Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense in Florida

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 Florida and surrounding areas.

There is a serious risk to Florida health care providers, lawyers, executives, facilities, and health care businesses. This serious risk is an allegation of Medicare fraud. Being involved in health care in Florida brings with it an increase in the probability that you’ll be investigated for Medicare fraud. If you’re being investigated for Medicare fraud in Florida, you need a Medicare fraud defense law firm. The Oberheiden & McMurrey, LLP is a health care fraud defense law firm serving the State of Florida. It is managed by Dr. Nick Oberheiden, a Harvard-trained defense attorney and negotiator.

Medicare Fraud in the State of Florida

Medicare fraud allegations mean that you’re being accused of violating a federal law. It means that a false claim is submitted for payment to the federal government. Despite the name, it includes all federal health care programs. This means that it may originate through Medicaid, Tricare, or even federal workers’ compensation. Medicare fraud is an allegation that you’ve violated one or more of these federal laws:

  • Physician Self-Referral Law (also known as Stark Law)
  • False Claims Act
  • Anti-Kickback Statute
  • U.S. Criminal code
  • Social Security Act

Florida has a higher probability of Medicare fraud investigations. In fact, it is one of nine areas that is subject to increased scrutiny of the Medicare Fraud Strike Force. The reason behind this is because Florida has a large population that relies on federal health care programs. This equates to more claims being filed. Because more claims are filed, the government believes that there is more potential for Medicare fraud. The Medicare Fraud Strike Force looks for, investigates, and prosecutes Medicare fraud.

The federal task force is actually made up of investigators and prosecutors from various federal agencies. If you’re being investigated, you may come into contact with agents from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. However, those aren’t the only involved agencies. There are other federal agencies that also routinely get involved.

How Do Most Medicare Fraud Allegations Start in Florida?

Medicare fraud investigations in the State of Florida often start because of billing mistakes that the federal government classifies as fraudulent billing practices or reimbursement requests. This can include excessive charges, fraudulent charges, and unauthorized charges. The most common billing issues 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 or equipment
  • Providing or accepting kickbacks

In the State of Florida, the most common investigated include doctors, nurses, hospice providers, nursing and registered care facilities, clinics, hospitals, medical device companies, pharmacies, laboratories, cancer treatment centers, and DNA centers. If you’re being investigated for Medicare fraud, call Oberheiden & McMurrey, LLP now to book your confidential initial consultation. Initial consultations are free of charge.

Civil and Criminal Liability for Medicare Fraud in Florida

Medicare fraud in the State of Florida can result in civil or criminal liability. In some instances, you may face both. 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 health care programs
  • Assessment of attorney fees
  • State disciplinary action
  • Loss of professional license
  • Loss of hospital privileges

Criminal penalties may include one or more of the following, if you are convicted of criminal Medicare fraud:

  • 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

Choosing the Right Florida Defense Attorney

Medicare fraud allegations require a competent Florida defense attorney to strategize and execute the best defenses related to the facts of your case. The attorney should be prepared and experienced to help you – regardless of whether you are facing civil or criminal charges.

Medicare fraud investigations lead many to hire a Florida health care lawyer. While a health care lawyer understands health care law, that’s only half of the battle. It is likely that you’ll also face various federal criminal charges, such as wire fraud and money laundering. A health care lawyer may not have experience handling federal criminal matters. They may not have the needed negotiation and defense skills to face federal prosecutors.

When criminal charges loom, people often look for a Florida criminal defense attorney to assist them. However, most criminal defense attorneys in Florida aren’t necessarily prepared to handle federal criminal matters. They also likely don’t have the intimate knowledge of health care law, billing, coding, or medical utilization rules. Because Medicare fraud is extremely serious, you do not have the luxury of taking the time to try and explain those key components.

Rather, you need to find legal advocates that have experience in health care law and federal criminal defense. You need a health care fraud defense attorney serving the State of Florida. As you look for legal advocacy, watch for these four necessary 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

After you’ve put together a list of potential lawyers or firms, you should ask them these three questions to learn more about their Medicare fraud experience:

  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 have you tried in court?

Florida Medicare Fraud Defenses

Oberheiden & McMurrey, LLP uses proven strategic defenses for our Florida clients who are accused of Medicare fraud. We’ve developed three primary defense points that we use in each case. Their effectiveness has been proven time and time again in Florida and across the nation.

Early government contact. Our experience has shown us that early contact with the federal government is one of the best ways by which we can advocate for our Florida clients and reduce the risk of criminal charges. When federal investigators have too much time to investigate you without interruption, you’re likely to face criminal charges. Our goal is to lessen that risk. This is why we contact the federal government right away to get answers to the important questions like:

  • 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?

Because many of our team members previously held senior positions as federal health care fraud prosecutors with the Department of Justice, we are often able to get the questions answered within hours of our engagement. We also use the answers to these questions to begin planning a strategic defense for our Florida clients.

Addressing the lack of evidence. Evidence is essential to any lawsuit. As such, the government must present evidence that proves beyond a reasonable doubt that you committed a crime. We test the evidence in each case to determine if the government is able to reach this Constitutional standard. Because of this one strategy, we routinely achieve the following results:

  • 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

Disputing intent. In addition to proving that you committed a crime, the government must also be able to prove that you acted with criminal intent. Since most Florida Medicare fraud cases don’t start with someone deciding to defraud the government, we dispute the intentions of our clients. Most Medicare fraud investigations occur because a mistake was made. The most common mistakes that trigger a Medicare fraud investigation in Florida 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

Healt hcare providers and businesses in Florida that face Medicare fraud allegations often accept the penalties without ever giving thought to their intention. They believe that if the government accuses them of something, they must be guilty. While the mistakes that caused the investigation should be addressed and remedied, they shouldn’t result in criminal charges. Our goal is to show the federal government that our clients had no criminal intent.

Developing and implementing strategic defenses. Each Florida Medicare fraud case must be considered on its own because each has its own set of facts. When we analyze the facts surrounding a case, we are able to develop and implement the best and most applicable strategic defenses to assist our Florida clients. 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.

Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP serves the State of Florida by providing excellent Medicare fraud defense representation. We’ve assisted Florida 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, and 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

Oberheiden & McMurrey, LLP provides legal representation of providers, businesses, and facilities in the State of Florida. If you’re being investigated by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, or Florida State law enforcement, call us right away. Our initial consultations are confidential and are provided at no charge to you.

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.

Florida Medicare Fraud Defense Lawyers

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 & McMurrey, LLP
Serving the State of Florida 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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