Healthcare Fraud Appeals Attorneys

Representation for Physicians, Pharmacists, Hospitals, and Other Providers in All Types of Healthcare Fraud Appeals

For healthcare providers, receiving an unfavorable audit determination or being found guilty of healthcare fraud is not the end of the process. You have the right to file an appeal—and you may have various grounds to do so.

At Oberheiden P.C., we represent physicians, pharmacists, hospitals, and all other types of providers in healthcare fraud appeals. We handle appeals of administrative, civil, and criminal matters, and we rely on extensive relevant experience to provide effective representation. If you need to challenge the outcome of an audit or judicial proceeding, we can provide a comprehensive assessment of your options, and we encourage you to contact us promptly for a complimentary initial consultation.

Experienced Lawyers for Federal Healthcare Fraud Appeals

When you receive an unfavorable audit determination or an unfavorable judgment or verdict in court, this can feel like the end of the road. But, in reality, it is just the start of the process. There are multiple levels of appeal for federal healthcare audits and enforcement proceedings—and this is because regulators and legislators understand that the process is flawed.

While some unfavorable audit determinations and healthcare fraud convictions are justified, some are not. Both substantive and procedural mistakes can—and do—lead to unjust results. As a result, asserting your right to appeal is crucial, and you need to pursue your appeal with experienced counsel on your side.

Our federal healthcare lawyers represent clients in all types of healthcare fraud appeals. This includes handling all levels of appeals for audits, civil enforcement proceedings, and criminal healthcare fraud prosecutions:

1. Healthcare Audit Appeals

Fee-for-service contractors working with the Centers for Medicare and Medicaid Services (CMS) audit healthcare providers across the United States for billing compliance, and they routinely make unjustified determinations of liability. These unjustified determinations are frequently based on false and unsubstantiated accusations of upcoding, unbundling, double-billing, and other forms of healthcare billing fraud.

The same is true for audits conducted by and on behalf of the U.S. Department of Labor (DOL), U.S. Department of Veterans Affairs (Tricare), and other government payors.

As a result, many healthcare providers find themselves needing to challenge the outcomes of their billing audits. While each payor has its own appeals process, there are generally multiple stages of appeal. For example, when challenging the outcome of an audit that resulted in a finding of Medicare fraud, the stages in the process are:

• Filing a Request for Redetermination
• Filing a Request for Reconsideration
• Requesting a Hearing Before an Administrative Law Judge (ALJ)
• Requesting Review by a Medicare Appeals Council
• Seeking Judicial Review in Federal District Court

Appeals can succeed at any stage of the process, and at Oberheiden P.C. we focus on reversing our clients’ false allegations of healthcare billing fraud as quickly and efficiently as possible. If you need to appeal the outcome of a Medicare, Medicaid, DOL, or Tricare audit, it is important that you act promptly, and we encourage you to contact us today.

2. Civil Healthcare Fraud Appeals

Many healthcare fraud enforcement actions are civil in nature. The Anti-Kickback Statute, False Claims Act, Stark Law, and various other federal healthcare laws all include provisions for civil enforcement.

Under most federal fraud statutes, one of the key distinguishing factors between civil liability and criminal culpability is intent. If a provider overbills the government unintentionally, criminal prosecution may be unwarranted, but the provider can still face civil liability for healthcare fraud.

Since evidence of intent is not necessary for the government to pursue allegations of civil healthcare fraud, civil enforcement actions frequently lead to fines and other penalties. While these penalties are justified in some cases, many healthcare providers that are found civilly liable will have grounds to file an appeal.

Challenging the outcome of a civil healthcare fraud enforcement action generally involves filing an appeal in federal district court, although providers may first need to pursue administrative appeals in some cases. If you, your practice, or your business has been found civilly liable for healthcare fraud, our lawyers can explain what steps you need to take in order to seek a reversal. We can then take all necessary steps on your behalf, whether this involves dealing directly with the agency that imposed civil liability or challenging this agency’s decision in court.  

As with audit appeals, when you need to appeal the outcome of a civil healthcare fraud enforcement action, it is important to act promptly. Strict deadlines apply, and you can lose your right to appeal if you wait too long to file. When you choose Oberheiden P.C. to represent you, your practice, or your business, our lawyers will do everything necessary to preserve your appellate rights, and we can provide representation on an emergency basis if necessary.

3. Criminal Healthcare Fraud Appeals

A significant portion of our healthcare fraud appeals practice is devoted to representing clients in criminal matters. Federal prosecutors can pursue criminal healthcare fraud charges under several statutes; and, in these cases, prosecutors will often pursue charges for ancillary offenses such as mail fraud, wire fraud, and conspiracy as well. Each of these charges carries a substantial fine and prison term, and it is not unusual for convicted healthcare providers and executives to face life-altering sentences.

If you have been criminally convicted of healthcare fraud, it is important that you consult with a lawyer promptly in this scenario as well. Here, too, strict deadlines apply. You must file a timely notice of appeal to preserve your rights, and then you must begin working with your appellate counsel immediately to build your appellate case.

Federal criminal appeals are very different from federal criminal trials. Regardless of your guilt or innocence, you may have a variety of grounds available to challenge your conviction. Some examples of potential grounds for challenging a criminal healthcare fraud conviction include:

• The trial judge abused his or her discretion in allowing jurors or evidence
• The trial judge made an error of law
• The trial judge committed “plain error” in applying the law to the facts of your case
• The weight of the evidence does not support the judge’s or jury’s verdict
• Your defense counsel was ineffective or the prosecutor’s office engaged in misconduct

If you do not have grounds to challenge your conviction on appeal, you may have grounds to challenge your sentence. Federal criminal sentences are subject to appeal on various grounds as well. When you choose Oberheiden P.C. for your healthcare fraud appeal, our lawyers will thoroughly examine the trial record from your case to assess your appellate options. Based on this assessment, we will help you choose the best path forward, and then we will prosecute your appeal as efficiently as possible.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former Department of Justice

Brian J. Kuester

Former U.S. Attorney
Former DA

John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach

Former Special Agent (OIG)

Michael Koslow

Former Supervisory Special Agent (FBI)

Chris Quick

Former Special Agent (FBI & IRS-CI)

Ray Yuen

Former Supervisory Special Agent (FBI)

FAQs: Filing a Federal Healthcare Fraud Appeal

Schedule a Complimentary Consultation at Oberheiden P.C.

Do you need to know more about filing a federal healthcare fraud appeal? If so, we encourage you to get in touch promptly. Call 888-680-1745 or contact us online to schedule a complimentary consultation at Oberheiden P.C.