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Healthcare Fraud Defense Attorneys Representing Providers in Cincinnati, Ohio

Compliance – Defense – Litigation in Cincinnati

Cincinnati address – by appointment only:
250 East 5th Street 15th floor
Cincinnati, OH 45202
888-680-1745

Cincinnati has become a center for healthcare fraud investigations. Providers in Cincinnati, Ohio and health businesses such as hospitals, pharmacies, labs, home health and hospice agencies, must know that the federal government is aggressively pursuing fraud in the Cincinnati area. The intense scrutiny is resulting in license revocations, raids, arrests, and criminal prosecution.

The Attorney General of the United States instructed federal authorities to seek the maximum punishment for any federal law violation, including healthcare fraud statutes. Many federal agencies are involved including:

  • The U.S. Department of Justice (DOJ),
  • The Drug Enforcement Administration (DEA),
  • The Department of Health & Human Services (DHHS),
  • The Office of Inspector General (OIG), and
  • The Medicare Fraud Strike Force.

Previous cases centered on Medicare and Medicaid fraud. New task forces, however, have expanded their focus to include alleged fraud against private insurance plans. Effective and experienced legal advice and defense skills are more important than ever. The difference between an attorney learning on the job, or one who knows how to handle a health care fraud case, can mean continuing your business or ending up in federal prison.

Healthcare Fraud Defense Attorneys Representing Providers in Cincinnati, Ohio

Experienced Defense Lawyers for Cincinnati, Ohio Healthcare Providers and Businesses

Oberheiden, P.C. offers clients in Cincinnati, Ohio the experience of more than 2,000 healthcare fraud cases, hundreds of grand jury testimonies, and Medicare audits. We feature attorneys with Department of Justice work history, and a team of specialists focused on advising and defending health providers. We want to protect your license, livelihood, and freedom. If your business or practice is at risk due to allegations of healthcare fraud, we urge you not to take chances. Instead, put lawyers with a proven record to work for you.

  • More than 2,000 healthcare fraud investigations
  • Dismissal of state and federal indictments
  • More than 70 years of Department of Justice experience

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)

A Healthcare Fraud Defense Team You Can Trust

Our Cincinnati healthcare fraud attorneys provide full-service legal counsel for all healthcare fraud related matters. If your business or practice is facing an audit or investigation, Oberheiden, P.C. will assist you through the process. With hundreds of cases like yours previously managed, clients from across Ohio know they can expect reliable advice and proven solutions from our firm. Call today to have a former federal prosecutor assess your case.

“Impeccable Service”
“Our experience with [Oberheiden, P.C.] was overwhelmingly positive! We recently brought a range of complex legal issues to the table, which they responded to with a systematic, prudent approach. Throughout our work together, Oberheiden, P.C. served as an invaluable source of practical guidance and legal leadership. We would recommend them highly and without reservation to anyone. Simply, the best!” – Satisfied Client

“Trustworthy attorney who also understands the compliance, legal and business aspects of our group”
“Our companies have worked with firms all over the country within various specialties and now use [Oberheiden, P.C.] almost exclusively. Nick represented our companies in some federal law investigations. His guidance and expertise allowed us to continue to concentrate on our core business as he dealt with the complex legal issues.” – Satisfied Client

Our healthcare fraud defense team represents Cincinnati clients in cases involving:

  • Medicare and Medicaid Fraud (18 U.S.C. 1347),
  • Controlled Substances Act (21 U.S.C. 841),
  • Anti-Kickback Statute (42 U.S.C. 1320a-7b),
  • Stark Law Statute (42 U.S.C. 1395nn), and
  • False Claims Act (31 U.S.C. 3729-3733).
  • Opioids and Narcotic Diversion. It is no secret that Cincinnati and other major cities around the country are experiencing a dramatic increase of prescription investigations. In this climate of investigations, Cincinnati medical providers and pharmacies need to make a decision. Do I risk being the next target or, do I seek professional guidance to protect or defend me?
  • Medicare Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) look for improper payments by analyzing claims and medical records from the member/provider. Many times this involves a statistical sampling of files to establish an error rate. Another type of Medicare audit is conducted by Zone Program Integrity Contractors (ZPICs). ZPIC audits identify and stop potential fraud then refer cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that a mishandled audit can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice prosecutors with first-hand knowledge of the process guide our clients through the audit. We make sure clients can continue their business and not worry about their license or a government investigation.
  • Medicare and Medicaid Fraud. Cincinnati medical providers and healthcare companies are most often charged with Medicare or Medicaid fraud, typically pursuant to 18 U.S.C. 1347. According to that statute, a conviction in a criminal case may result in years of federal imprisonment. Oberheiden, P.C. has a record of resolving billing, coding, physician certifications, claims submissions, and other Medicare and Medicaid issues. Cases often conclude with neither civil, nor criminal liability. If your practice is subject to a federal healthcare investigation, you should promptly consult with an experienced healthcare fraud defense attorney. Don’t allow the government time to build a case against you. What begins as a simple ZPIC audit, OIG subpoena, or other form of governmental inquiry, can quickly grow out of control. Don’t let this happen!
  • Illegal Kickbacks. The Anti-Kickback Statute penalizes knowingly soliciting, paying, and/or accepting any form of remuneration (e.g. cash, checks) to induce or reward referrals for items or services reimbursed by federal healthcare programs. When it comes to fighting Anti-Kickback charges, nothing replaces experience and a proven skill set. The key in these cases is to convince prosecutors that perceived kickbacks either do not exist or are subject to important exceptions. This makes potentially unlawful arrangements entirely consistent with applicable laws.
  • Cincinnati Billing and Coding Violations. Cincinnati is home to many healthcare providers, companies, and facilities that bill Medicare and Medicaid. If your healthcare practice is accused of:
      • Billing for medically unnecessary services,
      • Upcoding,
      • Unbundling,
      • Double-billing, or
      • Billing for services not rendered,

    you should quickly contact Oberheiden, P.C. to avoid civil or criminal prosecution.

