California Medicare Fraud Defense Lawyer

Oberheiden P.C. is a healthcare law defense firm with experience in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our law office has talented attorneys with degrees from Harvard and Yale. Our California Medicare fraud defense lawyers serve clients in California and throughout the U.S.

California’s healthcare providers and related businesses risk investigation for Medicare fraud. If you receive notice that you’re under investigation for Medicare fraud, you need legal help. Oberheiden, P.C. serves California healthcare providers, facilities, and businesses. Healthcare fraud defense attorney Dr. Nick Oberheiden is our founder and managing partner.

What Is Medicare Fraud?

Medicare fraud is a federal offense with both civil and criminal penalties. It includes federal healthcare program like Medicaid, Tricare, and federal workers’ compensation. Medicare fraud is submitting false claims to a federal healthcare program for an illegal payment. If under investigation, you’re suspected of violating at least one of the following:

• Stark Law (Physician Self-Referral Law)
• Anti-Kickback Statute
• False Claims Act
• Social Security Act
• U.S. criminal law

Medicare fraud is serious. California’s healthcare providers, facilities, and businesses have a much higher risk of being accused. This is because the state has a huge number of citizens receiving federal healthcare benefits. The federal government believes the great number of claims may lead to an increase in fraud. In fact, California is one of nine areas monitored by the Medicare Fraud Strike Force. The job of these task forces is to monitor, investigate, and prosecute instances of fraud.

The Medicare Fraud Strike Force is a specialized body composed of prosecutors and investigators from several federal agencies. They work in areas of the nation where Medicare fraud is most prevalent.

What Is the Most Common Reason for Medicare Fraud Investigations in California?

When the federal government becomes suspicious of billing errors, unusual billing practices and reimbursement requests, they may open an investigation. Unauthorized, excessive, or false charges can also trigger attention. Common causes in California include:

• Billing for medically unnecessary supplies
• Billing for unnecessary services
• Billing for services that were never performed (referred to as phantom billing)
• Billing for equipment or services that were never ordered
• Certification for medically unnecessary supplies or services (hospice care and medical devices)
• Inflating charges
• Double billing
• Upcoding
• Overuse of services or equipment
• Providing kickbacks
• Accepting kickbacks

Who is most likely to be investigated in California?

Keep in mind that any person, facility, or business that files claims for reimbursement from federal healthcare programs can be looked at for Medicare fraud.

A Look at the Civil and Criminal Penalties

Medicare fraud investigations can involve both civil and criminal penalties. You may face one or more of the following civil penalties:

• Treble damages
• Payment of civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future federal healthcare program claims
• Federal healthcare program exclusion
• Attorney fees

Medicare fraud charges are serious, and it is crucial to seek legal advice immediately if accused.

In addition to civil penalties, you could face criminal ones as well. Possible criminal penalties for Medicare fraud in California include:

• Criminal record
• Huge fines
• 10 years in federal prison for each count of Medicare fraud
• 20 years in federal prison if the fraud results in serious bodily injury
• A life sentence in federal prison if the fraud results in patient death

You could also face state disciplinary measures, lose your license, and lose your hospital privileges.

You Must Choose the Right California Medicare Fraud Defense Attorney

When suspected of Medicare fraud, it is critical to choose the right California Medicare fraud defense lawyer. The attorney must have the expertise and skills to counter the federal government on your behalf.

It is especially important to secure legal representation if you are facing Medicare fraud allegations, as these healthcare fraud cases are complex and the consequences of a conviction can be severe.

Many healthcare providers, businesses, and facilities promptly search for the services of a healthcare attorney. This makes sense to some, but it’s important to know that Medicare fraud is often charged along with criminal matters like tax evasion, mail fraud, wire fraud, and money laundering. A healthcare attorney may not have the training or experience to successfully assist with these charges.

The services of a criminal defense attorney may seem needed when facing criminal charges. But, not all criminal defense attorneys have experience with federal criminal matters. Many won’t have knowledge of healthcare law and the intricacies of billing, coding, and medical usage rules.

You should look for the services of a California Medicare fraud defense attorney who has these four qualifications:

• A proven track record of success in Medicare fraud cases
• Industry knowledge
• Deep familiarity with healthcare laws and their exceptions
• Litigation and trial experience

As you complete your research, you’ll have a list of potential California Medicare fraud defense attorneys. You should then ask these questions to ensure that they have the Medicare fraud experience that you need:

• How many Medicare fraud cases have you handled in your career?
• How many of those cases resulted in neither civil nor criminal charges, or in dismissals for your clients?
• How many Medicare fraud cases have you tried in court?

California Medicare Fraud Defense Strategies

Oberheiden, P.C. serves California healthcare providers, businesses, and related entities using our three criteria. These guidelines defend our clients from allegations of Medicare fraud. They also help us develop an effective defense for their particular facts. Our overall goal is to reduce the likelihood of facing criminal charges.

Early intervention. One of the best defense strategies is early involvement with federal agents. The more time the United States government has to investigate, the more likely you’ll face charges. Once hired, we contact the government for answers to these questions:

• What is the investigation about?
• What prompted the investigation?
• Is this civil or criminal?
• Which federal agencies are involved in the investigation?
• Who is being investigated?
• How can the matter be resolved?

The answers are important in creating the best defense. We typically get answers within the first few hours of work for our clients.

The federal government must present evidence proving beyond a reasonable doubt that you committed a crime. This is a Constitutional standard we test in each and every case. By addressing and testing their evidence, we routinely see the following results:

• Dismissal of case
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reducing a felony to a misdemeanor
• No prison sentence

Lack of criminal intent. The government must do more than prove that you have committed a crime. It must also show that you acted with criminal intent. Yet, there are very few purposeful acts of Medicare fraud in California. The allegation of Medicare fraud usually occurs because of common mistakes. The most likely ones are:

• Using unqualified or untrained staff
• Inadequate supervision of staff
• Delegation and outsourcing of work to unqualified entities
• Business errors
• Human error
• Oversight
• Overwhelmed staff
• Lack of a Medicare compliance program
• Failure to keep up with changing healthcare laws and rules

Our goal is to show the federal government that you made a mistake. You did not commit a crime.

Using applicable and strategic defenses. Each Medicare fraud case has some similarities, but not the same defense because facts differ from case to case. We take time to analyze each case to develop strategic and applicable defenses. We handled a case where the government alleged that our client fraudulently certified home healthcare services. We proved our client had the protection of a delegation exception making the certification legal. In another case, we refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. can provide a California Medicare fraud defense lawyer to those accused of illegal kickbacks and fraudulent billing practices, and a number of other violations. We assist with:

• Healthcare fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

We provide legal counsel for healthcare providers, businesses, and facilities in California. If you’re under investigation by the federal government, call us right away. Our initial consultation is confidential and free of charge.

Frequently Asked Questions

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