Chicago Healthcare Fraud Defense Lawyers - Oberheiden, P.C.
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Chicago Healthcare Fraud Defense Lawyers

Dr. Nick Oberheiden
Attorney Nick Oberheiden
Chicago Healthcare Defense
Team Lead envelope icon Contact Nick
Chicago address – by appointment only:
205 North Michigan Avenue Suite 810
Chicago, IL 60601
888-680-1745

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.

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.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd
Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester
Brian J. Kuester

Former U.S. Attorney

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney

Local Counsel

John W. Sellers
John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara
Linda Julin McNamara

Federal Appeals Attorney

Aaron L. Wiley
Aaron L. Wiley

Former DOJ attorney

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (DOJ)

Chris Quick
Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow
Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen
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.


Important Healthcare Fraud Defenses

Chicago Healthcare Fraud Defense Lawyers

Oberheiden, P.C. is a healthcare fraud defense firm. We develop individualized strategies for our Chicago clients. We’ve defended hundreds of people. Several of our healthcare fraud attorneys have experience as former healthcare auditors and healthcare fraud prosecutors with both the Department of Justice and the Medicare Fraud Strike Force. We use this experience to develop strategic defenses for each of our clients.

Contacting the federal investigator. The main priority of our firm is to help our clients avoid criminal charges. Once retained, we promptly contact the federal prosecutor. This lessens the time that the federal government has to investigate you without interruption. This is important. If the federal government has too much time to investigate you, you could face criminal charges. Our goal is to get answers to these most important questions within hours:

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

Proving a mistake was made. Proving a mistake was made. The federal government must prove that you committed a crime and that you acted with criminal intent. They must present evidence that meets a high legal standard. Often, the federal government will try to use billing inaccuracies to prove that you committed a crime. We’ve found that billing errors usually don’t occur because someone acted with criminal intent to defraud the government. They happen because of a mistake. Mistakes should certainly be corrected, but they should not lead to criminal conviction. The most common errors that cause problems include:

  • Hiring unqualified workers,
  • Delegation errors,
  • Outsourcing errors,
  • Lack of oversight,
  • Insufficient supervision, and
  • Frequently changing laws and rules in healthcare billing.

Using legal defenses for each case. The Chicago healthcare fraud defense attorneys at Oberheiden, P.C. examine the facts in each case to develop the right defenses for each client. Often, this includes the use of statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a healthcare fraud case.

Preserving your professional reputation. Allegations of healthcare fraud can damage your professional reputation. Oberheiden, P.C. will help protect your reputation both inside and outside the courtroom. Our attorneys will correct misinformation presented to the public by the media about our clients. We also address slanderous comments.

If you’re under investigation for healthcare fraud in Chicago, Illinois, call us at Oberheiden, P.C. This call is free and confidential.

Our Track Record

The commitment of Oberheiden, P.C. 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.
 

Our Chicago healthcare fraud defense lawyers are available every day of the year. Call, complete our contact form, or email us directly.

888-680-1745
Including Weekends
Oberheiden, P.C.
Serving Chicago, Illinois and Surrounding Areas
www.federal-lawyer.com

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.
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