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 Legal Defense for the San Diego Area

California Office
550 W C St #1150
San Diego, CA 92101

(Meeting location by appointment only)

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 represent numerous clients in the San Diego and Southern California area and continue to serve clients in San Diego as well as throughout California State.

In San Diego, California, health care providers, executives, lawyers, businesses, organizations, and facilities are at a risk of being put under investigation for violating Medicare fraud law. In fact, health care entities in San Diego are at a disproportionately higher risk to be found in violation than the national average. If you find yourself under investigation for Medicare fraud, you need a legal advocate in Medicare fraud who operates in San Diego and its surrounding areas. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and managing partner of the Oberheiden Law Group, PLLC.

Defining Medicare Fraud

Medicare fraud has been deemed a federal offense. It brings with it both civil and criminal penalties and repercussions. It should be noted, however, that Medicare fraud is not limited exclusively to Medicare. It involves the submission of false claims from any and all federal government health care program. It includes Tricare, Medicaid, and federal workers’ compensation. It is can include 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 occurs upon an illegal payment being made by the federal government to a provider, facility, or business after a false claim is filed.

San Diego and the areas that surround it are faced with a much higher risk of investigation because of the fact that San Diego is one of only nine locations in the United States that is under heavy observation by the Medicare Fraud Strike Force. Such thorough monitoring is thanks to the fact that San Diego has a vast amount of federal health care program beneficiaries. This increases the number of claims that are filed through CMS. This significant number of claims is the reason why the government keeps such a close eye on the area. The objective of the Medicare Fraud Strike Force is to watch for, investigate, and prosecute occurrences of Medicare fraud.

The Medicare Fraud Strike Force is a coalition of investigators and prosecutors made up of a variety of federal agencies, such as the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. You should keep in mind that there are more agencies in the Medicare Fraud Strike Force than merely those previously mentioned. Throughout the course of an investigation, it is possible that you will come into contact with one or more representatives from each agency.

Billing Mistakes in San Diego: The Main Cause of Medicare Fraud Investigations

The majority of investigations into Medicare fraud in San Diego, California occur because the federal government has reason to believe that a particular business or individual is utilizing fraudulent billing practices or reimbursement requests. This can possibly include fraudulent charges, unauthorized charges, and excessive charges. The most common matters in San Diego 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

In San Diego, doctors, nurses, health care services, nursing homes, registered care facilities, clinics, hospitals, DME providers, pharmacies, labs, DNA centers, and cancer treatment centers are some of the most frequently investigated for Medicare Fraud.

Potential Civil and Criminal Penalties for Medicare Fraud

Medicare fraud allegations are infamous for bringing about serious civil and criminal penalties. If you are currently under investigation for Medicare fraud, you should call the Oberheiden Law group as soon as you possibly can. Civil penalties can 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 very serious. They may 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 allegations possess the ability to leave your life scarred with long-persisting effects. On top of every other previously mentioned penalty, you also run a high a risk of having your license revoked. You could be confronted with disciplinary proceedings. You are even at risk to potentially lose your hospital privileges. Due to the possible consequences, it is absolutely critical that you choose a skilled San Diego defense attorney. As you are going about your research, you should look for a defense attorney who has the skills and the experience that you require for ample assistance during either a civil or criminal investigation and prosecution.

A large number of practitioners in the San Diego area are under the misguided impression that they should hire the services of a health care attorney. Once you are alleged of Medicare fraud, you are confronted with the extremely likely risk of facing serious federal crimes, such as tax evasion, wire fraud, mail fraud, and money laundering. While it may be true that a health care attorney could be familiar with health care law, they may not possess adequate experience and understanding of federal criminal defense that you may be in need of. In addition, they may not have the negotiation skills necessary to confront the federal government or to face federal prosecutors in a court of law, such as in a trial.

Many others opt to look for a San Diego defense attorney; this is because they realize that they face the risk of being confronted with criminal charges. However, most San Diego criminal defense attorneys don’t have the necessary experience to handle federal criminal matters. In addition, they may also not have experience with or knowledge of the complexities of billing, coding, and medical utilization rules.

You are in need of a health care fraud defense attorney serving San Diego, California and the surrounding areas. Keep an eye out 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, it is urgent that you ask three specific questions so that you know whether or not the law firm has the experience in Medicare fraud that you need.

  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 offers proven, vigorous defense strategies for our clients in San Diego, California. Many of the members of our Health Care Fraud Defense Team are former senior prosecutors for federal health care programs with the Department of Justice. We combine this with our experience as defense attorneys to formulate proven defenses. Our primary and principal priority is to diminish the possibility of criminal charges.

Immediate contact with the federal government. Through our work in Medicare fraud defense, we have learned that one of the very best possible ways we can assist our clients is to get into contact with the federal government as early as we can. If the government has an abundance of time to launch an investigation into you, there is a significantly higher chance that you will be met with criminal charges. We strive to get into contact with all pertinent federal agencies as to get answers to questions such as:

  • What is the investigation about?
  • What prompted the investigation?
  • Is this civil or criminal?
  • Which federal agencies are involved in the investigation?
  • Who all is being investigated?
  • How can the matter be resolved?

We keep the lines of communication open with the government, meaning that we can typically get answers to these questions within hours.

Lack of evidence.  The federal government is obligated to bring forth evidence to prove that you have committed a crime. This evidence must meet a constitutional standard known as ‘beyond a reasonable doubt.’ We analyze and examine the evidence presented in each case and put its validity into question. Due to this strategic move, we frequently observe the following outcomes:

  • 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 the government being required to present concrete evidence that you have committed a crime, the government is required to prove that you acted with criminal intent. This is consistently troublesome for the government to prove, because the majority of San Diego Medicare fraud investigations that are launched do occur thanks to 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

In actuality, San Diego, California, and its surrounding areas see very few legitimate instances of Medicare fraud. In spite of this, businesses and people that are facing allegations thanks to a mistake will, oftentimes, simply assume that they have perpetrated a crime and just need to accept the punishment. Due to this, many can no longer work in their profession.

The Oberheiden Law Group, PLLC strives to promptly address any obvious lack of criminal intent. We move to prove to the federal government that, despite the possibility that you may have made a mistake that very likely should be addressed and rectified, your actions were not laced with criminal intent.

Development of applicable defenses. Each Medicare fraud case is unique in its own way, despite the commonalities shared between all of them. The Oberheiden Law Group carefully examines each case with tact and a discerning eye in order to formulate forceful and strategic defenses. We recently handled a Medicare fraud case where the government accused our client of fraudulently certifying 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 Medicare fraud defense for San Diego, California health care businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation for illegal kickbacks and fraudulent billing practices. We also help with 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 San Diego, California. 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, San Diego or California law enforcement, call us immediately. Our initial consultations are free of charge, and they are 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 San Diego, California

Nick OberheidenDr. Nick 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 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, complete our contact form, or email us directly.

714-294-2000
Including Weekends
Oberheiden Law Group, PLLC
Serving San Diego, CA 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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