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Medicare Fraud Legal Defense for the Phoenix Area

Medicare fraud is a federal crime that can devastate your Phoenix medical practice or business. If you’ve been accused of Medicare fraud, contact the Oberheiden & McMurrey, LLP now. Our firm is skilled in audits related to federal health care programs, Medicare fraud defense strategies, asset protection, compliance programs, jury trials, development of fraud defense, qui tam defense, OIG subpoena responses, grand jury subpoena responses, federal criminal defense, and with internal investigations. Our team of lawyers includes a former Chief Health Care Fraud Coordinator from the U.S. Attorney’s Office, former federal health care prosecutors, and former federal senior trial attorneys.

What Is Medicare Fraud?

Medicare fraud is a violation of federal law. It can have civil or criminal consequences. It happens when one or more claims are filed with a federal health care program by health care providers, businesses, or entities that want to be reimbursed for their services, equipment, or supplies. Medicare fraud isn’t limited to just Medicare. It includes Medicaid, Tricare, and federal workers’ compensation. This accusation results in an investigation into the potential violation of at least of the following:

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

Medical providers, pharmacies, and other medical entities are investigated for Medicare fraud in Phoenix, Arizona more often than in other cities. Phoenix is one of nine locations in the nation with a larger number of Medicare beneficiaries than in other areas. This causes more federal claims to be filed. The increase in claims makes the federal government believe that there is also a higher likelihood of Medicare fraud.

Phoenix, Arizona and the surrounding areas are monitored by the Medicare Fraud Strike Force at all times. This federal agency is made up of prosecutors and investigations from several federal agencies. You may be contacted by the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. If you’re contacted by any representative of a federal agency about Medicare fraud, immediately call Oberheiden & McMurrey, LLP.

What You Need to Know About Medicare Fraud Investigations in Phoenix

Medicare fraud investigations in Phoenix and the surrounding area often start because a claim is filed with a federal government health care program. The claim is ultimately deemed as fraudulent because of inaccuracies noticed by the federal government health care program. Usually, the claim involves an unauthorized service or medical equipment, has an inaccurate charge, or has an excessive charge. The most common inaccuracies found in Phoenix claims include:

  • Billing for services that weren’t performed (phantom billing);
  • Double billing for equipment or services;
  • Claims made for medically unnecessary medical services or equipment;
  • Claims made for medically unnecessary supplies;
  • Claims made for medically unnecessary certification (such as hospice or home health care );
  • Charges that are inflated;
  • Up-coding;
  • Overuse of medical services or equipment;
  • Providing or accepting kickbacks.

Individual medical providers, physicians who own businesses, nursing facilities, registered care workers and facilities, hospitals and clinics, pharmacies, DME providers, DNA testing labs, and cancer centers are some of the most commonly targeted for Medicare fraud investigations in Phoenix, Arizona and the surrounding areas.

Medicare Fraud Has Civil and Criminal Consequences in Phoenix

Medicare fraud in Phoenix and the surrounding areas have civil and criminal consequences. Civil consequences can include:

  • Repayment of claims that are investigated;
  • Future claims will not be paid;
  • Fine of up to $11,000 per false claim;
  • Exclusion from federal health care programs;
  • Treble damages;
  • Attorney fees.

You could be forced to appear in front of the state disciplinary or licensing board. This could mean that you lose your professional license or your hospital privileges.

The criminal consequences of Medicare fraud 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.

How to Hire the Right Phoenix Medicare Fraud Attorney

Medicare fraud requires the right attorney. These allegations often include serious federal criminal charges like tax fraud, wire fraud, mail fraud, and money laundering. Do your research to make sure that you hire an attorney who can handle the unique circumstances of Medicare fraud cases.

A Phoenix health care fraud defense attorney will understand the implications of federal criminal charges and the intricacies of health care law. Watch for these traits:

  1. Successful handling of previous Medicare fraud cases;
  2. Knowledge of Medicare and health care fraud laws and regulations;
  3. Deep understanding of statutory exceptions;
  4. Litigation and federal jury trial practices.

Additionally, you should ask the following questions to learn more about their skills:

  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 Defense Strategies for Phoenix Clients

Oberheiden & McMurrey, LLP takes the time to look at each case to determine the most effective defense strategies for Phoenix clients. While we understand the importance of settling cases where possible. We have represented hundreds of clients. Our Health Care Fraud Defense Team is led by a former Chief Health Care Fraud Coordinator with the U.S. Attorney’s office. Several members of our team are former DOJ federal trial lawyers and prosecutors.

Reaching out to the federal government. The main objective is to lessen the likelihood of criminal charges against our Phoenix clients. We reach out to the federal government immediately after we are retained by our clients. This gives us the opportunity to 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?

Because of our open lines of communication with the federal government, we are usually able to get those questions answered within just a few hours. If you’re in Phoenix or the surrounding area, call Oberheiden & McMurrey, LLP right away.

Evidence must meet a high burden of proof. All criminal investigations rely on evidence. All evidence must meet certain legal standards known as a burden of proof. In this type of investigation, the federal government’s evidence must meet a legal standard known as “beyond a reasonable doubt.” Oberheiden & McMurrey, LLP looks at the evidence to determine if the federal government will be able to meet that burden of proof. Relying on this strategy has given us the following results on a regular basis:

  • Charges against our clients are dismissed;
  • Clients do not face criminal charges;
  • Clients usually keep their professional license;
  • Clients receive a civil fine, but no criminal plea;
  • Reduction of a felony to a misdemeanor;
  • No prison sentence.

Proving a mistake was made. Additionally, federal investigators must prove that you acted with criminal intent. Criminal intent, in relation to Medicare fraud, means that you made a conscious decision to try and scam a federal health care program. This is difficult for the investigators to prove since most Medicare fraud investigations in Phoenix and the surrounding areas begin as a result of a mistake. These mistakes most often affect the billing or the coding process. The most common mistakes that cause a Medicare fraud investigation include:

  • 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.

While these mistakes should be corrected, they aren’t crimes. Oberheiden & McMurrey, LLP works to prove that you made a mistake that you are willing to address and correct.

Medicare fraud exceptions as defenses. Medicare and other health care laws have exceptions and loopholes. The Oberheiden Law group analyzes each case to determine if exceptions may be used to defend our clients in Phoenix. One of our clients was recently accused of providing fraudulent certification for home health care services. We proved that our client was legally 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 provides legal representation for Phoenix, Arizona and the surrounding area for individual medical providers, entities, business owners and executives, attorneys, hospitals, clinics, pharmacies, labs, and other related medical businesses being investigated for fraudulent billing, illegal kickbacks, and allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. Additionally, we are able to assist you with health care fraud defense needs, creating and implementing compliance programs, internal investigations, protection of your assets, state licensure or disciplinary proceedings, and federal jury trials.

Oberheiden & McMurrey, LLP is available to help individuals, entire health care systems, and other medical entities in Phoenix, Arizona or the surrounding areas. If you’re under investigation by the DOJ, the Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Strike Force, the IRS, Phoenix or Arizona state law enforcement, contact us immediately. The call is free and 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.

Medicare Fraud Defense Lawyers Serving Phoenix, Arizona

Nick OberheidenNick 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 knowledge 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 skills 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 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. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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