Miami Medicare Fraud Defense Attorneys
Miami Medicare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
Healthcare practitioners and facilities accused of Medicare fraud in Miami, Florida need the assistance of an experienced team of healthcare fraud defense attorneys. The Miami Medicare fraud defense attorneys at Oberheiden, P.C. have extensive experience with Miami and Florida healthcare fraud investigations. A great number of cases ended with neither civil nor criminal liability outcomes. Oberheiden, P.C. is comprised of former Medicare Fraud Strike Force prosecutors, former civil and criminal healthcare fraud prosecutors from the Department of Justice, as well as other highly experienced attorneys, such as Dr. Nick Oberheiden, a recognized Miami Medicare fraud defense lawyer.
What Is Medicare Fraud?
Medicare fraud in Miami, Florida doesn’t just cover Medicare. It may also refer to the submission of false or fictitious claims to other government healthcare programs. Other programs include Medicaid, Tricare, and federal workers’ compensation. In Miami, Medicare fraud is a serious charge.
Medicare fraud may also constitute a violation of several laws:
- False Claims Act
- Anti-Kickback Statute
- Stark Law (Physician Self-Referral Law)
- Social Security Act
- U.S. Criminal Code
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)
Medicare Fraud and Miami
Miami is seen as a hot-bed for Medicare fraud. The large number of retirees means there are more Medicare benefits recipients. The Centers for Medicare and Medicaid Services (CMS) closely watch the use of Medicare and other government-related healthcare claims due to this population.
Aggressive Allegations of Medicare Fraud
Businesses and individuals in Miami providing healthcare-related services and goods could be targets of aggressive tactics used by government entities. The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) is a federal task force made of members of several government agencies:
- Department of Justice
- Department of Health and Human Services
- Office of the Inspector General
- Federal Bureau of Investigation
Understanding Medicare Fraud
Healthcare providers and businesses must understand the basics of what can trigger Medicare fraud claims. There are some billing practices of which you should be aware. Even if done accidentally, they can lead to an investigation of fraud. This is a list of examples of the most common acts that may cause accusations of Medicare fraud.
- Phantom billing – billing for services that were never performed
- Billing for medically unnecessary services
- Billing for unordered supplies or equipment
- Certification for medically unnecessary services, such as home health or hospice
- Certification for supplies that are not medically necessary, such as DME
- Overuse of services or equipment
- Providing or accepting kickbacks
Some of the most commonly targeted entities for Medicare fraud investigations include:
- Doctors
- Home Health Facilities
- Hospice Care
- Nursing Homes
- Nurses
- Registered Care
- Hospitals
- Pharmacies
- Labs
- Medical Device Providers
- Physician Syndicates
- DNA Centers
- Cancer Centers
- DME Companies
Penalties for Medicare Fraud
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The penalties for Medicare fraud are very serious. They can destroy your future goals. You may be required to pay recoupment requests. You may not be eligible for payment on future claims. Civil fines can cost you as much as $11,000 per false claim. There may be an exclusion from federal healthcare programs. You may face treble damages and attorney fees. Criminal fines, a criminal indictment, or prison time are also possible penalties. Being sentenced to prison could mean up to 10 years for each count of fraud or up to 20 years if the fraud resulted in serious bodily injury. If the patient dies, you could receive a life sentence.
You Must Choose the Right Defense Lawyer
Because of the serious consequences, it is imperative that you choose the right Miami defense lawyer. Do not rely on a beginner. Choose a lawyer who understands how to plan and execute complex healthcare defense strategies.
Should You Choose a Healthcare Lawyer?
Allegations of Medicare fraud lead many to believe they need a healthcare lawyer. Medicare fraud is typically charged in combination with other crimes like mail fraud, wire fraud, tax evasion, and money laundering. While a healthcare lawyer may understand healthcare laws, they may not have training or experience in the criminal aspects of the charges. A healthcare lawyer may not be able to provide you with the best defense against federal prosecutors.
Should You Choose a Criminal Defense Lawyer?
Since Medicare fraud can carry additional criminal charges, individuals and facilities may need to consider working with a criminal defense lawyer. However, many criminal defense lawyers center on DUIs, crimes like rape, or drug offenses. They may not have experience in managing complex healthcare fraud allegations. They may lack knowledge of rules related to medical billing, coding, or service utilization.
Choosing the Right Miami Medicare Fraud Defense Attorney
If you’re facing allegations of Medicare fraud in Miami, you need to choose the right healthcare fraud defense lawyer. We suggest four questions to ask any lawyer you consider for hire:
- Do they have a proven track record in complex healthcare fraud cases?
- Do they have intimate knowledge of the industry?
- Do they have an immense understanding of healthcare laws?
- Do they have litigation and trial experience?
If yes, follow with four specific questions related to Medicare fraud:
- How many Medicare fraud cases have you handled during your career?
- How many of those cases resulted in neither civil nor criminal charges?
- How many of those cases resulted in a dismissal for your clients?
- How many Medicare fraud cases have you tried in court?
