Health Care Fraud Defense
Table of Contents
- Our Federal Defense Lawyers Represent Clients in Federal Health Care Fraud Cases Nationwide
- Why to Choose Oberheiden, P.C. for Federal Health Care Fraud Defense
- Cases We Handle
- Proven Results at All Stages of Federal Health Care Fraud Prosecution
- Potential Consequences of a Federal Health Care Fraud Audit or Investigation
- Speak with a Federal Health Care Fraud Defense Lawyer at Oberheiden, P.C.
Our Federal Defense Lawyers Represent Clients in Federal Health Care Fraud Cases Nationwide – Including all CMS, DEA, DOJ, and OIG Matters
Regardless of your role within the health care industry, facing federal fraud allegations is an extremely serious matter. If federal agents are targeting your business or practice based upon allegations of Medicare, Medicaid, Tricare, or Department of Labor (DOL) fraud, failing to defend yourself effectively could result in exposure to significant civil or criminal penalties.
Federal health care fraud allegations can take a variety of different forms, and federal prosecutors can pursue civil and criminal charges under a multitude of federal statutes. As a result, when facing a federal health care fraud investigation, a critical early step is to determine the scope and nature of the allegations against you. Are you being accused of overbilling Medicaid or Tricare? Are you being accused of using Medicare-reimbursed funds to pay “kickbacks” or referral fees? Are you being accused of improperly prescribing, dispensing, or billing for opioid medications? Until you know why you are being targeted, you simply have no way of asserting an effective defense.
At Oberheiden, P.C., a significant portion of our practice is devoted to defending clients in federal health care fraud matters. When you engage our federal defense team to represent you, our attorneys will work to quickly get to the bottom of the government’s investigation. To find out why you are being targeted and what penalties are on the table, call 888-519-4897 for a free and confidential case assessment from one of our senior health care fraud defense lawyers.
Your Health Care Fraud Defense Team
Why to Choose Oberheiden, P.C. for Federal Health Care Fraud Defense
Our firm is comprised entirely of attorneys who are highly-experienced in federal civil and criminal matters, and many of our attorneys have well over a decade of experience in federal health care fraud defense. This includes founding attorney Dr. Nick Oberheiden, who is recognized nationwide for his results in civil and criminal health care fraud investigations, as well as several former senior prosecutors and trial attorneys with the U.S. Department of Justice (DOJ).
With centuries of combined experience in high-level federal matters, including more than 70 years of experience as DOJ prosecutors and trial lawyers, our attorneys have handled federal health care fraud cases involving all relevant federal agencies. This includes assisting in and defending against investigations and prosecutions conducted by the Department of Justice, Centers for Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS), and other agencies ranging from the Federal Bureau of Investigation (FBI) to the Internal Revenue Service (IRS). Our attorneys have been on both sides of cases involving all relevant statutes and sources of regulatory authority, and we have avoided charges and won trials in cases involving virtually all health care fraud allegations prosecuted under federal law.
If you or your business or practice is being targeted by federal authorities, this is the type of experience you need on your side. You need attorneys who can not only level the playing field, but who can tip the scales in your favor. With our attorneys’ vast federal defense experience and in-depth knowledge of the legal and medical principles involved in federal health care fraud investigations, we have become go-to defense counsel for health care providers and medical industry businesses across the country.
This is Why You Are in Good Hands
When you choose Oberheiden, P.C. for your federal health care fraud matter:
- We will begin working on your defense immediately. With our attorneys’ experience representing health care providers and medical industry businesses across the country, we have cultivated a body of knowledge that allows us to get to work on our clients’ cases immediately. Unlike other firms, we do not need time to get up to speed on the legal and medical issues involved.
- We will work diligently to secure an efficient and discrete resolution. In today’s world, even unproven allegations can have devastating consequences for a business or practice. Our attorneys understand these types of concerns, and we will work to secure a discrete and favorable outcome as efficiently as possible.
- We will promptly assess your risk. By immediately intervening in the government’s investigation, we can quickly discern the allegations against you, including the volume of these allegations and whether they are civil or criminal in nature.
