Detroit Medicare Fraud Defense Attorneys - Oberheiden, P.C.
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Detroit Medicare Fraud Defense Attorneys

Our Detroit Healthcare Fraud Defense Group is headed by Dr. Nick Oberheiden. Dr. Nick Oberheiden is a nationally recognized healthcare fraud defense attorney and managing principal of Oberheiden, P.C.

Detroit address – by appointment only:
220 West Congress St. 2nd Floor
Detroit, MI 48226
313-462-7972

Medicare Fraud in Detroit

Medicare fraud is filing false claims to a governmental healthcare program. Programs include, Medicare, Medicaid, Tricare, or federal workers’ compensation. They fall under the False Claims Act, Anti-Kickback Statute, Physician Self-Referral Laws (Stark Law), Social Security Act, or U.S. Criminal Code. All include a healthcare provider or entity illegally receiving money from a federal program.

Detroit plays a central role in Medicare investigations. The city has some of the largest number of Medicare recipients in the US. With the number of services billed, the Centers for Medicare and Medicaid Services (CMS) keep a close eye on claims. Detroit is one of fifteen U.S. cities where a special task force to monitor, investigate, and prosecute Medicare Fraud exists.

Government prosecutions tend to be more aggressive and frequent in Detroit than in other communities. The elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT) leads activities. HEAT is a task force of prosecutors from a number of relevant federal agencies.

Forms of Medicare Fraud

Medicare Fraud refers to the submission of false or fictitious claims to a governmental healthcare program. Fraud cases allege illegal billing practices and payment requests for fake, excessive, or unauthorized services. Charges may involve any of the following acts:

  • Billing for Services Not Performed (Phantom Billing)
  • Billing for Services that Were Not Medically Necessary
  • Billing for Supplies and Equipment Never Ordered
  • Billing for Supplies and Equipment Not Medically Necessary
  • Certification for Services Not Medically Necessary (e.g. Home Health or Hospice Fraud)
  • Certification for Supplies Not Medically Necessary (e.g. DME)
  • Double Billing, Up-Coding, Inflating Bills
  • Overuse of Services or Equipment
  • Offering or Accepting Kickbacks

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)

What Are the Penalties?

Targets are exposed to recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, exclusion from federal healthcare programs, treble damages, attorney fees, criminal fines, criminal indictment, licensing actions and loss of hospital privileges, or prison.

  • Up to 10 years in prison for each count of fraud
  • Up to 20 years in prison if the fraud resulted in serious bodily injury (commonly through counterfeit or excessive medication)
  • A life sentence if the fraudulent Medicare practice results in a patient’s death.

Detroit Medicare Fraud Defense Attorneys

Choosing the Right Defense Lawyer

It is vital to select a lawyer who has the skills and experience to win against the government. With so much at stake, healthcare fraud defense strategies are not for the average attorney. It’s not an area of law to take chances!

Healthcare Lawyers. Some people believe that a healthcare lawyer is the right choice to defeat the government. Our experience tells us otherwise. Medicare Fraud is often charged along with mail fraud, wire fraud, tax evasion, or money laundering. An effective defense requires an in-depth knowledge of criminal procedure. Healthcare lawyers do not practice this type of law. They are not trained to negotiate with federal agents. Nor do they have the experience to battle federal prosecutors in court.

Criminal Lawyers. Hiring a criminal defense lawyer sounds like the best thing to do in defending against fraud charges. When accused of healthcare fraud, there’s no time to explain the nuances of healthcare law to an attorney. The best criminal defense attorney may have experience in DWI, rape, or drug offenses. That doesn’t mean the knowledge needed to manage complex healthcare fraud matters exists. There may also be a lack of experience with billing, coding, and medical utilization rules.

Healthcare Fraud Defense Lawyer. The ideal Detroit Medicare Fraud lawyer to seek when accused of Medicare Fraud and other healthcare offenses should meet the following four criteria:

  • Proven Track Record
  • Industry Knowledge
  • Profound Insight Into Healthcare Laws
  • Extensive Litigation & Trial Experience

Before investing money, clients must test the lawyer’s specific experience in Medicare Fraud cases. Specifically, clients should ask the lawyer candidate the following 3 GOLDEN QUESTIONS:

  • How many Medicare Fraud cases have you handled so far?
  • How many of your cases resulted in no civil and no criminal charges or dismissals for your clients?
  • How many healthcare fraud cases have you tried in court?

