federal government is discovered to be inaccurate, the federal government will likely launch an investigation into your billing practices under the criminal provisions of the False Claims Act.
  • Prescription Fraud. The federal government pays special attention to health care practices that have an unusually high number of narcotic prescriptions. If you are suspected of running a “pill mill,” you are at a high risk of being investigated for insurance fraud and for violating DEA dispensing rules.
  • Billing Fraud. The federal government is persistent about investigating the up-coding of claims. Up-coding means that the next higher code is used for a service when the billing is done. The federal government is also prone to investigating phantom billing (billing for services that were not provided), billing for patients who do not exist (referred to as ghost patients), and billing for equipment or services that are deemed not medically necessary.
  • Certification Errors. The home health care and hospice industry is frequently a practice that the federal government chooses to maintain a close eye on. The most common accusations include fraudulent certification for home health care and hospice care.

The Oberheiden Law Group has a successful track record in helping our clients avoid criminal charges. If you’re being investigated by the federal government for health care fraud in Phoenix, Arizona or the surrounding areas, call the Oberheiden Law Group now. Your initial call is free and confidential.

Civil and Criminal Penalties of Health Care Fraud

Health care fraud in Phoenix can result in civil or criminal charges. Both courts have their own set of penalties that they may levy against you if you are found guilty. In civil court, you could be ordered to repay the claims, you could be denied reimbursement on future claims, and you could be excluded from filing claims with federal health care programs in the future. You may also be called in front of the state disciplinary board. You could lose your license and your hospital privileges.

Criminal penalties include more than a criminal record. You could be ordered to pay hefty fines that cost you hundreds of thousands of dollars, even if you’re only found guilty of a misdemeanor. You could receive a federal prison sentence:

  • Up to 10 years for each count of health care fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
  • Life sentence if the health care fraud resulted in the death of a patient.

Phoenix clients often ask us about the worst-case scenario for health care fraud allegations. The worst-case scenario involves criminal charges or getting a prison sentence. Whether you will face either of those depends on factors such as the severity of any injury suffered by the patient, whether the prosecutor is interested in pursuing criminal charges, and the reason why the investigation was started.

The Oberheiden Law Group provides legal defense strategies for Phoenix area providers, entities, and businesses in health care fraud defense cases. We use our experience as former health care prosecutors and as defense lawyers to develop strategic legal defenses for our clients. If you’re being investigated for health care fraud, call us right away. The call is free and confidential.

How to Tell If the Investigation Against You Is Criminal

Health care fraud investigations in Phoenix, Arizona and the surrounding areas can be civil or criminal. They can even start off as civil and become criminal. This is why it is important to immediately contact the Oberheiden Law Group right away if you are being investigated.

Being contacted by a prosecutor isn’t a good indicator that the investigation against you is criminal. Federal agencies that have prosecutors have civil and criminal branches. That’s why you cannot rely on this. Signs of a criminal investigation into health care fraud include search warrants, seizure warrants, arrest warrants, target letters, contact from a federal criminal prosecutor, involvement from the IRS, or the receipt of a grand jury subpoena.

Developing Health Care Fraud Defenses in Phoenix

The Oberheiden Law Group is a health care fraud defense firm providing legal advocacy to individual health care providers, entire health care systems, and health care businesses in Phoenix, Arizona and the surrounding areas. We’ve handled hundreds of cases during our time as a firm. Several of our lawyers have previous experience as health care auditors and as health care fraud prosecutors with the Department of Justice and with the Medicare Fraud Strike Force. We use our combined experience to benefit our clients. This combined experience has led us to develop strategic health care fraud defenses that we use with our Phoenix clients.

Immediate contact with federal investigators. Our main priority is to help you avoid criminal charges. From our experience, we’ve learned that one of the most efficient ways that we can do this is to immediately contact federal investigators on behalf of clients. This reduces the amount of time that the federal government has to investigate you without an interruption. Immediately after we are retained, we contact federal investigators to get answers to the most important questions:

  • What is the investigation about?
  • What is the purpose of it?
  • How long will the investigation take?
  • What is the most likely outcome?

We are often able to get the answers to those questions within just hours after we are retained.

Evaluating the legal standards. The federal government must meet a high legal standard to show that you committed a crime and that you also acted with criminal intent. We evaluate the evidence and the legal standards in each case. Often, the federal government will point to billing inaccuracies to say that you committed a crime. Yet, we’ve found that these inaccuracies occur not because of fraud, but because of a mistake. While these mistakes should certainly be addressed and corrected, they shouldn’t cause you to face criminal penalties. Mistakes often occur when health care practices or businesses grow quickly or because someone makes a mistake. The most common mistakes that cause these allegations include the use of unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care .

Developing strategic defenses for each case. The Oberheiden Law Group reviews each case and develops strategic legal defenses for our Phoenix clients. This may also include reviewing and utilizing the applicable statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a health care fraud case.

Preserving your professional reputation. Health care fraud allegations can hurt your professional reputation. It’s one of the main concerns of our clients. Our lawyers will look for the right opportunities to correct any misinformation given to the public by the media. We also address slanderous comments.

If you’re under investigation for health care fraud in Phoenix, Arizona or the surrounding area, call the Oberheiden Law Group now. The call is free and confidential.

Our Track Record

The commitment of the Oberheiden Law Group is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former health care prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home health care entities, and many other health care organizations against any form of alleged health care fraud. Here are some recent examples of our case outcomes.

  • Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation 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.
  • Representation of a Health Care Marketing Group Against an Investigation by the Office of Inspector General for Alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
    Result: No civil or criminal liability.
  • Representation 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.
  • Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation 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.
  • Representation of Physician 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.
  • Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
    Result: No civil or criminal liability.

Health Care Fraud Defense Lawyers Serving Phoenix, Arizona

Nick OberheidenNick Oberheidenis 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 Law Group, PLLC
Serving Phoenix, Arizona 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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