- We will be fully prepared if your case goes to trial. If your only option is to go to court, we will be fully prepared to represent you at trial when the time comes. Our attorneys have handled hundreds of civil and criminal trials in federal jurisdictions nationwide
- We will help you and your team make informed decisions. When facing a federal health care fraud investigation, there are several critical mistakes you need to avoid. Our attorneys will walk you through everything you need to know and train your staff so that you can effectively aid in your defense.
More about Our Federal Health Care Fraud Defense Practice
Cases We Handle
We represent individuals and businesses in civil and criminal health care fraud matters nationwide. This includes representing licensed professionals, practice and business owners, facility administrators, clinics, laboratories, hospitals, hospices, home health agencies, and other clients in audits, investigations, and prosecutions in all 50 states. With a significant portion of our practice devoted to federal health care fraud defense, we routinely represent clients facing allegations such as:
- Overbilling Medicare, Medicaid, Tricare, or the DOL
- Improperly prescribing, dispensing, or diverting opioid medications
- Billing for services not provided (so-called “phantom billing”)
- Improper practices related to physician certifications or patient election statements
- Billing for services that were not medically-necessary
- Falsifying patient records or test results
- Double-billing federal benefit programs and/or a private health insurer
- Offering or accepting illegal kickbacks, bribes, or referral fees
- Billing and coding violations (including “upcoding” and “unbundling”)
- Attempt or conspiracy to commit health care fraud
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Proven Results at All Stages of Federal Health Care Fraud Prosecution
If you have been contacted by federal agents or auditors working with CMS, it is important that you seek legal representation promptly. While going to trial on federal charges is a very real possibility, it is also possible that you could resolve your case short of trial – and potentially without charges ever being filed. In fact, we have resolved the vast majority of our clients’ cases at the investigative stage; and, to date, we have avoided prosecution in every False Claims Act investigation we have handled.
1. Fee-For-Service Contractor Audits (MAC, RAC, ZPIC)
Fee-for-service contractors working with CMS audit Medicare-participating health care providers on a regular basis. Unfortunately, these auditors have a financial incentive to find violations, and they often lack the up-to-date and in-depth knowledge required in order to accurately assess providers’ compliance with the Medicare billing regulations. We regularly represent providers in audits and appeals involving Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), and other CMS fee-for-service audit contractors.
2. Federal Investigations
Federal health care fraud investigations can be civil or criminal in nature, and they can involve agents from CMS, DEA, DOJ, FBI, IRS, OIG, and various other agencies and task forces. The majority of our federal heath care fraud defense practice involves representing clients at the investigative stage, and we have protected the majority of our clients against any civil or criminal liability.
3. Grand Jury Proceedings
If you have been served with a grand jury subpoena, you do not have any time to waste. Federal prosecutors are pursing criminal charges, and an indictment will put your case on the path toward trial. We have extensive experience representing clients in federal grand jury proceedings, from challenging subpoenas to providing advice and representation in the courthouse.
4. Pre-Trial Practice and Plea Deal Negotiations
Once an indictment or civil charges have been issued, there will still be a significant amount of time before your case goes to trial. While many firms use this time exclusively for trial preparation, we use it as an opportunity to continue to fight for a favorable pre-trial resolution. From having indictments dismissed to negotiating plea deals that protect our clients’ practices and keep them out of prison, we utilize a variety of aggressive pre-trial defense strategies to protect our clients from the possibility of a “guilty” verdict at trial.
5. Trials and Sentencing
At the federal level, trial on the merits and sentencing are separate proceedings. Each requires a different approach, and our attorneys have extensive experience on both sides of federal health care fraud trials. We can use this experience to protect you, whether that means convincing the jury that the government has not met its burden of proof or arguing for a sentence below what is called for under the Federal Sentencing Guidelines.
6. Appeals
In addition to handling civil and criminal health care fraud cases at the trial level, we also represent clients on appeal. Our defense team includes highly-experienced appellate attorneys who are licensed to practice before multiple U.S. Circuit Courts of Appeal.
