Hospice Care Fraud Defense
Hospice Care Fraud Defense Attorneys Serving Healthcare Professionals Across the US
Since 2015, the U.S. government has intensified its fraud investigations of hospice services. As a consequence, hospice providers find themselves increasingly accused of criminal misconduct and exposed to civil liabilities. The government believes that many hospice providers are committing healthcare fraud by billing for unnecessary services to the dying. Because hospice fraud is prosecuted as a federal felony, the mere accusation of someone’s involvement in a fraud scheme means the threat of years in prison.
Clearly, the last thing you want is the government to brand you as a criminal or to impose a civil liability that causes you to lose the business you have created. Our team of former federal prosecutors and experienced hospice care fraud defense lawyers want to fight for your innocence. Call us today at 888-680-1745 today and speak with a former federal prosecutor at no charge to you.
Put our highly experienced team on your side
Our “Emergency Defense Package”
Clients in need have no time to waste. Our “Emergency Defense Package” has been featured in news and media across the country as a tool to provide immediate help to clients under government investigation. The “Emergency Defense Package” is a proven protocol that has been developed over years that will address your most pressing questions, such as:
- Is the investigation civil or criminal?
- Should I talk to the government?
- Do I have a duty to talk to federal agents?
- What should I tell my employees?
- Can I continue my business?
- What happens next in my case?
The “Emergency Defense Package” has been developed by experienced counsel and former government officials and is designed to provide instant assistance 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 to find out how our “Emergency Defense Package” will make a difference in your case.
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
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)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
Free Consultation
Oberheiden, P.C. has successfully assisted clients in healthcare fraud cases across the country from San Francisco to Washington D.C., San Antonio, Austin, Dallas, Houston, Georgia, New Mexico, and Oklahoma, to name just a few of our practice centers. Call us today and benefit from our experience and industry knowledge in a free and confidential consultation with our former federal prosecutors and experienced defense counsel.
What Constitutes Hospice Fraud in Texas?
Hospice 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. As noted, almost every for-profit hospice company in the country has been or will be accused of fraud at some point.
- Booming Business. The government has been increasingly executing criminal search warrants in connection with hospice care in the last few years. Largely, this increased prosecution is due to the realization that more than half of all Medicare patients die while they are in hospice, either in-patient or in their own homes. In the past ten years, almost every for-profit hospice in the country has faced government fraud charges.
- Example: In 2015, a federal appeals court affirmed a fifteen-year prison sentence and $16.2 million restitution order for a home hospice owner who was found guilty of paying doctors and nurses to fake patient records and for paying for referrals.
- Certification Errors. Obviously, falsified records and kickbacks are often raised as reasons for indictments in all types of healthcare fraud. However, the most common fraud charges relating to hospice care center on the Medicare rule that hospice care is only available if a physician has certified that the patient has six months or fewer to live. Lack of such certification, the falsification of certifications, or failure to discharge such patients in a timely fashion if their condition and life expectancy improves form the basis of these fraud charges.
- Unnecessary Services. In addition, the federal government will often file fraud charges on the basis that medication has been ordered that is not for pain or symptom relief, but rather to treat the underlying condition. For a patient to properly receive hospice care, he or she has to agree to stop treating their condition and accept only palliative care. Similarly, the government may file charges based on a claim that the provider has ordered unnecessary or redundant medical equipment, such as wheelchairs or walkers. Often, such cases may be investigated based on nothing more than data analytics noting that certain hospices are outliers in the area of cap repayments, live discharges, elevated levels of care, length of stay, or use of particular diagnostic codes.
What Are the Penalties?
The possibility of being held accountable for Medicare, Medicaid, Tricare, and other healthcare fraud because of your hospice practice, should caution you to invest your time and resources intelligently into a strategic and thoughtful defense plan.
Hospice 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 Healthcare 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 healthcare 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.
A Team You Can Trust
The hospice care fraud defense attorneys of Oberheiden, P.C. have successfully defended clients against Medicare Fraud, Medicaid Fraud, Tricare Fraud, Anti-Kickback, and False Claims Act accusations and concluded a large number of healthcare fraud cases with no civil or criminal liability on behalf of their clients. See for yourself, our healthcare defense track record is impeccable.
We are a team of former federal prosecutors and experienced defense attorneys that are committed and dedicated to assist you when you need help. We have helped nurses, physicians, business owners, hospitals, laboratories, pharmacies in healthcare investigations across the country.
This Is How We Defend Hospice Fraud
When you hire the attorneys and former government officials of Oberheiden, P.C., you will notice that we know your industry and we know exactly how the government builds its case.
- Industry Knowledge. Because hospice fraud charges may often stem 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 business. You need attorneys that understand billing and coding violations. Our attorneys have analyzed, reviewed, and defended close to 500,000 billed claims. Similarly, if you are accused of certification errors, you need lawyers that understand the legal requirements of hospice certifications to get your case dismissed.
- Government Experience. The difference between liability and human error is often a fine line that requires convincing negotiation skills and attention to details. The lawyers and former government officials of Oberheiden, P.C. have proven healthcare and law enforcement experience. Our attorneys have extensive knowledge and competence in handling any fraud allegations in the healthcare industry. See for yourself, and look at our track record.
- Civil, not Criminal. We want to keep investigations civil, not criminal. In many instances, 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?
A very important question is whether the government investigation is civil or criminal: Is the government seeking monetary remedies or is the government seeking criminal indictments and imprisonment? Healthcare fraud statutes offer both options, making the issue of civil versus criminal a critical threshold question. Approximately 1,500 individuals are indicted in federal court for healthcare fraud each year and more than 2,500 individuals are under Medicare criminal investigation.
How do we know? 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 carefully analyze the way our clients had been notified about the investigation; we draw conclusions from which agent and which federal agency contacted our clients; and we evaluate which government official is in charge of the investigation with the understanding that the government employs so-called civil and criminal lawyers. That said, the mere involvement of a prosecutor or a federal agency does not suggest that your case is automatically a criminal investigation.
Call us today to discuss your case with our attorneys. All initial consultations are free and confidential. Let us handle your case.
Our Track Record
- 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. - Investigation by the Department of Health and Human Services and the Office of Inspector General for alleged Healthcare Fraud.
Result: No civil or criminal liability, case dismissed. - Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act violations.
Result: No civil or criminal liability, case dismissed. - Investigation by the Department of Defense for alleged Tricare fraud.
Result: No civil or criminal liability, case dismissed. - Investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
Result: No civil or criminal liability, case dismissed. - Investigation by the Department of Health and Human Services for alleged Medicare Fraud.
Result: No civil or criminal liability, case dismissed. - Investigation by the Office of Inspector General for alleged healthcare fraud.
Result: No civil or criminal liability, case dismissed. - Investigation by the Office of Inspector General for alleged False Claims Act violations.
Result: No civil or criminal liability, case dismissed. - 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. - Investigation by the Department of Defense for alleged Tricare fraud.
Result: No civil or criminal liability, case dismissed. - Investigation by the Department of Justice for alleged Medicare Fraud.
Result: No civil or criminal liability, case dismissed. - Investigation by the Department of Health and Human Services for alleged Stark Law violations.
Result: No civil or criminal liability, case dismissed. - 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.
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