New Jersey Healthcare Fraud Defense Attorneys

New Jersey/New York Office
30 Wall Street, 8th Floor
New York, NY 10005
888-680-1745
(Meeting location by appointment only)

At the Oberheiden, P.C., we work to defend our clients as New Jersey Healthcare Fraud Defense Attorneys, and throughout the tri-state area and defend them against allegations of civil or criminal healthcare fraud. The team leader is Dr. Nick Oberheiden, whose experience in defending cases of healthcare fraud is nationally known.  In the past few years, our team has represented dozens and dozens of clients in criminal investigations and cases, including:

  • Healthcare Fraud Allegations
  • Grand Jury Subpoenas
  • OIG Investigations
  • Internal Investigations
  • Compliance Programs
  • Medicare & Tricare Audits
  • Qui Tam Defense
  • Criminal Defense
  • Jury Trials
  • Asset Protection

If you have been accused of healthcare fraud or are facing a government investigation into your healthcare business, call us today to speak to one of our senior attorneys to discuss possible resolutions.  We are available seven days a week, including weekends.  All initial consultations are free and confidential. 

Healthcare Fraud Investigations in New Jersey

In the past few years, the United States government has set up specialized task forces to investigate, monitor, and prosecute Medicare Fraud aggressively in nine cities across the nation.  One of those task forces is headquartered in Brooklyn, and focuses on allegations of fraud in New Jersey.  Therefore, owners of healthcare businesses and medical services providers in the tri-state area must know that healthcare fraud prosecutions in this geographic area will occur more frequently, more publicly, and much more aggressively than in other cities and states.  Medicare Fraud investigations from the Brooklyn office are led by the Healthcare Fraud Prevention and Enforcement Action Team, a coordinated and unique group consisting of law enforcement officers and attorneys from multiple federal agencies, including the Department of Justice, the Office of the Inspector General, the Department of Health and Human Services, and the Federal Bureau of Investigation.

 

An Explanation of Healthcare Fraud

Many of our clients have the same question initially, which is, “How is healthcare fraud established by prosecutors?”  A simple answer is that healthcare fraud has been committed any time there has been an attempt, whether successful or not, to obtain money by means of a fraudulent or false representation to any government health plan, including Tricare, Department of Labor, Medicare, or Medicaid.  The most common types of healthcare fraud that are pursued by the federal government are:

  • Anti-Kickback Violations. Under the anti-kickback law, it is illegal for a person, including marketers, contractors, distributors, healthcare providers, or business owners, to receive any form of payment or remuneration in return for referring a patient to a provider or business. Note that it is illegal not only to receive cash for a referral, but also anything else having monetary value.
  • Stark Law: It is unlawful under the Stark Law for doctors to refer their patients to certain types of healthcare businesses, such as toxicology laboratories or pharmacies, that are owned in whole or in part by the physician or one of his immediate family members. The same prohibition applies to businesses in which the doctor or family member has an investment or with which the doctor has a compensation agreement.  The Stark Law does contain certain exceptions, which must be analyzed with care to ascertain their applicability to a given situation.
  • False Claims Act Violations.   Because the False Claims Act imposes liability for any misstatement of fact made to any federal agency, any billing error may lead to a prosecution under this statute, even if the error was accidental.  Unintentional errors are subject to civil penalties only, but the federal government will not hesitate to seek criminal fines and incarceration if it believes that the misstatements of fact were intentional.
  • Prescription Fraud. Recently, there has been an increased awareness of and focus on the number of Americans who have substance abuse problems, many of which are related to prescription pain medication.  For that reason, the government is hyper-focused on prescription fraud and overbilling, whether from violation of the Drug Enforcement Agency’s guidelines for dispensing medicine or commission of insurance fraud by writing prescriptions for medicine that is not medically necessary.
  • Billing Fraud. Errors in billing are one of the most common reasons for the opening of a healthcare fraud investigation.  Most such errors are caused by a misunderstanding of billing codes or human error, but they can still cause an audit or prosecution if the government becomes aware of them.  Included in billing fraud are up-coding, bundling, and unbundling, all of which are methods of manipulating the billing codes to increase reimbursement.  Other types of billing fraud include ghost patients (patients who do not exist or were never treated) and phantom billing (charging for services that were never performed).
  • Certification Errors. One of the most recent phenomena in healthcare fraud prosecution is the increased emphasis on the hospice and home healthcare industries.  Frequently, federal prosecutors focus on allegations that medical providers provide false certifications by claiming the patient is either homebound or terminally ill when this is not the case.