  • Physician “Self-Referrals.” The federal Stark Law imposes penalties for what are commonly known as physician “self-referrals.” Physicians are prohibited from referring certain federal healthcare benefit program beneficiaries to entities in which the referring physicians have a financial interest. Liability under the Stark Law statute can be financially ruinous. Similar to the Anti-Kickback Statute, the Stark Law includes various exceptions. Oberheiden, P.C. has a record of identifying relevant exceptions to protect our clients.

Call us today if you are concerned about your role in a case or if you have been contacted by federal officials. As we have for so many others, Oberheiden, P.C. will find a way to protect you.

Healthcare Fraud Q&A with the Attorneys at Oberheiden, P.C.

Q: What types of health providers are being targeted in Cincinnati, Ohio?

 

The government’s aggressive stance on opioid misuse and health fraud forces all Cincinnati medical providers to evaluate their situation. Do you risk being the next prosecution or do you seek legal counsel to avoid or defend against unjust charges? Oberheiden, P.C. has been hired by clients in Ohio and across the country to assist with the following provider types:

  • Compound Pharmacies
  • DNA Testing Centers
  • Toxicology Laboratories
  • Healthcare Marketers
  • Home Health & Hospice Agencies
  • Hospitals & Surgery Centers
  • Drug Rehabilitation Centers
  • Pharmacies
  • Physicians

Q: What are some examples of billing and coding errors that can trigger federal healthcare fraud investigations?

 

The level of interest and audit resources the government has for investigations in Cincinnati has increased in the last five years. Auditors and medical data experts report providers with above average billing and payment records. They also notice any coding and billing actions that may indicate underlying financial associations between referring providers and related individuals or entities. Some of the issues we most frequently see include:

  • Billing for kickbacks and referral fees
  • Billing for non-allowable costs
  • Billing for services not provided
  • Billing for services that were not medically necessary
  • Billing for unlicensed or excluded services
  • Double-billing Medicare, Medicaid, Tricare, and/or private insurance carriers
  • Failure to comply with payment conditions or secondary payer rules
  • Upcoding, unbundling, and other coding violations

Learn more about these and other forms of billing fraud.

Q: What are some examples of practices that can lead to allegations of prescription drug fraud?

 

Prescription fraud, drug diversion, and pill mills are among the top law enforcement priorities of the DEA and the DOJ. Anyone in the business of prescribing Schedule II or III drugs in Cincinnati must know the slightest violation of the Controlled Substances Act is serious. Violations can lead to license revocation and criminal prosecution. We have represented numerous types of medical providers with allegations of:

  • Failure to adhere to the requirements for electronic and hard-copy prescriptions
  • Permitting unauthorized use of DEA registration numbers
  • Prescribing drugs without medical necessity or justification
  • Prescribing outside of accepted medical treatment principles
  • Prescribing to drug-dependent patients
  • Prescription drug diversion
  • Prescription forgeries and modifications
  • Providing prescription medications for treatments that are not FDA-approved

Q: What are the penalties for healthcare fraud?

 

Health fraud, if not well defended, can result in civil and criminal penalties, including incarceration. In the past, many cases were civil in nature and a defense lawyer’s job was to avoid monetary fines or mitigate them to an acceptable level. Recently, there is a shift from civil to criminal prosecution. New physician arrests, license revocations, government raids, and sentencing news is released regularly. Cincinnati is no exception to this trend. Most federal health fraud statutes are criminal felony laws, so providers must make sound decisions to avoid or defend against allegations. Oberheiden, P.C. offers clients in Cincinnati and surrounding areas superior experience in these matters.

Q: What steps can I take to protect my business or practice now that I am aware of the government’s investigation?

 

If your business or practice is a target in a federal health fraud case, we invite you to consult with the accomplished healthcare fraud and criminal defense attorneys of Oberheiden, P.C. to assess and resolve fraud allegations.

Oberheiden, P.C. has successfully defended clients in complex healthcare investigations and government prosecutions involving Medicare Fraud, Medicaid Fraud, Tricare Fraud, False Claims Act, Qui Tam Defense, Stark Law Violations, and Physician Self-Referral Prohibitions across the country, including in Ohio. Call us today to find out how we would approach your case.

Schedule a Confidential Case Evaluation With Proficient Cincinnati Healthcare Defense Lawyers

Our team of Cincinnati health fraud defense lawyers is available to begin working on your case immediately. To speak with our attorneys in confidence, please call 888-680-1745 or request a free case evaluation online now.

Areas We Serve in Cincinnati, Ohio

Subject to our terms and conditions and in accordance with the applicable local rules of United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel: Cincinnati, Hamilton, Middletown, Fairfield, Covington, Mason, Florence, Independence, Oxford, Lebanon, Norwood, Forest Park, Erlanger, Springboro, Fort Thomas, Newport, Sharonville, Blue Ash, Wilmington, Loveland, Springdale, Maysville, Dearborn County, Franklin County, Ohio County, Boone County, Bracken County, Campbell County, Grant County, Kenton County, Pendleton County, Brown County, Clermont County, Hamilton County, Warren County, Butler County, Wilmington, Clinton County.

Additional Pages for Cincinnati, Ohio

Oberheiden, P.C.
Compliance – Litigation – Defense
888-680-1745
Serving the State of Ohio and Surrounding Areas
Federal-Lawyer.com
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