Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense Lawyers

When you are under investigation for phantom billing or up-coding, or accused of billing medically unnecessary services, you do not have time to introduce your lawyer to the world of billing, coding, and medical necessity. You must expect your attorneys to know every nuance and detail of your industry so that the focus in times of crisis can immediately switch to strategic defense.

Medicare fraud constitutes a federal felony and monetary liabilities can be enormous. The possibility of being held accountable for Medicare, Medicaid, Tricare, and other health care fraud, should caution you to invest your time and resources intelligently into a strategic and thoughtful defense plan. Clearly, the last thing you want is the government to brand you as a criminal or to impose civil liability that causes you to lose the business you’ve created. See our track record for yourself and discuss with us how to keep your record clean.

A Medicare Fraud Defense Team You Can Trust

The attorneys of the Oberheiden & McMurrey, LLP have successfully defended physicians, practice owners, physician owned entities, toxicology laboratories, pharmacies, service management organizations, health care marketing companies, and many others in False Claims Act, qui tam lawsuits, Stark Law, Anti-Kickback, Medicare, Medicaid, Tricare, and DOL investigations. See for yourself; our health care investigation track record is impeccable.

Each member of our Health Care Practice Group has handled at least one hundred (100) health care matters. Moreover, Lynette S. Byrd is a former federal prosecutor who prosecuted some of the largest health care cases in the district during her tenure with the U.S. Attorney’s Office and the Department of Justice. Lynette’s insights of the protocols, decision-making, and how the Office of Inspector General and others proceed in health care investigations are extremely valuable to determine the right defense. Ms. Byrd and attorney Dr. Nick Oberheiden will exclusively handle your defense. No junior lawyer or paralegal will work on your case.

Free Consultation

Oberheiden & McMurrey, LLP is headquartered in Dallas, Texas, and it assists clients in investigations nationwide. When you call us we will inform you how our Emergency Defense Package will apply to your case. The Emergency Defense Package has been developed by experienced counsel over years and is designed to provide instant relief to targets of investigations. The Emergency Defense Package contains several proven steps to take over control and not be jostled by the government. Call us today and benefit from our experience and industry knowledge.

What Constitutes Medicare Fraud?

Medicare fraud refers to the submission of false or fictitious claims to a governmental health care program. According to government statistics, claims of approximately $ 50 billion per year are considered suspicious and subject to Medicare fraud investigation. Thus, no matter how well you think you have organized your practice and operations, the chances of being audited by Medicare eventually are real, especially if your practice is successful and you submit high volume claims to the Centers for Medicare and Medicaid Services (CMS). In particular, the following statutes form the basis for Medicare investigations:


False Claims Act

Knowingly submitting false statements or making misrepresentations of fact to obtain a federal health care payment to which the health care provider is not entitled, e.g. a laboratory submits claims to Medicare for a higher level of services than actually provided. See, 31 U.S.C. Sect. 3729-3733. For the criminal component of the False Claims Act, see 18 U.S.C. Sect. 287.

Stark Law (Self-Referrals)

Making prohibited referrals for certain designated health services to an entity in which the physician or the physician’s immediate family has an ownership or financial interest or compensation arrangement, e.g. a surgeon refers business to an MRI clinic that his wife owns. See, 42 U.S.C. Sect. 1395nn. For safe harbor exceptions, see 42 C.F.R. Sect. 1001.952.

Anti-Kickback Statute

Knowingly soliciting, paying, and/or accepting any form of remuneration to induce or reward referrals for items or services reimbursed by federal health care programs, e.g. an arrangement that is not covered by regulatory safe harbors and whereby cash or other benefits are offered or exchanged for referrals. See, 42 U.S.C. 1320A-7b(b).

Civil Monetary Penalties Law

Examples for civil monetary penalties to arise are presenting a claim that the claimant knew or should have known is for an item or service not provided as claimed or that is false and fraudulent; presenting a claim that the claimant knew or should have known is for an item or service that is not reimbursable by Medicare; or any violation of the Anti-Kickback Statute.

Civil monetary penalties authorize the government to charge up to $ 50,000 per each false claim plus up to three times the amount claimed for each item or service, or up to three times the amount of remuneration offered, solicited, paid, or received. See, 42 U.S.C. Sect. 1320a-7a


Criminal Fraud Statute

Whoever knowingly or willfully executes or attempts to execute a scheme to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program in connection with the delivery of or payment for health care benefits, items, or services, shall be fined or imprisoned of up to 10 years, or both. See 18 U.S.C. Sect. 1347.

Health care fraud applies not only to health care providers, but instead to “anyone,” including physicians, nurses, practice managers, non-licensed individuals, practice owners, health care businesses, and even institutions.


What are the Penalties?

Medicare fraud is investigated by the Office of Inspector General (OIG), the Department for Health and Human Services (HHS), the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), Medicaid Fraud Control Units (MFCUs), and State Medicaid Agencies in cooperation with the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the General Services Administration (GSA), and the Centers for Medicare and Medicaid Services (CMS).

If found guilty, targets of investigations may be exposed to recoupment requests, non-payment of future claims, civil fines of up to $ 11,000 per false claim, exclusion from federal health care programs, treble damages, attorney fees, criminal fines, criminal indictment, or incarceration in a federal prison.

Liability does not require a specific intent to violate the law; in fact, the government does not even need to prove actual knowledge of the wrongfulness of the transaction.

This is How We Defend Medicare Fraud

When you hire the medicare fraud defense attorneys and former government officials of Oberheiden & McMurrey, LLP, you will notice that we concentrate our defense against False Claims Act, Stark Law, Anti-Kickback violations, and fraud charges by focusing on three core abilities.

