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former federal prosecutors

Medicare Fraud Defense Attorneys Assisting Health Care Professionals Avoid Criminal Penalties

Former Medicare Prosecutors & Defense Counsel

Recognize the Threat of Investigation

Medicare fraud is a federal crime and is generally investigated by federal authorities.  The two federal departments that are most involved in enforcing Medicare laws are the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), with the DOJ traditionally handling criminal investigations and HHS traditionally handling civil investigations.  Within the DOJ, the Federal Bureau of Investigation (FBI) plays a large role in investigating allegations of Medicare fraud.  Within HHS, the Office of the Inspector General (OIG) is the primary investigative agency.  The DOJ and HHS have recently increased their collaborative investigative efforts through joint task forces such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT) and Medicare Fraud Task Forces in select cities including Detroit.  Additionally, the Center for Medicare and Medicaid Services (CMS) participates in monitoring and detecting Medicare fraud.

Understand the Potential Liability

The government has vast discretion over how it chooses to prosecute providers who have been investigated and suspected of engaging in Medicare fraud. The DOJ can choose to bring civil charges, criminal charges, or both. Providers should understand what the potential liabilities in order to be well prepared to make quick, informed decisions during the process of litigation. Also, an understanding of the potential liability can help reinforce adherence to regulations as a top priority, and thereby avoid potential liability.

Criminal Charges

Criminal charges are the most severe threat to providers that are under investigation for Medicare fraud.  Individuals who have been criminally charged with Medicare fraud often suffer invasive, embarrassing, and disruptive searches and seizures, such as raids of their homes and offices.  Confiscated items may include cellular phones, computers, and hardcopy documents as well as personal or business banks accounts.  Individuals who are ultimately convicted on criminal charges of Medicare fraud are subject to severe penalties including lengthy prison terms, probation, and large criminal fines.  Achieving a criminal conviction on Medicare fraud charges is significantly more difficult that prevailing on civil charges.  A prosecutor must prove – beyond a reasonable doubt – that the defendant intended to defraud Medicare.

Civil Charges

Medicare fraud investigations may also be civil in nature, in which case the provider’s exposure is generally more limited.  But even civil charges should not be taken lightly.  Penalties for civil charges of Medicare fraud include civil monetary penalties of up to $ 20,000 per violation, recoupment of up to three times the government’s damages, non-payment of claims, repayment of the government’s legal costs and fees, and exclusion from participation in federal healthcare programs.  Civil cases may prevail with weaker evidence of improper intent than criminal cases.

Rely on Experienced Healthcare Defense Attorneys

From our experience with hundreds of Medicare Fraud cases, we have witnessed first-hand how allegations of fraudulent activity can result from mistakes or confusion about recent changes in healthcare regulations.  Over-worked or under-trained staff members, lack of organizational oversight, or employee negligence can cause errors in billing processes or documentation.  There is a huge difference between an honest mistake that resulted in an overpayment and an intentional attempt to defraud Medicare.  At Oberheiden & McMurrey, LLP, we understand how innocent mistakes can be made, and we routinely help our clients avoid criminal charges and mitigate or even eliminate civil liability by proving to federal investigators that the activities in question resulted from human error or misunderstandings and not fraudulent conduct.

After years of defending Medicare fraud investigations, we know that the earlier a target has a defense strategy in place, the more likely the target will avoid civil or criminal charges following the investigation.  Therefore, at Oberheiden & McMurrey, LLP, we treat every case as an emergency and start working on our clients’ cases immediately after we are hired.  We strive to answer our clients’ most pressing questions as soon as possible, such as:  Is the case civil or criminal? What exposure to liability do they have?  What charges are at issue?  What is the scope of potential outcomes?

Free Consultation

If you are a Detroit doctor or healthcare professional that is under investigation for Medicare fraud, you need to contact legal counsel immediately. The experienced attorneys at Oberheiden & McMurrey, LLP are available seven days a week, including weekends, to speak with you about your case.