Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Health Care Fraud Defense Team Serving the State of California

Oberheiden & McMurrey, LLP 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 the State of California and surrounding areas.

If you’re a health care practitioner, entity, or business in the State of California and you’re facing allegations of health care fraud, call the Oberheiden & McMurrey, LLP now. 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, elite former lead prosecutors of the Medicare Fraud Strike Force, and accomplished lawyers with education from the nation’s best schools of law, including Yale and Harvard.

If you’re ready to learn how we can help, call now and ask to speak with a member of our Health Care Fraud Defense Team. Your initial consultation is free and totally confidential.

California Is Closely Watched for Health Care Fraud

California is one of nine areas in the United States that is closely watched by the Medicare Fraud Strike Force in an attempt to minimize health care fraud. The Medicare Fraud Strike Force is a team of prosecutors and investigators from several federal agencies, including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. This list isn’t all-inclusive. Other federal agencies are often involved in the Medicare Fraud Strike Force.

California is watched closely because of the large number of citizens that are beneficiaries of a federal health care program. Naturally, when there are more beneficiaries of a health care program, there are more claims filed from that area. The government wants to ensure that they are not paying out on false claims. So, the Medicare Fraud Strike Force monitors, investigates, and prosecutes allegations of health care fraud. In 2016, the Department of Justice investigated more than 300 allegations of health care fraud. Roughly 80 of those investigations involved individual health care providers. The rest involved a health care entity or business. The agency recovered more than $900 million in claims.

What Is Health Care Fraud?

Federal health care fraud is an attempt to receive reimbursement for medical services or equipment through a federal health care program like Medicaid, Medicare, Tricare, or federal workers’ compensation with one or more false claims. It includes 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 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 upcoding of claims. Upcoding 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.

Oberheiden & McMurrey, LLP has a successful history of helping our clients avoid criminal charges. If you or your health care practice, entity, or business are being investigated for health care fraud in California, call Oberheiden & McMurrey, LLP immediately. The call is free and confidential.

The Severe Penalties of Health Care Fraud

Health care fraud is an extremely serious allegation that can lead to both civil and criminal penalties. Civil penalties include repayment of claims and non-payment of future claims, and you may be excluded from federal health care programs. You could be called before the state disciplinary board, lose your license, and lose your hospital privileges. Criminal penalties include criminal charges, fines in the hundreds of thousands of dollars, and 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

During many initial consultations, we are asked about the worst-case scenario for health care fraud in California. The possibility of facing criminal prosecution or a prison sentence depends on several factors, such as the severity of any injury suffered by a patient, whether the prosecutor is interested in pursuing charges, and the reason why the investigation was started.

Oberheiden & McMurrey, LLP is ready and able to defend you in California against health care fraud. Our experience as former health care prosecutors and defense attorneys give us unique insight from which our clients may benefit. If you’re being investigated, call us right away. Initial consultations are free and confidential.

Is It a Criminal Investigation?

Health care fraud investigations can be civil or criminal. Oberheiden & McMurrey, LLP has a distinguished reputation for helping clients avoid criminal charges because we contact the federal government early to start the legal advocacy process. Call us as soon as you can if you’re contacted about an investigation so that we can start planning your defense immediately.

Being contacted by a federal prosecutor isn’t a sign that you’re being investigated and facing criminal charges. All federal agencies with prosecutors have a civil and a criminal division. That’s why you can’t determine the nature of the charges you may face based solely on the fact that you’ve been contacted by a prosecutor. Determining whether the investigation is criminal in nature can depend on the legal interpretation of many different elements such as OIG subpoenas, the manner in which the inquiry is made or in the way in which the allegations are made, and other indicators of criminal prosecution. Criminal prosecution may be signaled by the use of search warrants, seizure warrants, arrest warrants, target letters, involvement of federal criminal prosecutors, IRS involvement, or grand jury subpoenas.

If you have questions about whether you’re facing civil or criminal health care fraud charges, pick up the phone and call Oberheiden & McMurrey, LLP now. We have experience representing individual providers, entire health care systems, and other related health care businesses. We provide our health care defense services to individuals, businesses, and entities in and around California that are being investigated by the Department of Justice, the Department of Defense, Office of Inspector General, Drug Enforcement Administration, the Federal Bureau of Investigation, Medicare Fraud Control unit, California state law enforcement, or the IRS.

Custom Health Care Fraud Defense Strategies for California Clients

Oberheiden & McMurrey, LLP is a health care fraud defense law firm providing legal representation in California. Our attorneys have handled hundreds of cases and trials. Many of our lawyers have previous experience as a health care auditor and prosecutor with the Department of Justice. Their former experience is an asset to our firm and our clients.

Immediate legal advocacy for California clients. In each case, our goal is to help clients avoid criminal charges. Our experience and track record prove that the best way to defend our California clients against criminal charges is to intervene early by contacting the federal government. We begin to advocate for you immediately by getting into contact with federal prosecutors. We can get answers to the most important questions within just a few hours:

  • What is the investigation about?
  • What is the purpose of it?
  • How long will the investigation take?
  • What is the most likely outcome?

Lack of criminal intent and proof of a crime. The federal government has high standards that they must meet in order to prosecute you. They must prove beyond a reasonable doubt that you committed a crime and that you performed your actions with criminal intent. In each case where the government indicates criminal charges to be involved, we put this high standard to the test. Often, prosecutors will cite billing inaccuracies in an attempt to prove criminal intent. We have learned from experience that mistakes happen and that those mistakes do not and should not be equivalent to criminal activity. Oberheiden & McMurrey, LLP has provided successful legal defense for clients all across the United States by proving that these inaccuracies are results of organization or human error and did not happen because of intent to defraud the government. In our experience, we’ve learned that unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care are the most frequent errors that cause these investigations. Although these issues should be corrected, they should not lead to criminal liability.

Using strategic defenses. Oberheiden & McMurrey, LLP develops strategic legal defenses for each of our California clients. This often includes locating applicable defenses and statutory loopholes. Many of our cases have been successful based on these legal exceptions. For example, in the context of Stark Law, which involves medical necessity certifications, we have been able to point to exceptions to either attenuate or entirely resolve a health care fraud case.

Protecting your reputation. Oberheiden & McMurrey, LLP is committed to you both inside and outside of the courtroom. Accusations of health care fraud can be devastating to your career. Our clients are often very concerned about how these accusations will affect them in the future. The media holds the power to destroy a business using accusations and rumors. Their reports are often biased and they do not include the entire story. Our attorneys look for opportunities to address slander, and will also book news spots to correct misinformation.

Contact Oberheiden & McMurrey, LLP now to discuss the details of your case. Calls are free and confidential.

Our Track Record

The commitment of Oberheiden & McMurrey, LLP 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 Attorneys Serving the State of California

Nick OberheidenNick 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. 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.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving the State of California 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. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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