Orange County Medicare Fraud Defense Attorney - Oberheiden, P.C.
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Orange County Medicare Fraud Defense Attorney

Oberheiden, P.C. is a healthcare 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 Healthcare 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 Orange County as well as throughout California State.

Healthcare providers, lawyers, executives, business, organizations, and facilities operating out of Orange County, California run the risk of being subjected to a Medicare fraud investigation. In fact, healthcare entities in Orange County are at a higher risk than the national average. If you are under investigation for Medicare fraud, you require the advocacy of our Orange County Medicare fraud defense attorneys.

Defining Medicare Fraud

Medicare fraud is considered a federal offense. It carries with it both civil and criminal penalties. It is worth noting, however, that Medicare fraud is not just limited to Medicare. It encompasses the submission of false claims from any and all federal government healthcare programs. This includes Tricare, Medicaid, and federal workers’ compensation. It is comprised of 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.

Orange County and the areas surrounding it are confronted with a higher risk of investigation, thanks to the fact that it is one of only nine locations in the United States that is monitored more heavily by the Medicare Fraud Strike Force. This heavy surveillance is because Orange County has a large number of federal healthcare program beneficiaries. This naturally increases the number of claims filed through CMS. The substantial amount of claims is the primary reason why the government watches the area with such a close eye. The task of the Medicare Fraud Strike Force is to watch out for, investigate, and prosecute instances of Medicare fraud.

The Medicare Fraud Strike Force is a team of investigators and prosecutors made up of an assortment of federal agencies such as the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. It is worth noting that there are more agencies in the Medicare Fraud Strike Force than just those previously listed. During the course of an investigation, you are likely to come into contact with one or more representatives from each agency.

Billing Mistakes in Orange County: The Main Cause of Medicare Fraud Investigations

Most of the investigations into Medicare fraud that occur in Orange County, California happen because the federal government has reason to believe that a particular business or individual is making use of fraudulent billing practices or reimbursement requests. This can possibly include fraudulent, unauthorized, and excessive charges. The most common matters in Orange County 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, healthcare services, nursing homes, registered care facilities, clinics, hospitals, DME providers, pharmacies, labs, DNA centers, and cancer treatment centers in Orange County are some of the entities most commonly investigated for Medicare Fraud.

Potential Civil and Criminal Penalties for Medicare Fraud

Medicare fraud allegations often bring about serious civil and criminal penalties. If you are being investigated for Medicare fraud, you should call the Orange County Medicare fraud defense lawyer at Oberheiden P.C. immediately. 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 healthcare programs
  • Assessment of attorney fees

Criminal penalties are also exceptionally 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

Orange County Medicare Fraud Defense Attorney

Planning Your Strategic Defense

Medicare fraud allegations have the power to leave long-lasting effects on your life. On top of every other previously mentioned penalty, you are also at a risk of losing your license. You could be faced with disciplinary proceedings. You could even potentially lose your hospital privileges. Because of the possible consequences, it is utterly essential that you choose the best possible Orange County Medicare fraud defense lawyer. As you are doing your research, you should seek out a defense attorney who has the skillset and experience that you need to assist you during either a civil or criminal investigation and prosecution.

In Orange County, California, there exist many healthcare providers and businesses who hire a healthcare attorney. Much to the chagrin of many a spurned practitioner, however, Medicare fraud often includes federal criminal offenses such as tax evasion, wire fraud, mail fraud, and money laundering. While it is true that healthcare attorneys may understand healthcare law, they may lack the experience to help you with criminal charges. They may not have the necessary experience to see through negotiations or, should it come to it, a trial.

Many others opt to look for an Orange County defense attorney; this is because they realize that they are at risk of facing criminal charges. However, the majority of Orange County criminal defense attorneys don’t possess the experience necessary to handle federal criminal matters. They may also not have knowledge of or experience with the complex billing, coding, and medical utilization rules.

You are in need of a healthcare fraud defense attorney serving Orange County, California and the surrounding areas. Keep an eye out for these four traits:

  • A proven track record of success in Medicare fraud cases
  • Industry knowledge
  • Deep familiarity with healthcare laws and their exceptions
  • Litigation and trial experience

Once you’ve narrowed down your options, it is imperative 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.

  • How many Medicare fraud cases have you handled during your career in law?
  • How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
  • How many Medicare fraud cases did you try in court?

Proven Strategic Medicare Fraud Defenses

Our Orange County Medicare fraud defense attorney at Oberheiden, P.C. provides proven, robust defense strategies for our Orange County, California clients. Many of our Healthcare Fraud Defense Team members are former senior prosecutors for federal healthcare programs with the Department of Justice. We pair this with our experience as defense attorneys in order to formulate proven defenses. Our chief and foremost priority is to cut down on the possibility of criminal charges.

