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 those in the St. Louis 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 St. Louis as well as throughout Missouri State.

Health care providers, executives, lawyers, business, organizations, and facilities in St. Louis are threatened by the chance of being put under investigation for Medicare fraud. To be certain, health care entities operating out of St. Louis are at a disproportionately higher risk to be deemed in violation of Medicare fraud law than the national average. If you are undergoing an investigation over Medicare fraud, you require the advocacy of a legal team in Medicare fraud who provide their services to St. Louis and the surrounding area. 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 is an exceptionally serious federal offense. Such dire charges carry with them both civil and criminal penalties and consequences. It would pertinent to understand, however, that Medicare fraud is not restricted to exclusively Medicare. It involves the submission of false claims from any kind of federal government health care program. It includes, but is not limited to, Tricare, Medicaid, and federal workers’ compensation. It possibly 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, facility, or business upon a false claim being filed.

St. Louis and its surrounding areas are plagued by a much higher risk of investigation than is usual thanks to the face that St. Louis is one of nine locations in the United States that is closely scrutinized by the Medicare Fraud Strike Force. This unrelenting stakeout is thanks in large part to the fact that St. Louis has a staggering number of federal health care program beneficiaries. This intrinsically increases the amount of claims that are filed through CMS. Such an extraordinary number of claims is the main reason why the government watches the area so closely. The goal of the Medicare Fraud Strike Force is to watch for, investigate, and prosecute occurrences of Medicare fraud.

The Medicare Fraud Strike Force is a collective team of investigators and prosecutors who come from a multitude of federal agencies, including, but not limited to, DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. Throughout the course of a given investigation, it is extremely likely that you will find yourself coming into contact with one or more representatives from each agency.

Billing Mistakes in St. Louis: The Main Cause of Medicare Fraud Investigations

Most Medicare fraud investigations that are initiated in St. Louis are launched because the federal government has reason to believe that a certain individual or business is practicing fraudulent billing methods or reimbursement requests. These methods can possibly include fraudulent charges, unauthorized charges, and excessive charges. The most common issues in St. Louis 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

Doctors, nurses, health care services, nursing home, registered care facilities, clinics, hospitals, DME providers, pharmacies, labs, DNA centers, and cancer centers in St. Louis are some of the most frequently investigated for Medicare Fraud.

Potential Civil and Criminal Penalties for Medicare Fraud

Medicare fraud allegations are extremely serious matters, as they are notorious for bringing about severe civil and criminal penalties. If you are under investigation for Medicare fraud, you need to make it your number-one priority to call the Oberheiden Law Group as soon as possible. Civil penalties can include any 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 have the power to irreversibly affect your professional life in an adverse way. In addition to all of the other previously listed penalties, you also run a high risk of having your license revoked. It is possible that you will be faced with disciplinary proceedings. You are even at risk of losing your hospital privileges. Knowing just what is on the line if those possibilities come to fruition, it is absolutely critical that you hunt down and hire a skilled and experienced St. Louis defense attorney. As you begin the process of researching, you should seek a defense attorney who has the skillset and experience that will be vital for you to come out unscathed from either a civil or criminal investigation and prosecution.

A disturbingly large number of medical practitioners who operate in the St. Louis area are swayed by the notion that they should employ the services of a health care attorney. Once allegations that you have committed Medicare fraud begin to be levied against you, you face the risk of facing extraordinarily serious federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. While it is true that a health care attorney can be well-versed in and have an adequate understanding of health care law, he or she may not have the appropriate experience and understanding of federal criminal defense that you will need. What’s more is that they might not have the negotiation skills necessary to face the federal government or to deal with federal prosecutors in a court of law, such as in a trial.

Many others opt to seek out a St. Louis defense attorney; this is because they understand that they are likely to be faced with criminal charges. However, most St. Louis criminal defense attorneys simply do not have the experience that is required to properly handle federal criminal matters. Moreover, they also might not have experience with or knowledge of the complexities of billing, coding, and medical utilization rules.

You need a health care fraud defense attorney serving St. Louis and its surrounding areas. Keep on the lookout 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 thinned out your options, it is very important that you ask three certain 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 creates and provides proven and powerful defense strategies for our clients in St. Louis. A sizable number of our Health Care Fraud Defense Team is made up of former senior prosecutors for federal health care programs with the Department of Justice. We combine this advantage with our experience as defense attorneys so that we can put forth proven defenses. Our primary objective is to come as close as we possibly can to annihilating the possibility of criminal charges.

Immediate contact with the federal government. Thanks to our extensive work in Medicare fraud defense, we have discovered that one of the most effective ways in which we can assist our clients is to work to get into contact with the federal government as early as it is possible for us to do so. If the government finds itself with an overabundance of time to launch an investigation into your particular practice, there is a dangerously higher chance that you will be confronted with criminal charges. We exert our greatest effort to get into contact with all relevant federal agencies in order to get you answers to such questions 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 normally get answers to these questions within hours.

Lack of evidence.  The federal government must, by law, present concrete evidence if they wish to prove that you are guilty of committing a crime. This evidence must meet a Constitutional standard known as ‘beyond a reasonable doubt.’ We scrutinize and evaluate the evidence that the government presents in each case and place the legitimacy of the evidence into question. Thanks to this powerful strategy, we consistently 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. Furthermore, not only is the government obligated to provide evidence that you have indeed committed a crime, the government is also required to prove that your actions possessed criminal intent. This frequently proves difficult for the government to substantiate, because the majority of St. Louis Medicare fraud investigations that are carried out are generally launched due to an honest mistake. The most frequently made 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

Truthfully, St. Louis and the areas surrounding it see a negligible amount of genuine instances of Medicare fraud. In spite of this, people and businesses that are faced with allegations because of a mistake will, many times, simply assume that they must have somehow committed a crime and therefore need to accept the punishment as a result. Thanks to this phenomenon, many can no longer work in their profession.

The Oberheiden Law Group immediately begins work to address any obvious lack of criminal intent. We put forth our utmost effort to prove to the federal government that, in spite of the possibility that you may have made a mistake (a mistake that should very likely be addressed and corrected), your actions were not made with any criminal intent.

Development of applicable defenses. Every individual Medicare fraud case is unique in its complexities, despite the common aspects that all of them share. The Oberheiden Law Group tactfully examines each case with a cautious and discriminating eye in order to formulate robust and defensible strategies. 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 St. Louis 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 those involved 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 St. Louis. 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, St. Louis law enforcement, call us immediately. Our initial consultations are free of charge and 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 St. Louis

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 or complete our contact form or by emailing us directly.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
Serving St. Louis, Missouri 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.

IF YOUR FREEDOM IS AT STAKE

YOU SHOULD CONTACT US TODAY

Contact the Experienced Attorneys of the Oberheiden Law Group Now for a Confidential Consultation

Contact Us Now
×