Compelling Defense Strategies
Oberheiden, P.C. prides itself on our experience managing Medicare fraud cases throughout the United States. We’ve handled more than 2,000 healthcare fraud cases and conducted more than 200 criminal trials. Based on the experience many of our attorneys have working in senior positions within the DOJ, we are able to develop winning defense strategies. We have successfully resolved Medicare fraud investigations and helped our clients avoid criminal charges.
Proactive Intervention
With early intervention, we are able to assist you before the allegations become a serious problem. The more time the government has to investigate, the more likely it is you will face criminal charges. We can often get answers to important questions within the first days of beginning work on your case. Having a lawyer represent you with the government can help you get the answers you need to these questions:
- What caused the allegations?
- Is the case civil or criminal?
- Which agencies are involved?
- What is the ultimate goal of the government?
- How can the allegations be resolved?
A Lack of Evidence
In the U.S. legal system, there is a heavy burden of proof placed upon the government. The government must show beyond a reasonable doubt that you committed an illegal act with criminal intent. This is a Constitutional standard that we will use in your defense. It can result in case dismissal, avoiding criminal charges, retaining your license, civil instead of criminal fines, reducing a felony to a misdemeanor, and no prison time.
We know many Medicare fraud claims begin due to a business or human error and without criminal intent. These mistakes happen for a variety of reasons. While that may be negligent oversight, it’s not criminal. The most common errors include:
- Unqualified or inadequately trained staff
- Errors made because of a lack of supervision
- Outsourcing work
- Improper delegation
- Business errors
- Human errors
- Overwhelmed staff members
- Human oversight
- No compliance program in place
- Lack of enforcement guidelines or procedures
No Criminal Intent
Many practitioners, facilities, and businesses accept penalties even if they face allegations because of an honest mistake. Mistakes are common, but should not result in convictions or liabilities. A lack of criminal intent means that the person or business involved had no desire to commit fraud.
The Use of Applicable Defenses
Appropriate defenses are extremely useful against allegations. Applicable defenses are ones that make sense for your particular case. Recently, we handled a Medicare fraud case in which the government alleged our client fraudulently certified a need for home healthcare. Our applicable defense involved a delegation exception that made the certification compliant with the law. In a separate case, we refused to admit liability and proved to the prosecutors that our client acted within a safe harbor exception. Because no two Medicare fraud cases are the same, applicable defenses are a necessity.
Oberheiden, P.C.
Oberheiden, P.C. provides representation for allegations of fraud in the health care industry.
We can help with:
- Compliance programs
- Defenses for healthcare fraud allegations
- Internal investigations
- Qui tam defense
- Asset protection
- Licensure or disciplinary proceedings
- Jury trials
We provide representation to clients in Miami, Florida who are being investigated by the Department of Justice, Department of Defense, FBI, DEA, Office of the Inspector General, Medicaid Fraud Control Unit, Miami or Florida law enforcement, or the IRS.
Our Track Record
- Medicare Fraud: Successful defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office
Result: No civil or criminal liability. - Medicare Fraud: Successful 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.
Result: No civil or criminal liability. - Medicare Fraud: Successful defense of physicians accused of civil and criminal Medicare fraud by the Department of Health and Human Services and the Office of Inspector General.
Result: No civil or criminal liability. - Medicare Fraud: Successful defense of nationally operating healthcare company against an investigation by the Department of Defense.
Result: No civil or criminal liability. - Medicare Fraud: Successful defense of healthcare marketing company against an investigation by the Office of Inspector General.
Result: No civil or criminal liability. - Medicare Fraud: Successful defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
Result: No civil or criminal liability. - Tricare Fraud: Successful defense of physician owned entity against an investigation by the Department of Health and Human Services.
Result: No civil or criminal liability. - Tricare Fraud: Successful defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
Result: No civil or criminal liability. - Stark Law: Successful defense of a physician owned entity against an investigation by the Department of Justice.
Result: No civil or criminal liability. - Stark Law: Successful 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. - Stark Law: Successful 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. - Stark Law: Successful defense of a physician owned entity against an investigation by various branches of the federal government.
Result: No civil or criminal liability. - Stark Law: Successful defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
Result: No civil or criminal liability. - False Claims Act: Successful defense of a physician owned entity against an investigation by the Department of Defense.
Result: No civil or criminal liability. - False Claims Act: Successful defense of a physician owned entity against an investigation by the Department of Justice.
Result: No civil or criminal liability. - False Claims Act: Successful defense of physician owned entity against an investigation by the Department of Health and Human Services.
Result: No civil or criminal liability. - False Claims Act: Successful defense of a healthcare management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services.
Result: No civil or criminal liability. - False Claims Act: Successful defense of nationally operating laboratory against an investigation by the Office of Inspector General.
Result: No civil or criminal liability.
The Miami Medicare fraud defense lawyers at Oberheiden, P.C. can be reached directly by completing our contact form, or by calling (305) 928-8505 to get more information.
Additional Pages for Miami, Florida
- Miami corporate compliance
- Miami corporate investigations
- Miami False Claims Act & Qui Tam defense
- Miami federal criminal defense
- Miami healthcare fraud defense
- Miami hospice & home health fraud defense
- Miami hospital compliance and audits
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- Miami pharmacy compliance and audits
- Miami white collar criminal defense