At Oberheiden, P.C., our record of avoiding criminal charges for our clients is unparalleled.  If you suspect or know that either you or your healthcare business is under investigation by the federal government, time is of the essence. Call and speak to one of our senior attorneys today.  All initial consultations are free and confidential.

 

Penalties for Healthcare Fraud in NJ

Given the overall rise in the cost of healthcare as well as the number of Americans who are now covered, in whole or in part, by a government health plan, the United States federal government treats healthcare fraud as a serious offense costing the taxpayers hundreds of millions of dollars per year.  Healthcare fraud carries both civil and criminal penalties, and it is up to the prosecutors to determine which type of case to bring.  Civil penalties may include fines, repayment of amounts found to be wrongfully paid, orders for non-payment of future claims, and exclusion from federal healthcare programs.  Criminal penalties are even more serious, and may include fines as well as incarceration:  up to ten years in prison for each instance of healthcare fraud, which is increased to a sentence of up to 20 years for each instance that caused serious bodily injury to the patient and up to life in prison if the patient died.  See 18 U.S.C. §1347.

What will happen to me? Given the severity of the possible penalties, it is understandable that our clients want to hear the worst-case scenario up front. Of course, every case is different, but in general, the prosecutor’s decision between a civil and criminal case will turn on factors such as motivation, intent, amount of money involved, harm to patients, and the prosecutor’s interest in the particular healthcare industry involved or the facts of the particular case.  At Oberheiden, P.C., our unique ability to offer our clients a team of former federal prosecutors and renowned healthcare fraud defense attorneys allows us to avoid criminal prosecutions for our clients as often as possible.

If you suspect or know that either you or your healthcare business is under investigation by the federal government, time is of the essence. Call and speak to one of our senior attorneys today.  All initial consultations are free and confidential.

When Is Healthcare Fraud Criminal?

Only the federal prosecutor can decide whether to bring a case civilly or criminally.  However, due to our early intervention in healthcare fraud investigations and our unique set of defense strategies, our law firm has become well-known for avoiding criminal charges for many of our clients who are targeted by healthcare fraud investigations.  If you have received notice, or even suspect, that you are being investigated for healthcare fraud, either personally or as part of a healthcare business, you need to hire an experienced healthcare fraud defense attorney as soon as possible.  Call today to speak to one of our former federal prosecutors or experienced defense attorneys today so we can develop an immediate action plan on your behalf.

In many cases, when a healthcare fraud investigation begins, the government does not clarify whether they are seeking civil or criminal penalties.  Many people are under the mistaken impression that every case filed by the U.S. Attorney or an Assistant U.S. Attorney is criminal.  In fact, the U.S. Attorney’s Office contains both civil and criminal divisions.  Both sides are staffed by federal investigators and AUSAs.  For this reason, the fact that you have received a subpoena from the Department of Justice or a phone call from an FBI agent does not indicate that a criminal prosecution is planned.  In addition, a case that starts as a civil investigation may turn into a criminal prosecution if an incorrect defense strategy is employed.

Determining whether a federal healthcare fraud case is civil or criminal may require interpretation of document requests and subpoenas, the tone of the agents who contact witnesses and targets, or the nature of the allegations made, all of which require experienced and knowledgeable attorneys.  Certain things do indicate that a prosecution is likely to be criminal in nature, including IRS action, issuance of grand jury subpoenas, target letters, search warrants, seizures of property, arrest warrants, and the involvement of criminal prosecutors.

