We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Health Care Fraud Defense Lawyers serving Provo, Utah

Health care providers, entities, and businesses in Provo, Utah or the surrounding areas are at risk of being investigated for health care fraud. If you’re being investigated, call the Oberheiden Law Group, PLLC. We have 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 proudly serve clients in Provo as well as throughout the state of Utah.

To learn more about your legal options if you’re being investigated for health care fraud, call the Oberheiden Law Group and ask to speak with a member of our Health Care Fraud Defense Team. Initial calls are free and confidential.

Provo, Utah Is Diligently Observed for Health Care Fraud

Provo, Utah is one of nine locations in the United States that is diligently observed for health care fraud by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is a federal team of prosecutors and investigators from assorted federal agencies including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. Other federal agencies may be part of the team as well.

Provo and the surrounding areas are strictly monitored because of the number of residents in the area who are beneficiaries of federal health care programs. The number of beneficiaries increase the number of claims that the federal government receives. The increase in claims to the federal government for reimbursement causes the government to heavily scrutinize the area for higher instances of health care fraud. In 2016, the Department of Justice released a statement that they investigated around 300 cases of health care fraud. This breaks down to 80 cases involving individual providers and the rest of the cases centered on a health care entity or business. The agency recovered more than $900 million in fraudulently paid out claims.

What Is Federal Health Care Fraud?

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

  • 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 proven track record of success with helping our clients avoid criminal charges. If you’re being investigated in Provo, Utah or the surrounding areas for health care fraud, call the Oberheiden Law Group. The call is free and confidential.

A Look at the Civil and Criminal Penalties of health care Fraud

Health care fraud in Provo can lead to civil or criminal charges. Both courts have penalties. Civil penalties include repayment of the amount you or your business received from the program, non-payment of future claims, and exclusion from filing claims with federal health care programs. You could also be the center of disciplinary hearings by the state board and you could lose your license and hospital privileges.

Criminal penalties include a criminal record, expensive fines, and you could also receive a federal prison sentence of:

  • 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

Health care providers and businesses in Provo often ask us about the worst-case scenario for an allegation of this nature. The worst-case scenario is criminal charges and receiving a federal prison sentence. Whether or not you will face either of those will depend on many factors such as how severe the injuries were that were suffered by the patient, whether the prosecutor plans to pursue criminal charges, and why the investigation started.

The Oberheiden Law Group works to provide compelling and strategic legal defenses in Provo and the surrounding areas for providers, entities, and businesses facing health care fraud allegations. We utilize our dual experience as former health care prosecutors and as defense attorneys to provide the right defenses for each of our clients. If you’re under investigation for health care fraud, call us now. The call is free and confidential.

Is the Investigation Against You Criminal?

Health care fraud investigations can be civil or criminal in Provo, Utah or the surrounding areas. Investigations often start off as civil and then become criminal. This is why it is important to immediately contact the Oberheiden Law Group right away if you’re under investigation.

Being contacted by a prosecutor isn’t a good sign to rely on to determine if the investigation against you is criminal. Federal agencies with prosecutors have both civil and criminal prosecutors. That’s why you cannot use this as an indicator.

Signs of a criminal investigation include the receipt or serving of 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.

Health Care Fraud Defenses in Provo, Utah

The Oberheiden Law Group is a health care fraud defense firm providing advocacy to individual health care providers, entire systems, and businesses in Provo, Utah and the surrounding areas. We’ve handled hundreds of health care fraud defenses cases. Several members of our firm have experience as former health care auditors and former health care fraud prosecutors with the Department of Justice and the Medicare Fraud Strike Force. We use our experience to develop strategic health care fraud defenses for our Provo clients.

Contact with the federal government. The main priority of our firm is to help clients avoid criminal charges. We’ve learned from our experience that the most effective way to do this is to immediately contact the federal government on behalf of our clients. This provides less uninterrupted time to the federal government to conduct their investigation against you or your business. Directly after we are retained, we contact the federal government. Within hours, we can usually 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?

Analyzing evidence and the legal standards. The federal government must use evidence to meet a high legal standard to show that you committed a crime and that you acted with criminal intent. We analyze the evidence and the legal standards in each case. The federal government tries to use billing inaccuracies to try to prove that you committed a crime. However, we’ve found that billing inaccuracies rarely occur because of an actual crime. Rather, they happen because someone makes a mistake. While mistakes should be corrected, they shouldn’t lead to criminal penalties. The most common errors that cause health care fraud investigations include hiring unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care.

Strategic legal defenses for each case. The Oberheiden Law Group studies the facts involved in each case to develop strategic legal defenses for our Provo clients. This may also include researching and utilizing applicable statutory loopholes and exceptions. For instance, 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.

Working to protect your professional reputation. Health care fraud allegations can do damage to your professional reputation. It’s one of the main concerns that our clients have when they are being investigated. The Oberheiden Law Group looks to correct any misinformation given to the public by the media. We also address slanderous comments.

If you’re being investigated for health care fraud in Provo, Utah or the surrounding areas, call the Oberheiden Law Group. The initial 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 Provo, Utah

Nick OberheidenNick Oberheiden is 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 Provo, Utah 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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