We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Experienced Medicare Fraud Defense for the Provo, Utah Area

An allegation of Medicare fraud can ruin health care clinics, facilities, businesses, and the careers of providers in Provo, Utah or the surrounding areas. If you’re contacted by the federal government and you are told that you are being investigated for Medicare fraud, call the Oberheiden Law Group, PLLC now. We are skilled in Medicare fraud defense strategy implementation, federal health care audits, asset protection, development and implementation of compliance programs, health care fraud defense, qui tam defense, responding to OIG or grand jury subpoenas, internal investigations, and federal jury trials. Our Health Care Fraud Defense Team is managed by a former Chief Health Care Fraud Coordinator from the U.S. Attorney’s Office and staffed by former federal health care prosecutors and former federal senior trial attorneys.

What You Need to Know About Medicare Fraud

Medicare fraud is a federal violation. It has both civil and criminal penalties. When inaccurate claims are filed with a federal health care program by a health care provider, business, or an entity for reimbursement for services, equipment, or supplies, that is Medicare fraud. Medicare fraud also covers Medicaid, Tricare, and federal workers’ compensation. Accusations of Medicare fraud mean that the federal government believes that you violated at least one of the following:

Medical providers (including doctors and nurses), clinics, hospitals, and other medical businesses and entities are investigated in Provo, Utah for Medicare fraud than in cities of similar size throughout the nation. This is because Provo is one of nine areas in the United States with a substantial number of people who rely on a federal health care program like Medicare. This causes more claims to be filed for reimbursement with the federal government. Because of the increase in claims, the federal government believes that there is a higher likelihood of Medicare fraud in the area.

Provo and the surrounding areas are constantly watched by the Medicare Fraud Strike Force. This is a team of federal prosecutors and investigators from several federal agencies. You may be contacted by representatives of 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, call the Oberheiden Law Group without delay.

The Common Reasons Why Medicare Fraud Investigations Start in Provo

Medicare fraud investigations in Provo and the surrounding area start because of an inaccurate claim that is filed with the federal health care program. The claim often involves an unauthorized charge for medical equipment or a medical service, an inaccurate charge, or an excessive charge. Common inaccuracies that cause these investigations in Provo and the surrounding areas 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.

Medicare Fraud – Civil and Criminal Penalties

Medicare fraud allegations in Provo, Utah and the surrounding areas may lead to civil or criminal penalties. Civil penalties may 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

Additionally, you may be called to appear in front of the state disciplinary or licensing board. You might lose your professional license or your hospital privileges.

Criminal penalties for Medicare fraud may 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.

Hiring Practices for a Provo Attorney

Medicare fraud allegations require you to hire the right attorney. An allegation of this nature is more than violating a federal law. In fact, you could be charged with tax fraud, wire fraud, money laundering, or even mail fraud. That’s why you should follow these hiring practices to choose an attorney who can help you with this allegation.

A Provo health care fraud defense attorney can assist you by representing you against the federal government. As you look into your options, watch for these key 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 Provo Clients

The Oberheiden Law Group evaluates each case to determine the right Medicare fraud defense strategies for our Provo clients. We do look to settle cases when it is possible, but we are prepared to go to court on your behalf if it becomes necessary. We have provided legal advocacy for hundreds of clients.

Contacting the federal government. Our main objective is to reduce the possibility for our clients in facing criminal charges. After we are retained, we immediately contact the federal government to ask the most important questions related to the case:

  • 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?

We are often able to get answers to those questions within just a few hours. This enables us to immediately begin to plan for your defense or to resolve your case. If you’re in Provo or the surrounding area, call the Oberheiden Law Group for help.

Evaluating evidence presented by the federal government. Criminal investigations require evidence. Evidence must meet legal standards to be used. This standard is known as a burden of proof. In a Medicare fraud investigation, the burden of proof is known as “beyond a reasonable doubt.” We evaluate the evidence to determine if the federal government has evidence that can fulfill this burden. This single 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.

No criminal intent. Federal prosecutors must also prove that you acted with criminal intent. With Medicare fraud, this would mean that one day you made a plan to try and scam a federal health care program out of money for services or equipment that you didn’t provide. Most Medicare fraud investigations in Provo and the surrounding areas start because of a mistake that is made most often during the billing or coding process. The most common mistakes 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.

These mistakes should certainly be addressed and corrected, but they don’t make you a criminal. Our law firm works to prove that you made a mistake.

Using exceptions and other defenses. Medicare and other health care statutes have exceptions that may be used when appropriate. This is why we evaluate each case. It allows us to recognize facts that point to an exception or a loophole. 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.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group serves medical providers, business owners, executives, lawyers, hospitals, health care entities, clinics, labs, pharmacies, and health care businesses in Provo, Utah and the surrounding areas under investigation for billing fraud, illegal kickbacks, allegations of services not rendered or medically unnecessary services, and unlawful joint ventures. We also provide assistance with health care fraud defense, creating and implementing compliance programs, internal investigations, asset protection, state licensure or disciplinary proceedings, and jury trials.

The Oberheiden Law Group works with individuals, entire health care systems, and other medical entities in Provo, Utah or the surrounding areas. If you’re contacted by or being investigated by the DOJ, the Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Strike Force, the IRS, Provo or Utah state law enforcement, call us right away. The initial 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 Provo, Utah

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 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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