Louisiana Medicare Fraud Attorneys

With experienced Louisiana Medicare Fraud attorneys, Oberheiden, P.C. is a national defense law firm of experienced criminal defense attorneys and former federal prosecutors. Our Healthcare Fraud Defense Group is headed by senior attorney Dr. Nick Oberheiden. e brings remarkable experience to representing healthcare service providers and others facing Medicare fraud investigations in Louisiana. Are you under government scrutiny? Have you already been charged with Medicare fraud? If so, we urge you to contact us immediately to begin building your defense.

This page is a resource for individuals and healthcare companies facing Medicare fraud investigations in Louisiana. The information presented here will explain the following:

• What is Medicare fraud?
• Civil and criminal penalties in Medicare fraud;
• Defense strategies for Medicare fraud inquiries;
• Choosing a lawyer to represent you;
• What makes us different?

Are You Facing a Medicare Fraud Investigation in Louisiana?

The federal government deters Medicare fraud by several means. They include civil or criminal liability. Each year, Medicare and other government benefit programs pay billions of dollars in false claims. In FY 2020, the Centers for Medicare & Medicaid Services (CMS) estimates improper payments at nearly $43 billion.

Louisiana is among the federal government’s top priorities when it comes to fighting Medicare fraud. Healthcare providers in Louisiana bill a great number of Medicare claims on a daily basis. This volume of claims garners federal government attention. The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) is a coordinated effort to investigate and prosecute local healthcare providers suspected of Medicare fraud. Louisiana is one of only nine areas nationwide where the government has placed a team from HEAT.

Medicare Fraud: An Overview

Medicare fraud involves a number of federal statutes, including:

• False Claims Act;
• Anti-Kickback Statute;
• Physician Self-Referral Laws (Stark Law);
• Social Security Act; and
• U.S. Criminal Code.

There are many forms of Medicare fraud. All involve illegally receiving money from the federal government from submitting a false or fictitious claim to the Centers for Medicare and Medicaid Services (CMS).

Some of the most common forms of Medicare fraud include:

• Phantom billing – billing for services never performed;
• Billing for medically unnecessary services;
• Billing for supplies and equipment never ordered;
• Billing for medically unnecessary supplies and equipment;
• Certification for medically unnecessary services (common in Home Health and Hospice Fraud Investigations);
• Certification for medically unnecessary supplies (including Durable Medical Equipment (DME));
• Double billing, upcoding, and unbundling services;
• Overuse of services and equipment; and
• Offering and accepting kickbacks.

Providers treating Medicare beneficiaries in Louisiana are entitled to payment for approved services, supplies, and equipment from CMS. However, widespread abuse of the Medicare system led the government to take a skeptical view of any provider submitting a high volume of claims. No provider in Louisiana can escape scrutiny if the government suspects wrong-doing.

Civil and Criminal Penalties for Medicare Fraud

The laws listed above impose severe penalties for those found guilty of Medicare fraud. Sanctions include:

• Recoupment requests;
• Civil fines of up to $11,000 per false claim;
• Treble damages;
• Federal attorney fees; and
• Criminal fines.

Those convicted or held civilly liable for Medicare fraud can also be excluded from future participation in federal healthcare programs. In health care fraud prevention, providers can face license revocation and loss of hospital privileges, as well.

In a criminal case, a conviction can carry a sentence which includes federal imprisonment:

• Medicare fraud: up to 10 years in prison for per count;
• Medicare fraud resulting in serious bodily injury: up to 20 years in prison; or
• Medicare fraud resulting in death: life imprisonment.

Key Defense Strategies for Medicare Fraud Investigations in Louisiana

At Oberheiden, P.C. we have handled hundreds of proceedings and conducted many criminal trials in Louisiana and nationwide. With this experience, we developed four defense strategies that are effective in securing positive results. These are:

• Early intervention;
• Exposing the government’s lack of evidence;
• Establishing a lack of criminal intent; and
• Asserting specific defenses under applicable healthcare laws.

Early Intervention

In Medicare fraud investigations, early intervention with agencies is critical. When you find out about the investigation, the government has already invested time and resources in building a case against you. To level the playing field, you need to retain an attorney as soon as possible. At Oberheiden, P.C., we immediately reach out to our government contacts for answers to these key questions:

• What is the investigation about?
• What prompted it?
• Is the case civil or criminal?
• Which agencies are involved?
• Who else is under investigation?

Whenever possible, we strive to provide our clients these answers within the first hours of engagement.

Exposing the Government’s Lack of Evidence

In order to obtain a conviction, federal prosecutors must prove guilt beyond a reasonable doubt. This includes proving that you committed an illegal act and that you did so with criminal intent. A substantial burden of proof exists for prosecutors. Our Louisiana Medicare fraud attorneys work to expose the government’s lack of evidence in order to stave off criminal charges entirely or prevent a conviction at trial.

Establishing Lack of Criminal Intent

The federal government has the burden of proving that you acted with criminal intent. Thus, a key strategy in our defense is establishing that any alleged fraud was, in fact, unintentional error. These errors are most often byproducts of:

• Unqualified staff;
• Supervision errors;
• Delegation or outsourcing;
• Structural deficits;
• Simple oversight;
• Lack of an effective compliance program; and
• Constantly changing Medicare rules.

While these issues present problems, they do not rise to the level of criminal intent. In our experience, intentional Medicare fraud is rare in Louisiana. Our team can use its knowledge and experience to explain any billing errors. Such arguments may well protect you from criminal prosecution.

Asserting Specific Defenses Under Applicable Healthcare Laws

Our team will use all relevant legal defenses available given the facts of your case. In a recent case, prosecutors alleged our client had falsely certified a patient’s need for home healthcare services. We successfully argued that a delegation exception made our client’s action fully compliant with the law. In another case, our Louisiana Medicare fraud lawyers used a safe harbor provision to help our client avoid federal prosecution. These are just two examples of numerous defenses that may be available.

How to Choose the Right Louisiana Medicare Fraud Lawyer to Represent You

Put an Experienced Team of Healthcare Fraud Defense Lawyers on Your Side

If you are facing a Medicare fraud investigation, the best choice for your legal representation is a team of experienced healthcare fraud defense lawyers.

At Oberheiden, P.C., our Healthcare Fraud Defense Group brings notable experience to helping clients fight their federal charges. Our lawyers have:

• A proven record of success;
• Industry knowledge;
• Expertise in federal healthcare and criminal laws; and
• Litigation and trial experience.

Unlike other defense firms, at Oberheiden, P.C. our Louisiana Medicare fraud defense lawyers take a team approach to defending clients. As a result, you will benefit from the collective experience of all members of our team. We have represented numerous clients in Louisiana and throughout the country in Medicare fraud investigations. This is the type of experience you need when your future is on the line.

About Oberheiden, P.C.

At Oberheiden, P.C., our Louisiana Medicare fraud defense lawyers represent nearly all types of entities in the healthcare industry. This includes cases involving allegations or suspicion of illegal kickbacks, fraudulent billing practices, rendering medically unnecessary services, and unlawful joint ventures. We have specific expertise defending clients in investigations conducted by:

• Department of Defense;
• Department of Justice;

• Department of Health and Human Services

• Drug Enforcement Administration;
• Federal Bureau of Investigation;
• Internal Revenue Service;
• Medicaid Fraud Control Unit;
• Office of Inspector General;
• Louisiana law enforcement; and
• Other state and federal agencies

With so much at stake, you cannot afford to retain under skilled lawyers. To meet with the members of our Healthcare Fraud Defense Group, request a free case evaluation today.

We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form to request a free consultation.