Baton Rouge Healthcare Fraud Defense Attorneys

Attorney Nick Oberheiden
Baton Rouge Healthcare Defense
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Oberheiden, P.C. is a healthcare law defense firm with particular experience in the areas of regulatory compliance, corporate structuring, litigation, United States government investigations, and criminal defense. Among our team are talented Baton Rouge healthcare fraud defense attorneys with years of relevant experience and education from the country’s best schools such as Harvard and Yale Law Schools. Our attorneys serve clients in Baton Rouge as well as throughout Louisiana.

Healthcare fraud allegations in Baton Rouge are serious matters. If you’re under investigation for healthcare fraud, call Oberheiden, P.C. today. We have extensive legal experience in:

OIG and grand jury subpoenas,
Medicare and Tricare audits,
Fraud allegation defense,
Internal investigations,
Compliance programs,
Qui tam defense,
Protection of assets,
Criminal defense, and
Jury trials.

Want to learn more about your legal options? Call Oberheiden, P.C. now and speak with our Baton Rouge healthcare fraud defense lawyers. Initial calls are free of charge and confidential.

Healthcare Fraud in Baton Rouge

Baton Rouge is monitored by the Medicare Fraud Strike Force because of the large number of citizens in the area who rely on federal healthcare programs. The number of beneficiaries means more claims filed with the federal government for payment. The large number of claims is a trigger that fraud may be happening. In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal investigations. Federal prosecutors filed charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year. (OIG/HHS)

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Healthcare Fraud Basics

Healthcare fraud is an attempt to receive payment from a federal healthcare program for medical equipment or services for an incorrect or misleading claim. Federal healthcare programs include Tricare, Medicare, Medicaid, and federal workers’ compensation. Healthcare fraud includes at least one of the following laws:

Anti-Kickback Statute – Federal healthcare law restricts the exchange of money or other valuables for patient referrals. Any person may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
Stark Law – Stark Law is more commonly known as the Self-Referral Law. It bars physicians from referring patients to certain healthcare entities if the physician or an immediate family member has an ownership or investment interest in the entity. Or, if there is a compensation arrangement between the providers. There are statutory exceptions to this law.
Prescription Fraud – Prescribing a high volume of narcotics is closely watched by federal agents. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA dispensing rules.
Billing Fraud – One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates allegations of phantom billing (services not provided), ghost patients (patients who do not exist), and billing for medically unnecessary services or durable medical equipment.
Certification Errors – Federal authorities pay close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.

Each Baton Rouge healthcare fraud defense lawyer at Oberheiden, P.C. have a history of success helping clients avoid charges. If you, your healthcare practice, or your business are under investigation for healthcare fraud in Baton Rouge, call us today. Initial calls are free and confidential.

Civil and Criminal Penalties of Healthcare Fraud

Healthcare fraud is extremely serious and can result in civil or criminal liability. Civil penalties may include repayment of claims, non-payment of future claims, and exclusion from federal healthcare programs entirely. You could be called before the state disciplinary board, lose your license, and/or lose your hospital privileges.

Criminal penalties can include fines that cost you hundreds of thousands of dollars, criminal indictment, or a prison term of:

Up to 10 years for each count of healthcare fraud
Up 20 years for each count of fraud that results in serious bodily injury
Life sentence if the healthcare fraud results in death

Clients ask us about worst-case scenarios for healthcare fraud in Baton Rouge. Criminal prosecution can depend on many factors. The severity of the injury received by a patient, if the prosecutor has interest in pursuing criminal charges, and the reason the investigation began, are a few. If you’re being investigated for healthcare fraud in Baton Rouge, you should call Oberheiden, P.C. today to speak to an experienced Baton Rouge healthcare fraud defense attorney from our firm to learn about your options. Initial consultations are confidential and free of charge.

Signs That You May Be Facing a Criminal Charge

Healthcare fraud charges can be civil or criminal in nature. Oberheiden, P.C. utilizes early intervention and a strategic defense to help our Baton Rouge clients. If you are being investigated, contact us promptly.

It’s not always easy to know if you are facing civil or criminal charges. The U.S. Attorney’s Office and other federal agencies have both a civil and a criminal division. So, being contacted by a federal prosecutor doesn’t always mean a criminal charge is imminent. However, civil cases can become criminal in nature. Oberheiden, P.C. can help by contacting federal prosecutors on your behalf. If you’re contacted by a federal prosecutor, call us right away.

Determining charges depends on the legal reading of many factors including OIG subpoenas, and the manner in which the inquiry or allegations are made. Expect criminal prosecution if you receive a(n):

search warrant,
seizure warrant,
arrest warrant,
target letter,
IRS involvement,
grand jury subpoena, or
there is involvement of a federal criminal prosecutor.

