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 Legal Defense Serving the Portland Area

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 Portland as well as throughout Oregon State.

Portland, Oregon health care providers, executives, lawyers, businesses, and facilities face the risk of being investigated for Medicare fraud. This risk is even higher than the national average. If you’re being investigated for Medicare fraud, you need the advocacy of an attorney in Medicare fraud defenses serving the Portland, Oregon and surrounding areas. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and managing partner of the Oberheiden Law Group. Mr. Elliott heads the Health Care Fraud Defense Team, and is a recognized former federal health care fraud prosecutor.

Defining Medicare Fraud

Medicare fraud is a federal offense. It has both civil and criminal penalties. Medicare fraud doesn’t just include Medicare. It covers the submission of false claims from any federal government health care program. It includes Tricare, Medicaid, and federal workers’ compensation. It includes a violation of one or more of the following federal statutes:

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

Medicare fraud happens when an illegal payment is made by the federal government to a provider, business, or facility after a false claim is filed.

Portland and its surrounding areas face a higher risk of investigation because it is one of nine locations in the United States that is more closely monitored by the Medicare Fraud Strike Force. This is because Portland has a large number of federal health care program beneficiaries. This increases the number of claims filed through CMS. This large number of claims is the main reason why the government keeps such a close eye on the area. The job of the Medicare Fraud Strike Force is to watch for, investigate, and prosecute occurrences of Medicare fraud.

The Medicare Fraud Strike Force is a team of investigators and prosecutors from various federal agencies such as the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. Other agencies are also included. You could come into contact with one or more representatives from each agency.

Billing Mistakes in Portland: The Main Cause of Medicare Fraud Investigations

The majority of Medicare fraud investigations that happen in Portland, Oregon do so because the federal government has reason to believe that an individual or a business is using fraudulent billing practices or reimbursement requests. This may include false charges, unauthorized charges, and excessive charges. The most common issues in Portland include:

  • 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
  • Overuse of equipment
  • Providing or accepting kickbacks

Portland area doctors, nurses, health care services, nursing homes, registered care facilities, hospitals, clinics, pharmacies, DME providers, labs, DNA centers, and cancer treatment centers are some of the most commonly investigated for Medicare fraud.

Potential Civil and Criminal Penalties for Medicare Fraud

Medicare fraud allegations can result in serious civil and criminal penalties. If you’re being investigated for Medicare fraud, call the Oberheiden Law Group, PLLC 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

Criminal penalties are also extremely serious. They can include 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

Planning Your Strategic Defense

Medicare fraud can affect your life. In addition to the previously mentioned penalties, you could lose your license. You could face disciplinary proceedings. You could even lose your hospital privileges. Because of the potential consequences, it is imperative that you choose the right Portland defense attorney. When doing research, you should look for a defense attorney who has the skills and experience that you need to assist you during either a civil or criminal investigation and prosecution.

There are Portland, Oregon health care providers and businesses who hire a health care attorney. Unfortunately, Medicare fraud often includes federal criminal offenses such as tax evasion, wire fraud, mail fraud, and money laundering. A health care attorney may understand health care law, but he or she may lack the experience to assist you with criminal charges. He or she also may not have the negotiation experience or trial experience that is necessary.

Others look for a Portland criminal defense attorney because they realize that they may face criminal charges. However, most Portland criminal defense attorneys don’t have experience handling federal criminal matters. They also may not have experience with and knowledge of the complex billing, coding, and medical utilization rules.

You need a health care fraud defense attorney serving Portland, Oregon and the surrounding areas. Look 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

Once you’ve narrowed down your options, you must ask three specific questions so that you know whether or not the law firm has the experience that you need in 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?

Proven Strategic Medicare Fraud Defenses

The Oberheiden Law Group, PLLC provides proven, strategic defenses for our Portland, Oregon clients. Many of our Health Care Fraud Defense Team members are former senior prosecutors for federal health care programs with the Department of Justice. We couple this with our experience as defense attorneys to create proven defenses. Our number one priority is to minimize the possibility of criminal charges.

Immediate contact with the federal government. We’ve learned that one of the best ways to help our clients is to contact the federal government right away. If the government has too much time to investigate you, there is a higher probability of criminal charges. We get into immediate contact with the federal agencies involved to get answers to 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 is being investigated?
  • How can the matter be resolved?

We keep open lines of communication with the government, and can usually get answers to these questions within hours.

Lack of evidence.  The federal government must present evidence to show that you’ve committed a crime. This evidence must meet a Constitutional standard known as ‘beyond a reasonable doubt.’ We examine the evidence in each case and question its validity. We’ve regularly seen the following results from this strategic move:

  • 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

Lack of criminal intent. In addition to proving that you committed a crime, the government must also show that you had criminal intent. This is tough for the government to prove because the majority of Portland Medicare fraud investigations that occur do so because someone made an honest mistake. The most common mistakes 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

Portland, Oregon and its surrounding areas have very few legitimate instances of Medicare fraud. Yet, many times, people and businesses that are facing the allegations over a mistake just assume that they’ve committed a crime, and that they just need to accept the punishment. Because of this, many can no longer work in their profession.

The Oberheiden Law Group, PLLC immediately addresses the obvious lack of criminal intent. We work to prove to the federal government that although you made a mistake that likely should be addressed and corrected, there was no criminal intent involved.

Development of applicable defenses. Each Medicare fraud case has its own unique set of facts. The Oberheiden Law Group reviews each case thoroughly to determine applicable and strategic defenses. We recently handled a Medicare fraud case where the government alleged that our client fraudulently certified 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 aggressive, professional Medicare fraud defense for Portland, Oregon health care businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation for illegal kickbacks, fraudulent billing practices, and 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 Portland, Oregon. If you’re under investigation by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, Portland or Oregon law enforcement, call us immediately. Our initial consultations are free of charge and are always 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 Attorneys Serving Portland, Oregon

Nick OberheidenDr. Nick 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 Portland, Oregon 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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