Proven Defense Strategies

What makes Oberheiden, P.C. different is our experience and our track record. Throughout the practice, our attorneys have handled over 2,000 healthcare proceedings across the country. We have conducted more than 200 criminal trials. Many of our attorneys come from senior positions within the Department of Justice. They share their experience, insights, and contacts as former federal prosecutors to fight for you in court.

While every case differs, our Detroit Medicare Fraud lawyers prove quite successful in resolving healthcare cases without them falling to criminal charges.

  • Early Intervention
  • Lack of Evidence
  • Lack of Intent
  • Applicable Defenses

Early Intervention. Early intervention by experienced lawyers is key. The longer the government investigates, the higher the chance your case will turn into a criminal matter. Don’t let the government build its case. Hire lawyers with open channels to the government who can quickly initiate a dialogue with their contacts. Get answers to the most pressing questions: What is the case about? What prompted the inquiry? Is the case civil or criminal? What agencies are involved? Who else is under investigation? What is the government’s ultimate goal? How can we resolve the issue? We strive to provide our clients these answers within the first hours of engagement.

Lack of Evidence. The U.S. justice system places a heavy burden on the government to prove punishable misconduct. To find guilt, the government must prove beyond a reasonable doubt that an illegal act was committed with criminal intent. Our fraud defense lawyers put this constitutional standard to the test in every single case. The court routinely finds in our client’s favor.

  • Case Dismissed
  • Avoidance of Criminal Charges
  • License Maintained
  • Civil Fine, No Criminal Plea
  • Misdemeanor, No Felony
  • No Jail Time

In our experience, most incidents prompting an investigation stem from organizational and human errors, not criminal intent. Mistakes occur because healthcare providers focus on caring for their patients. Businesses of interest to the government have rapid growth and fast expansion in common. Whether patient care or business growth, organizational deficits and negligent oversight explain most mistakes. We commonly find the following causes for errors:

  • Unqualified Staff
  • Supervision Errors
  • Delegation & Outsourcing
  • Structural Deficits
  • Organizational Mistakes
  • Human Error
  • Oversight and Overwhelmed
  • Lack of Compliance Program
  • Constantly Changing Rules

Lack of Intent. Intentional healthcare fraud is rare. Too many business owners are ready to accept penalties for mere negligent oversight. In a busy practice, mistakes are common and should not result in fraud conviction or liability.

  Anti-Kickback False Claims Act Stark Law Criminal
Offense Nature Criminal Civil (& Criminal) Civil Criminal
Offense Element Illegal Referrals False Claims Self-Referrals Fraud Scheme
Government Burden Knowing & Willful Reckless Disregard Strict Liability Knowingly

Finding Applicable Defenses. In a recent case, the government accused our client of fraudulently certifying a need for home healthcare services. We showed that a recognized delegation exception applied making the certification compliant with the law. In another case, we refused to admit liability, ultimately convincing prosecutors that our client acted within a safe harbor exception.

Skilled Detroit Medicare Fraud Defense Attorney at Oberheiden, P.C.

Our Detroit Medicare fraud defense attorneys represent business owners, healthcare executives, lawyers, healthcare providers, hospitals, pharmacies, labs, and other healthcare entities. We defend you when accused of illegal kickbacks, fraudulent billing practices, allegations of medically unnecessary services, services not rendered, and unlawful joint ventures.

  • Healthcare Fraud Defense
  • Compliance Programs
  • Internal Investigations
  • Qui Tam Defense
  • Asset Protection
  • Licensure & Disciplinary Proceedings
  • Jury Trials

Our clients range from individual providers to entire healthcare systems. Our Detroit Medicare fraud defense lawyers represent clients in Detroit who are under investigation by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, the Drug Enforcement Administration, the Office of Inspector General, the Medicaid Fraud Control Unit, Detroit and Michigan law enforcement, or the Internal Revenue Service.

Our Track Record

  • Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud
    Result: No civil or criminal liability.
  • Defense 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.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Healthcare Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating healthcare company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of healthcare marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of physician owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of physician owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of healthcare management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
 

Our Detroit Medicare fraud defense lawyer is available every day of the year. You can call, complete our contact form, or email us directly.

 

Additional Pages for Detroit, Michigan

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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