If you have questions about the charges you may face, call Oberheiden, P.C. now. We provide counsel for providers, entire healthcare systems, and other related healthcare businesses.

Healthcare Fraud Defenses

Oberheiden, P.C. works on behalf of our clients. Many of the members on our Healthcare Fraud Defense Team have experience as healthcare auditors and as former federal healthcare fraud prosecutors. Such combined experience gives our Baton Rouge clients valuable insight and legal defense for their healthcare fraud cases.

Immediate contact with the federal government. Our main goal is to help our clients avoid criminal indictment. Experience has taught us that the best way in which we can advocate for our clients is to quickly contact the federal government. This immediate contact limits the amount of time the federal government has to pursue its case against you. We work to protect your career and your freedom. We can get answers to some important questions typically within a few hours after you retain us. Here are a few initial questions we will ask on your behalf:

What is the investigation about?
What is the purpose of it?
How long will the investigation take?
What is the most likely outcome?

Proving no criminal intent. The federal government must prove beyond a reasonable doubt that you committed a crime. They must also show that you acted with criminal intent. When criminal charges look certain, we test if the government will be able to meet Constitutional standards. The government will try to use billing inaccuracies to prove you had criminal intent. Oberheiden, P.C. knows this most often happens as the result of an organizational or human error. These mistakes should not be held to criminal standards. We have provided successful legal defense for clients across the United States by proving that inaccuracies are a result of human or organizational error and not criminal intent. Some factors leading to such mistakes are:

unqualified workers,
delegation errors,
outsourcing errors,
lack of oversight,
insufficient supervision, and
constantly changing laws and rules in healthcare billing.

Although these issues should be corrected, they should not lead to criminal conviction.

Strategic healthcare fraud defense. Oberheiden, P.C. develops strategic healthcare fraud defenses for each client. Many of the cases we’ve successfully defended were won because of statutory loopholes and exceptions. For example, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either ease or entirely resolve a healthcare fraud case.

Safeguarding the reputation of our clients. We are committed to doing more than providing healthcare fraud defense. We are determined to defend your image. Facing allegations of healthcare fraud can be damaging. Many of our clients express concern about how these accusations will affect their career and future. The media has a lot of power and your reputation could be destroyed by their rumors. Our attorneys will address instances of slander, and seek opportunities to correct misinformation about our clients. Call us today to learn more about your legal options. The conversation is confidential and there is no charge for your initial call.

Frequently Asked Questions

What is the Eliminating Kickbacks in Recovery Act?

To help reduce the profits for referring patients in need of drug and alcohol treatment, the U.S. Congress passed the Eliminating Kickbacks in Recovery Act (EKRA) in 2018. EKRA bars accepting or paying for referrals to recovery homes, clinical treatment facilities, or labs. EKRA focuses on more than facilities receiving payments, but also on physicians making referrals. If you operate a recovery home, clinical treatment facility, or lab, or refer patients to these services, it is important to discuss referrals with an experienced attorney.

What does “qui tam” refer to?

Qui tam is a Latin phrase that relates to a civil case filed by a person on behalf of the government. In relation to healthcare fraud claims, a qui tam lawsuit can fall under the False Claims Act. When a person has evidence they believe shows healthcare fraud, they can file a case on their own or present the evidence to federal officials. In some instances, the federal government will choose to intervene in the lawsuit and take over the case. Other times, the federal government will choose not to intervene. At this point, the whistleblower, or relator, has the option to pursue the claim on his/her own. If a whistleblower’s claim results in an award, they can receive to up to 30 percent of the amount recovered. Qui tam cases inspire suspicion due to the potential financial gains for whistleblowers. But, they can cause serious problems for healthcare providers. If you are part of a whistleblower lawsuit, contact a Baton Rouge healthcare fraud defense attorney.

What are the most common healthcare fraud claims in Baton Rouge?

The federal government manages the same set of laws that apply throughout the country. Some states, however, cause additional concerns for healthcare providers. Given Louisiana’s status as a hotspot for prescription drug abuse, federal prosecutors are on the lookout for the following:

Prescription drug fraud
Falsifying patient records
Inaccurately reporting test results
Billing for services or supplies not provided
Billing for medically unnecessary services, supplies or equipment
Illegal kickback arrangements

If you face healthcare fraud charges, you need an attorney who is familiar with the unique landscape where these cases arise.

Our Track Record

The commitment of each Oberheiden, P.C. Baton Rouge healthcare fraud defense lawyer is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. Here are some recent examples of our case outcomes.

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.

We are available every day of the year. Call, complete our contact form, or email us directly.