Potential Consequences of a Federal Health Care Fraud Audit or Investigation
The potential consequences of a federal health care fraud audit or investigation vary depending upon the type of fraud alleged and the number of violations of which you are being accused. In all cases, however, the consequences can be severe, and some practitioners and business owners will face business-threatening and life-altering consequences as a result of the government’s inquiry. Depending on the circumstances involved, the consequences of being targeted for health care fraud can include:
- Recoupments – Providers and businesses accused of overbilling Medicare, Medicaid, Tricare, or the DOL will be required to repay all overbilled amounts and may be subjected to pre-payment review going forward.
- Program Exclusion – Civil and criminal health care fraud violations can result in exclusion from Medicare, Medicaid, Tricare, and DOL program participation.
- Treble (Triple) Damages – In addition to recoupments, providers and businesses will also generally be required to pay treble damages, or three times the government’s actual losses.
- Licensing and/or Registration Consequences – Health care fraud offenses can result in loss of DEA registration and trigger disciplinary action by state licensing boards.
- Civil or Criminal Fines – Civil and criminal health care fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
- Federal Imprisonment – In criminal health care fraud cases, practitioners and business owners can face the potential for years, or even decades, of federal imprisonment.
- Civil or Criminal Fines – Civil and criminal health care fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
- Costs and Attorneys’ Fees – Providers and businesses found guilty of health care fraud may also be required to pay the government’s cost of prosecution.
Speak with a Federal Health Care Fraud Defense Lawyer at Oberheiden, P.C.
If you are being targeted by federal authorities, contact us for your free and confidential initial case assessment. To speak with a member of our federal health care fraud defense team as soon as possible, call 888-519-4897 or tell us how to reach you online now.
Related Compliance Pages
Click Here to view the list
- Administrative Complaints and Hearings
- Billing Fraud
- Civil Investigative Demands
- Defending Anti-Kickback Charges
- Drug Diversion
- False Claims Act / Whistleblower
- Is My DME Business Safe?
- MAC Audits
- Medicaid Audits
- Medical Board Hearings
- Medical License Defense Attorney
- RAC Audits
- Substance Abuse Defense
- Telemedicine Compliance
- The 5 Pitfalls of Home Health Care
- What Are the Penalties in Federal Workers’ Compensation Healthcare Fraud Cases?
- Why Me: What Should I Do in a Healthcare Audit?
- ZPIC Audit Defense Lawyers
- Medicare Fraud
- Home Health Agency (HHA) Fraud Defense
- Hospice Care Fraud Defense
- What is Health Care Fraud?
- What is Tricare Fraud?
- Reporting Pharmaceutical Fraud
- Government Health Care Investigation Lawyers
- DOL Investigations
- Defending Health Care Fraud Allegations During a Divorce
Potential Consequences of a Federal Health Care Fraud Audit or Investigation
The potential consequences of a federal health care fraud audit or investigation vary depending upon the type of fraud alleged and the number of violations of which you are being accused. In all cases, however, the consequences can be severe, and some practitioners and business owners will face business-threatening and life-altering consequences as a result of the government’s inquiry. Depending on the circumstances involved, the consequences of being targeted for health care fraud can include:
- Recoupments – Providers and businesses accused of overbilling Medicare, Medicaid, Tricare, or the DOL will be required to repay all overbilled amounts and may be subjected to pre-payment review going forward.
- Program Exclusion – Civil and criminal health care fraud violations can result in exclusion from Medicare, Medicaid, Tricare, and DOL program participation.
- Treble (Triple) Damages – In addition to recoupments, providers and businesses will also generally be required to pay treble damages, or three times the government’s actual losses.
- Licensing and/or Registration Consequences – Health care fraud offenses can result in loss of DEA registration and trigger disciplinary action by state licensing boards.
- Civil or Criminal Fines – Civil and criminal health care fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
- Federal Imprisonment – In criminal health care fraud cases, practitioners and business owners can face the potential for years, or even decades, of federal imprisonment.
- Civil or Criminal Fines – Civil and criminal health care fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
- Costs and Attorneys’ Fees – Providers and businesses found guilty of health care fraud may also be required to pay the government’s cost of prosecution.
