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Defending Health Care Fraud Allegations During a Divorce

It has become far from unusual for disgruntled spouses to turn a personal divorce matter into an escalated gambit of threatened criminal charges. Because physicians and health care business owners are particularly vulnerable for working in a heavily regulated and strictly enforced environment, threats of reporting health care violations— to potentially gain an advantage in the underlying custody and property dispute— must be taken extremely seriously.

The Oberheiden & McMurrey, LLP protects health care professionals. Our attorneys are former Department of Justice prosecutors, who previously supervised civil and criminal health care fraud investigations at the U.S. Attorney’s Office. From that experience we know how quickly a bullying remark can attract law enforcement attention. Our attorneys not just have the experience to defend against actual prosecution, but, more importantly, we know how to avoid criminal charges in the first place.

What Types of Threats Are Made During a Contested Divorce?

While the imagination of estranged spouses appears to be endless, in most cases that we are asked to intervene we observe the following reoccurring scare tactics.

  • Kickback Accusations
  • Prescription Abuse & Addiction
  • Medicare & Medicaid Fraud
  • Workers’ Compensation
  • Submitting False or Fictitious Claims
  • Overbilling
  • Lack of Supervision
  • HIPAA Violations
  • Defrauding Private Health Insurance Programs

To enhance the threat, it is popular to drag long-time friends, business partners, and even clients and patients into the family situation. Goal here is to frustrate and embarrass the other spouse and to ultimately achieve favorable settlement terms in the divorce.

  • Taking the Deposition of Business Partners
  • Taking the Deposition of Long-Time Friends
  • Taking the Deposition of the Office Manager
  • Calling Friends to the Stand
  • Introducing Financial Documents in Court
  • Hiring Malpractice Attorneys
  • Filing a Complaint with the Medical Board
  • Filing Criminal Charges

Our attorneys approach such blackmailing with a vigorous and relentless response.

What Happens During a Health Care Fraud Investigation?

Health care fraud is investigated by various federal agencies that include the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), and the Federal Bureau of Investigation (FBI). Although many investigations originate from the investigative work of specialized law enforcement agents, it is not uncommon for the government to pursue alleged legal violations based on private complaints.

Once misconduct has been reported, agents will start their investigation by conducting background information checks, interviewing former employees and other people with potential knowledge of the misconduct. Following these interviews, agents often confront the alleged perpetrator by suddenly showing up at a home, place of business, or medical practice.

It is critical to immediately consult with experienced health care fraud attorneys the moment you become aware of a threat or an actual investigation. Time is of the essence. The more time the government or a licensing board have to believe that you did something wrong, the more time you lose to build an effective defense strategy.

Until recently, Oberheiden & McMurrey, LLP attorney Lynette Byrd served the Department of Justice as a federal prosecutor in charge of civil and criminal health care investigations. Please do not hesitate to call these senior attorneys directly, also on weekends, especially if your case is an emergency. All calls are free and confidential.

Mistakes to Avoid

  • Do not underestimate the threat. Error on the side of caution. In highly emotional situations like a divorce or a separation, people sometimes display their darkest personality traits and are willing to do whatever it takes to prevail, to take revenge, and to hurt the former partner. Take the threat seriously. Develop a comprehensive defense strategy with an experienced attorney to master the situation.
  • Do not engage in discussions with your spouse. Obviously, your spouse is angry and willing to ruin your life. You should not expect a meaningful, constructive conversation, but malice and hostility. Also keep in mind that it is legal in many states to secretly record conversations and to hand over such recordings to the FBI and other law enforcement agencies.
  • Do not text or email your former spouse. Emotional and inappropriate responses and self-incriminations will hurt you later in court.
  • Do not have a family lawyer handle the prospects of a federal felony charge. Family lawyers are trained to handle property and child possession issues. They don’t deal with FBI agents on a daily basis and your case should not turn into an experiment for them. By contrast, experienced criminal defense attorneys understand how exactly the U.S. Attorney’s Office builds a criminal case and what to do against it.
  • Do not defend yourself. Health care violations constitute serious offenses that can ruin your career if not handled properly. Just like a lawyer should not set medical diagnoses or conduct surgeries, a physician or business owner should not play criminal defense attorney.
  • Do not waste time. Do not allow the government or a professional board time to build a case against you. When facing threats and exposure it is of cardinal importance to intervene instantly and aggressively before you find yourself in the role of an actual defendant.
  • Do not talk to federal agents or other government representatives in the absence of experienced criminal defense attorneys. When agents approach you, you are under an obligation to provide your name and to identify yourself. However, insisting on your criminal defense attorney’s presence is your constitutional right and doing so will not be construed against you and it does not make you appear “guilty.”
  • Do not believe investigators when they say that they just have a few simple questions or when they claim that the investigation is not about you. Law enforcement personnel use the moment of surprise and shock when they suddenly appear at your house or business without prior announcement. Agents are trained to make you feel “safe” and “chatty” to get information from you, including self-incriminating statements that they will later present at trial.
  • Do not lie to the government. While federal agents, for example, are allowed to lie to and mislead you, anyone lying to law enforcement may result in felony charges, see 18 U.S.C. Section 1001. Again, provide your name, but insist on having an experienced criminal defense attorney present in any interview, whether on the phone or in person.

The attorneys of Oberheiden & McMurrey, LLP have the experience necessary to handle government investigations. Our team includes numerous attorneys who previously prosecuted health care fraud on behalf of the government and now offer their insights and experience to the clients of Oberheiden & McMurrey, LLP.

What Are the Penalties of Health Care Fraud?

