Chicago Healthcare Fraud Defense Lawyers

Chicago, Illinois and the surrounding area has a high risk of healthcare fraud allegations for providers, businesses, and entities. Oberheiden, P.C. has substantial experience in:

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

Attorney Nick Oberheiden
Chicago Healthcare Defense
Team Lead envelope icon

Contact Nick

Chicago meeting location – by appointment only: We do NOT accept mail or service at this location.
205 North Michigan Avenue Suite 810
Chicago, IL 60601
888-680-1745

Our Team of Chicago Healthcare Fraud Defense Attorneys includes a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, several former healthcare fraud prosecutors, and former lead prosecutors for the Medicare Fraud Strike Force. Our attorneys offer our services to clients in Chicago as well as throughout Illinois.

An allegation of fraud in Chicago, Illinois or in the surrounding areas is extremely detrimental. Call Oberheiden, P.C. right away if you’re under investigation. Ask to speak with a member of our Chicago healthcare fraud defense attorney team. Your initial call is free and confidential.

Chicago, Illinois Is Constantly Monitored for Healthcare Fraud

In the United States, there are nine regions that are constantly monitored by the federal government for instances of healthcare fraud. Chicago is one of those regions. It is directly monitored by the Medicare Fraud Strike Force. The team is made of federal prosecutors and investigators from several federal agencies.

Chicago, Illinois and the surrounding areas face constant monitoring because of the number of people who receive federal healthcare program benefits. This means that there are more claims filed with the federal government healthcare program for payment. Since there are more claims filed, the federal government believes that more healthcare fraud also occurs.

In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal 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

What Is Healthcare Fraud?

It’s important to understand what constitutes healthcare fraud. Healthcare fraud is defined as an attempt to receive payment from a federal government healthcare program for medical services or equipment from incorrect or misleading claims. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It incorporates at least one of the following elements:

The Anti-Kickback Statute. Federal law restricts the exchange of money or other valuables for patient referrals. Anyone 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.
False Claims Act. If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an inquiry into your billing practices under the criminal provisions of the Act.
Prescription Fraud. Prescribing a high volume of narcotics is closely monitored by the federal government. 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 equipment.
Certification Errors. The federal government pays close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.

Oberheiden, P.C. works to help clients avoid criminal charges that often result from healthcare fraud allegations. If you’re in Chicago, Illinois or the surrounding area, call us now. Your first call is free and confidential.

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)

Civil and Criminal Penalties of Healthcare Fraud

Federal healthcare fraud can result in civil or criminal charges against you or your business. In civil court, you could be ordered to repay the amount of the federal claims, you may lose reimbursement for future claims, and you could be barred from future participation in federal healthcare programs.

If you face criminal charges, you could end up with a criminal record, expensive fines, or even a federal prison sentence of:

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

Often, we’re asked about the worst-case scenario for healthcare fraud for providers, entities, and businesses in Chicago, Illinois. Whether you’ll face criminal charges or a prison sentence depends on several factors. These are: the severity of injury suffered by a patient, if the prosecutor sees an advantage in pursuing criminal charges, and the reason the federal government began the case. If you’re under investigation for healthcare fraud, contact Oberheiden, P.C. Your initial call is confidential and free.

Oberheiden, P.C. is ready to help Chicago, Illinois healthcare clients based on our dual experience as former federal prosecutors and healthcare fraud defense attorneys. If you’re contacted and told you’re under investigation for healthcare fraud, call us today. Learn more about your legal options and how we can help. Initial consultations are confidential and free of charge.

Is the Healthcare Fraud Investigation Criminal?

Healthcare fraud investigations in Chicago, Illinois can be civil or criminal. Investigations can start as civil and then become criminal as the investigation progresses. Being contacted by a prosecutor is not an indicator determining the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor as an indicator. Rather, signs of a criminal case may include:

Search warrants,
Seizure warrants,
Arrest warrants,
Target letters,
Contact from a federal criminal prosecutor,
Involvement from the IRS, or
Receipt of a grand jury subpoena.

Frequently Asked Questions

Will I face criminal charges if I am under investigation for healthcare fraud?

It depends on the nature and severity of the alleged violations. Many healthcare fraud cases are civil in nature. If allegations are proven in a civil case, you could face hefty fines and professional sanctions. There are other federal laws with criminal charges, such as the False Claims Act and the Anti-Kickback Statute. A violation of the Anti-Kickback Statute is a felony punishable by up to five years in prison and up to a $25,000 fine for each violation. Charges under the False Claims Act may be either civil or criminal. Therefore, it’s not always clear if you are facing civil or criminal charges. You can’t be sure until you consult an experienced federal healthcare fraud defense attorney.

What should I look for in a Chicago federal healthcare fraud defense attorney?

If you think you, your practice or company is under review by the federal government, the choice of attorney may be the most important decision you make. When interviewing attorneys, it is important to select a Chicago federal healthcare fraud defense attorney or law firm that has specific experience in healthcare fraud cases. Even better, find a law firm that has multiple attorneys who used to be prosecutors for healthcare fraud cases. This provides the attorney with insight into how the federal government builds its case, what you can do to minimize your risk, and how to develop an effective defense strategy.

What is the False Claims Act?

The False Claims Act is the premier healthcare fraud prevention statute in the United States. The False Claims Act bars anyone from knowingly submitting a false or fraudulent claim to a federally funded program. In this context, knowingly refers to the submission of the claim. There is no requirement that you intended to defraud the government, only that you purposely submitted a claim that contains errors you knew about or should have known about. As a result, even well-intentioned providers and practices can find themselves in the middle of a federal healthcare case. There are defenses to alleged violations of the False Claims Act. An effective Illinois federal healthcare fraud defense attorney can help you better understand the nature of the government’s allegations and what you can do to defend against them.

Additional Pages for Chicago, Illinois

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 PC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.