If you need to know more about the differences between criminal and civil prosecution, call Oberheiden, P.C. today.  We represent healthcare clients ranging from complete hospital systems to individual providers.  In New Jersey, we defend clients from investigations by federal agencies as well as state and local law enforcement.

Defending Healthcare Fraud

Oberheiden, P.C. is a different kind of law firm:  one whose practice is defending clients against healthcare fraud allegations.  We have decades of experience in this area, and our clients have tried hundreds of jury and non-jury cases in courts around the country.  Our healthcare fraud defense team includes several former Assistant U.S. Attorneys who were in charge of audits, investigations, and prosecutions of healthcare fraud at the Department of Justices.  This unique team, together with our experienced criminal defense attorneys, now offer our clients their skills, insight, and experience.  Among the advantages you will realize by hiring Oberheiden, P.C. are:

  • Immediate Involvement. Our experience in the arena of healthcare fraud investigations has taught us that the likelihood of avoiding criminal charges is greatly enhanced by immediate attorney involvement and the deployment of a carefully planned defense strategy. Unfortunately, many criminal defense attorneys do not share our sense of urgency.  But there is simply no time to wait and see what might happen when it is your healthcare business, medical practice, money, and even freedom on the line.  We pride ourselves in answering your most important questions within hours of being engaged, including questions regarding the aim of the investigation, how long it will take, what is likely to happen, and the basis for the government’s belief that someone has committed fraud.
  • Emphasize the Lack of Intent. In order for the government to prove criminal healthcare fraud, it must prove criminal intent.  In every criminal case, the Constitution requires that each and every element of the crime be proven by the government beyond a reasonable doubt.  At Oberheiden, P.C., we take this standard seriously and require the government to meet its strict burden of proof in every case in which criminal charges are threatened.  For example, billing errors are often the basis for healthcare fraud cases, and the government often sees such errors as demonstrative of malicious intent or ill-will.  But we know that most such errors are caused by simple mistakes, untrained staff, or inadequate supervision.  In such cases, we have successfully avoided criminal charges for our clients on multiple occasions by showing the government that such errors were accidental and that there was no intent to defraud.  As we see it, criminal liability should not be premised on a mistake.
  • Sophisticated Defenses. We are not only trial lawyers; we are healthcare lawyers. For that reason, we have the knowledge to interpret and apply legal loopholes and statutory exceptions as well as the ability to win at the negotiation table or in court.  Our knowledge has made the difference for our clients in many different types of healthcare fraud cases.  For instance, we have shown how the statutory exceptions contained in the Stark Law’s prohibition against physician ownership of ancillary businesses to which patients are referred apply to our clients’ cases, which has lessened or even eliminated the case against our clients on multiple occasions.
  • Protecting Your Reputation. Although our legal strategies and defenses are a large part of our job, we also understand the effect that unfounded accusations can have on your business and your life. Our commitment is not just to defend you in court, but to protect your reputation as well.  We understand your fears regarding how your reputation will be affected by public perception and media reporting.  We have frequently intervened into libelous reporting and worked to create opportunities to speak to the media, in order to educate the public as to the truth of the asserted allegations.

Our attorneys appear in courts throughout the tri-state area and across the country to defend clients against allegations of healthcare fraud. If you are facing a healthcare fraud investigation, call us today for a free, confidential consultation regarding your legal issues.

Our Track Record

At Oberheiden, P.C., our primary goal is to protect our clients’ businesses from government interference and, most importantly, to prevent criminal charges from ever being filed.  Our team of former federal prosecutors and experienced healthcare defense attorneys have provides the highest possible level of healthcare fraud defense to clients including laboratories, pharmacies, hospices, home healthcare providers, business owners, physicians, hospitals, lawyers, and healthcare executives. Our recent successes for these clients include:

  • Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation 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 for Alleged False Claims Act and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
    Result: No civil or criminal liability.

Call today and speak to one of our experienced New Jersey Healthcare defense attorneys directly. We are available to discuss your situation in a free and confidential call seven days a week, including weekends.

888-680-1745
Including Weekends
Oberheiden, P.C.
Serving New Jersey, New York, and Surrounding Areas
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden, P.C. is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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