Here is the bad news. Health care fraud is a serious offense. If found guilty, penalties range from program exclusion to years of incarceration. The general health care fraud statute at 18 U.S.C. Section 1347 sanctions misconduct with up to 10 years imprisonment for each count of health care fraud as defined in that statute and up to 20 years imprisonment if the fraud resulted in a serious bodily injury (e.g. in a prescription scheme). It is important to understand that the U.S. Attorney’s Office has a plethora of choices to criminally prosecute health care providers and business owners for non-compliance with private insurance programs and HIPAA violations.

Effective and Proven Defense Strategies

Here is the good news. Oberheiden & McMurrey, LLP has the combined experience of more than a 1,000 health care fraud investigations and we have a track record that demonstrates our success of avoiding criminal charges. From our specific backgrounds we know that nothing is more important in a health care fraud scenario than to intervene early and to take control before the threat turns into an actual charge and the situation gets out of control.

Clients that approach us in the context of a divorce will receive answers to the following questions: Is the threat to be taken seriously? What would happen if the complaint is filed? What are the steps of an investigation? Which government agency would pick up the case? Who would make the decision whether or not to pursue the case and how can that decision be influenced by experienced attorneys? Is there an investigation already pending? Is an arrest warrant out against me? Is it likely that law enforcement agents will come to my house or my place of work? What is my exposure?

We believe that an effective defense requires two features: Profound familiarity with pertinent health care rules, regulations, billing codes, and certification requirements as well as superb negotiation and trial expertise to educate and convince the government (and possibly also the court) that the conduct in question did not occur or did not violate the law. Oberheiden & McMurrey, LLP has a long history of successfully resolving health care fraud matters by convincing the decision-makers that the purported facts are not what they seem to be.

Call Oberheiden & McMurrey, LLP today to discuss your situations with our experienced attorneys. All initial consultations are free and confidential. You can call us directly or complete our contact form or contact us by sending an email.

These Attorneys Will Protect You

Oberheiden & McMurrey, LLP has the specific experience to deal with accusations of Medicare and Medicaid Fraud, Tricare Fraud, DOL Fraud, Anti-Kickback, the False Claims Act, and Stark Law violations. Our clients are represented by experienced attorneys with a proven track record of successfully resolving complex health care law matters.

Nick OberheidenDr. Nick Oberheiden has successfully defended physicians, lawyers, and business owners in countless federal criminal proceedings. Dr. Oberheiden appears on behalf of his clients before the Department of Justice, the IRS, the FBI, the DEA, and other law enforcement agencies with a view towards resolving allegations by providing convincing clarifications and explanations.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). At the Department of Justice, Ms. Byrd represented the interests of the United States in health care prosecutions involving the FBI, the DEA, the IRS, and other law enforcement agencies.

If your business, your license, and your livelihood are on the line, you should not hesitate to consult with an experienced defense attorney with a proven track record today. Consultations are free and confidential.

Our Success Stories

Oberheiden & McMurrey, LLP represents clients across the United States to protect them against actual, threatened, or assumed investigations by the Department of Justice (DOJ), the Department of Defense (DOD), the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the Office of Inspector General (OIG), the Medicaid Fraud Control Unit (MFCU), the Internal Revenue Service (IRS), and other task forces. Here are some representative outcomes.

  • Spouse threatened to file health care fraud charges with the FBI against our client. Spouse further announced to inform all business partners and colleagues of our client about the alleged misconduct via mass e-mail.
    Result: We aggressively intervened and forced the blackmailing spouse to sign a sworn statement that established that all accusations were bogus. Per our client’s request, we did not pursue criminal charges against the blackmailing spouse, but we did help our client to settle the family case favorably.
  • Spouse threatened to file complaint with CMS and the Office of Inspector General to have physician be removed from accepted provider list to gain advantages in the marital property distribution.
    Result: We avoided the filing of a complaint and we obtained a restraining order against the ex-spouse and settled the complex, long-lasting family case within days.
  • Spouse threatened to expose doctor with alleged illegal billing and health care fraud in family court to gain an advantage in the couple’s custody battle.
    Result: We intervened. We conducted an internal audit at the doctor’s clinic, established a compliance program, and offered our expert testimony about alleged health care fraud violations in family court. We convinced the attorneys of our client’s ex-spouse to settle the family case expressly acknowledging that no misconduct did occur.
  • Spouse filed a complaint with the Medical Board and the DEA for alleged prescription fraud and abuse.
    Result: We intervened. We clarified the situation and both investigations against our client stopped immediately.
  • Successful defense of our physician client against an investigation by the Office of Inspector General and the FBI for alleged Medicare fraud.
    Result: We convinced the government to end the investigation without filing any charges.
  • Successful defense of our physician client against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: We convinced the government to end the investigation without filing any charges.
  • Successful defense of our physician client against an investigation by the Office of Inspector General and the Department of Justice for alleged Medicaid fraud.
    Result: We convinced the government to end the investigation without filing any charges.
  • Successful defense of a health care business owner against an investigation by the U.S. Attorney’s Office and the Office of Inspector General for alleged Tricare fraud.
    Result: We convinced the government to end the investigation without filing any charges.
  • Successful defense of a health care business against an investigation by the Office of Inspector General and the FBI for alleged violations of the False Claims Act.
    Result: We convinced the government to end the investigation without filing any charges.
  • Successful defense of a health care business against an investigation by the Office of Inspector General and the FBI for alleged health care fraud.
    Result: We convinced the government to end the investigation without filing any charges.

Free Consultation

If you have reason to believe that a threat of a complaint or an actual investigation is pending against you, you should call Oberheiden & McMurrey, LLP today to speak directly with one of our experienced attorneys.  Our attorneys are available seven days a week, including on weekends, to discuss your situation.  All consultations are free and confidential.

Oberheiden & McMurrey, LLP
Litigation – Compliance – Defense
(800) 810-0259
(214) 469-9009
www.federal-lawyer.com

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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