Industry Knowledge. We have industry knowledge. Because Medicare fraud often stems from billing and coding errors, intrinsic understanding of CMS protocols is critical. Don’t let misinterpretations of coding policies or missed updates to billing changes expose your practice. You need attorneys that understand billing and coding violations. Our health care fraud defense attorneys have analyzed, reviewed, and defended close to 500,000 billed claims. Similarly, if you are accused of Stark Law violations, you need medicare fraud defense lawyers that understand the safe harbor exceptions to get your case dismissed.

Government Experience. We have government experience. The difference between liability and human error is often a fine line that requires convincing negotiation skills and attention to details. The defense lawyers and former government officials of Oberheiden & McMurrey, LLP have proven health care and law enforcement experience. Our defense attorneys have extensive knowledge and competence in handling any fraud allegations in the health care industry. See for yourself, and look at our track record.

Civil, not Criminal. We want to keep investigations civil, not criminal. Our attorneys are able to persuade the government that errors, if they exist, were not done intentionally and willfully, but by accident and human error. Doing so is critical because in each fraud investigation the government has two choices: to investigate you to seek recoupments or to prosecute and indict you and seek imprisonment. The law provides for both.

Government Investigation: Civil or Criminal?

One of the predominant questions clients ask us when they call Oberheiden & McMurrey, LLP for help is to determine if the government investigation against them is civil or criminal; that is, whether the government is seeking monetary remedies or seeking criminal indictments and imprisonment. Health care fraud statutes provide for both, making the issue of civil versus criminal a critical threshold question. About 1,400 individuals are indicted in federal court for health care fraud each year and more than 2,500 individuals are under Medicare criminal investigation.

How do we know? Often times, when we first talk to our new clients and hear their side of the story, we develop a good sense. Years of experience combined with the insight and knowledge of our former government officials allow us to catch certain details and nuances of the investigation that do not strike the general audience as relevant. For example, we pay close attention to how our clients had been notified about the investigation, by which government agency they were contacted, and which government official is in charge of the investigation. The mere involvement of a prosecutor or a federal agency does not mean that the case is a criminal investigation.

Call us today to discuss your case with our medicare fraud attorneys. All initial consultations are free and confidential. We want you to gain relief and to move on with your life. Let us handle your case.

Who Is Investigated?

Health care Fraud exposes providers and business owners alike. Statutes apply to any individual or business that directly or indirectly contracts with and is paid for services by the United States government. Particularly exposed are service arrangements with the government in the following areas:

Industries:

  • Hospitals
  • Home Health Centers
  • Physician Owned Entities
  • Health care Providers (e.g. Physicians)
  • Laboratories (toxicology, biologics)
  • Pharmacies (incl. compound)
  • Medical Device Companies

Recent Examples:

  • Medicare Fraud Strike Force charges 90 individuals
  • Medicare Fraud Strike Force charges 89 individuals
  • Doctor Admits Taking Bribes in Test-Referral Scheme with Lab
  • Owner of Nursing Agency Convicted of Multi-Million Dollar Fraud Scheme
  • Principal in $28.3m Medicare Fraud Scheme Sentenced to 11 Years in Prison


(Published by U.S. Department of Justice at http://www.stopmedicarefraud.gov/newsroom/)

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, case dismissed.
  • 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, case dismissed.
  • 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, case dismissed.
  • 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, case dismissed.
  • 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, case dismissed.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability, case dismissed.
  • 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, case dismissed.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability, case dismissed.
  • Defense of a physician owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability, case dismissed.
  • 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, case dismissed.
  • 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, case dismissed.
  • 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, case dismissed.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability, case dismissed.
  • Defense of a physician owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability, case dismissed.
  • Defense of a physician owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • 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, case dismissed.
  • 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, case dismissed.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability, case dismissed.

Medicare Appeals Process

With the complexity of the regulations that make up Medicare rules, including its appeals process, there is no substitute for having a lawyer that understands the intricacies of both the law and the Medicare programs. Many healthcare providers, however, believe they can rely on billing professionals or other groups without legal experience to file their Medicare appeals.

The fact of the matter is that filing Medicare appeals without an experienced medicare fraud attorney can lead to costly risks, mistakes, and penalties that could have been avoided with the proper understanding and knowledge of the law.

Medicare appeals take place in the following five steps:

  • Redetermination by a Centers for Medicare & Medicaid Services (CMS) contractor
  • Reconsideration by a qualified independent contractor
  • Hearing before an administrative law judge
  • Review by an appeals council
  • Judicial review in the federal district court

Each step in the Medicare appeals process requires the correct evidence, argument, and punctuality to ensure that errors are not made that affect the rest of the process. Making mistakes in one step of the process may result in significant problems.

Don’t let mistakes in the appeals process create irreparable issues for you later on. At Oberheiden & McMurrey, LLP, our medicare fraud attorneys are experienced with the Medicare appeals process and have a long track record of successfully defending clients facing Medicare fraud charges.

Who Will Handle Your Case

When you hire us, you will not work with paralegals or junior lawyers. Each lawyer in our Healthcare Practice Group has handled at least one hundred (100) matters in the healthcare industry. So, when you call, you can expect a lawyer that immediately connects with your concerns and who brings in a wealth of experience and competence. For example, you need someone like Lynette S. Byrd, a former federal prosecutor in healthcare matters, who recently left the government and who is now sharing the valuable insights she gained as a healthcare prosecutor with our clients.

Bill C. McMurrey

Bill C.
McMURREY

Dr. Nick Oberheiden

Dr. Nick
OBERHEIDEN

Lynette S. Byrd

Lynette S.
BYRD

Glenn A. Harrison

Glenn A.
HARRISON

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