Immediate contact with the federal government. We have discovered that one of the best possible ways to assist our clients is to get into contact with the federal government as soon as possible. If the government has a wealth of time to launch an investigation on you, there is a much higher chance that you will be faced with criminal charges. Our Orange County Medicare fraud defense lawyers get into contact with all relevant federal agencies in order 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 maintain the lines of communication with the government, meaning that we can typically get answers to these questions within hours.

Lack of evidence. The federal government is required to present evidence in order to prove that you have committed a crime. This evidence has to meet a Constitutional standard known as ‘beyond a reasonable doubt.’ We analyze the evidence present in each case and place its validity into question. Thanks to this strategic move, we regularly 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. Not only does the government have to use concrete evidence that you have committed a crime, but it must also show that you had criminal intent. This is frequently difficult for the government to prove, because the majority of Orange County Medicare fraud investigations that are carried out do occur because of 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 healthcare laws and rules

Orange County, California, and its surrounding areas actually see very few truly legitimate occurrences of Medicare fraud. Despite this, businesses and individuals that are facing allegations over a mistake will, many times, simply assume that they have committed a crime and just resign to the punishment. Because of this, may can no longer work in their profession.

Oberheiden, P.C. works to immediately address the blatant lack of criminal intent. We strive to prove to the federal government that, although you made a mistake that should very likely be addressed and rectified, your actions were not out with criminal intent.

Development of applicable defenses. Each Medicare fraud case carries with it its own unique set of facts. Oberheiden, P.C. carefully examines each case with a thorough lens in order to determine powerful and strategic defenses. We recently handled a Medicare fraud case where the government accused our client of fraudulently certifying home healthcare 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.

Oberheiden, P.C.

Oberheiden, P.C. provides aggressive Medicare fraud defense for Orange County, California healthcare businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other healthcare entities under investigation for illegal kickbacks and fraudulent billing practices, and under investigation for allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. We can help you with:

  • Healthcare fraud defense
  • Compliance program creation and implementation
  • Internal investigations
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

Oberheiden, P.C. provides legal representation of providers, businesses, and facilities in Orange County, 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, Orange County 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 healthcare 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 Healthcare Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating healthcare company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of healthcare 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 healthcare 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.

Frequently Asked Questions

What are some examples of healthcare fraud?

 

Healthcare fraud refers to any bogus claim for reimbursement submitted to a federally funded program, such as Medicare, Medicaid or Tri-Care. In a typical arrangement, healthcare providers render services or supplies to a patient and then submit a form for reimbursement. It may seem as though, given the vast number of claims filed, the federal government doesn’t keep a close eye on these submissions. However, that is not the case. There are several agencies charged with investigating healthcare fraud, and investigators can pick up on even small or isolated instances of misconduct. The following are some of the most common reasons the government pursue healthcare fraud charges:

  • Billing for services that were not performed;
  • Billing for services that were not medically necessary;
  • Billing for supplies or equipment that were never ordered;
  • Billing for supplies or equipment that were not medically necessary;
  • Certification for services or supplies that were not medically necessary;
  • Double billing, up-coding, and inflating bills; and
  • Overutilization of services or equipment.

If you are at the center of a healthcare audit or investigation, contact a California federal healthcare fraud defense attorney as soon as possible.

What is the Anti-Kickback Statute?

 

The Anti-Kickback Statute (42 U.S.C. §1320a–7b) is a federal law limiting a medical provider’s ability to participate in certain referral relationships. More specifically, the AKS prohibits a provider from paying or receiving anything of value in exchange for patient referrals when the patient’s medical bills are being paid by a federally funded program, such as Medicaid or Medicare. While many cases involving alleged violations of the AKS involve the payment of money for referrals, other common kickbacks include expensive meals, hotel stays or vacations, prestigious or high-paying positions within a company. The AKS is a criminal law, and a conviction carries the possibility of jail time and other criminal sanctions. Additionally, civil liability may be pursued under the False Claims Act. If you are facing a violation of the Anti-Kickback Statute, it is imperative that you reach out to a dedicated Orange County, California federal healthcare fraud defense attorney immediately.

Are healthcare fraud charges civil or criminal?

 

It depends on the nature and seriousness of the violation. Some federal healthcare fraud statutes can only result in civil liability. For example, the Stark Law prohibits providers from referring a Medicare patient for certain designated health services to any entity in which the referring physician has a financial relationship. The Stark Law is a civil statute, meaning it carries the possibility of significant fines and other sanctions, but not incarceration. On the other hand, the Anti-Kickback Statute is a criminal law, which carries a potential penalty of five years in prison and a fine of $25,000. Additionally, if you are convicted under the Anti-Kickback Statute, you will be excluded from the Medicare/Medicaid programs for at least five years. If you are under investigation for healthcare fraud, it is imperative that you contact a Orange County, CA federal healthcare fraud defense attorney immediately to understand your options.


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Oberheiden, P.C.
Serving Orange County, CA and Surrounding Areas
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