Miami False Claims Act Defense Lawyers

Oberheiden, P.C. is a healthcare law defense firm with experience in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our firm is staffed by talented attorneys with years of relevant experience and education from the country’s best schools such as Harvard Law School and Yale Law School. We serve clients in Miami as well as throughout Florida.

At the Oberheiden, P.C., we represent individuals and companies in the healthcare industry in False Claims Act matters in the greater Miami area.

Our Healthcare Fraud Defense Group is a team of senior attorneys who have expertise in both False Claims Act investigations and prosecutions. The leader of our team is Dr. Nick Oberheiden. He is our firm’s managing principal and a nationally recognized healthcare fraud defense lawyer.

This page serves as a resource for those facing allegations of False Claims Act violations. Continue reading to learn:

• What Healthcare Companies and Executives Need to Know About the False Claims Act
• What to Expect if You or Your Company Has Been Named in a “Qui Tam” Lawsuit
• What Our Attorneys Can Do to Help You Avoid Civil and Criminal Responsibility

Miami Tops the Federal Government’s List of Priorities in Program Fraud Investigations

Miami’s healthcare industry gets government attention due to suspected fraud involving Medicare and other federal healthcare benefit programs. Florida is in the top five states in Medicare spending per recipient. To federal healthcare prosecutors, this means a high likelihood of substantial false and fraudulent claims. Healthcare industry professionals are found liable for millions of dollars in civil and criminal penalties each year.

To combat Medicare fraud in Miami, the federal government has a task force from its elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a joint effort of prosecutors from a number of federal agencies. With the help of state and federal law enforcement authorities, HEAT actively investigates and prosecutes those suspected of False Claims Act violations in Miami, FL.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former Department of Justice

Brian J. Kuester

Former U.S. Attorney
Former DA

John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach

Former Special Agent (OIG)

Michael Koslow

Former Supervisory Special Agent (FBI)

Chris Quick

Former Special Agent (FBI & IRS-CI)

Ray Yuen

Former Supervisory Special Agent (FBI)

1. What Healthcare Companies and Executives Need to Know About the False Claims Act

The False Claims Act is a federal law imposing civil and criminal penalties on individuals and companies that “knowingly” submit false or fraudulent claims for compensation under United States government contracts and federal benefit programs. It is a key tool in the government’s fight against healthcare fraud.

What Does it Mean to “Knowingly” Submit a False or Fraudulent Claim?

It is illegal to knowingly submit or cause the submission of false or fraudulent claims for payment. But, the word “knowingly” is misleading. To knowingly submit such a claim, you don’t have to know that it was false or fraudulent. The False Claims Act attributes knowledge when a party should have known that a claim for payment violates the law. This means that the following all constitute potential violations of the False Claims Act:

• Mistakenly using outdated (“false”) billing codes
• Double-billing for services, supplies, medications, and durable medical equipment (DME)
• Unbundling and upcoding reimbursable services
• Billing for services, supplies, and medications that were not provided
• Billing for services, supplies and medications that were medically unnecessary

Unfortunately, there is a fine line between an honest mistake and a “knowing” violation. As a result, many well-meaning companies and practitioners face substantial liability. And, many innocent providers end up in unwarranted probes.

What are the Risks of Violating the False Claims Act?

Violations of the False Claims Act can result in both civil and criminal penalties. Specific penalties depend on the nature and extent of the alleged false and fraudulent claims involved.

Civil Penalties

Individuals and companies that knowingly submit false claims can be held liable for three times the government’s losses. Possible fines can be up to $11,000 per false claim.

Criminal Penalties (18 U.S.C. § 287)

For intentional violations of the False Claims Act, individuals and companies face criminal penalties of up to five years in federal prison and fines per false claim of up to:

• $250,000 for individuals, or $500,000 for companies in felony offenses
• $100,000 for individuals, or $200,000 for companies in misdemeanor violations

2. What to Expect if You or Your Company Has Been Named in a “Qui Tam” Lawsuit

A “qui tam” lawsuit is brought by a private citizen on behalf of the United States government to collect monies owed. All that is required to initiate action is a simple allegation of False Claims Act violations (see 31 U.S.C. § 3729). Qui tam lawsuits can be extremely disruptive and costly. These allegations often come from former employees, or competitors.

If you or your company has been named in a qui tam lawsuit in Miami, here is a brief overview of what you can expect:

Initial Government Assessment

When the private citizen (“relator”), files a complaint, the government conducts a review of the allegations. If the accusations appear true, government attorneys and federal agents begin an investigation. The government subpoenas defendants’ corporate, financial, billing, and other records. Records are scanned for any evidence of wrong doing.

Decision on Government Intervention

Based on the records obtained, the government’s attorneys make a decision. They will either terminate involvement in the case or, intervene. If the government takes up the case, they often include violations of the Anti-Kickback Statute, the Truth in Negotiation Act, and other anti-fraud laws.

Negotiations Regarding Settlement

During the assessment and investigative stages, the Miami False Claims Act Defense attorneys engage in negotiations for a settlement. Qui tam cases move slowly. You can expect to wait several months for a settlement offer.

Liability and Relator Compensation

If the case doesn’t settle and defendants are held civilly responsible, they can face treble damages. This means three times the government’s losses. Civil fines of $11,000 per false claim are also assessed. The False Claims Act’s qui tam provisions entitle the relator up to 25 percent of the amount recovered if the government intervenes. The amount increases to 30 percent if the relator pursues a successful case after the government declines intervention.

3. What Our Miami False Claims Act Defense Attorneys Can Do to Help You Avoid Civil and Criminal Responsibility

Allegations of False Claims Act violations are serious. Take action early to help your chances of avoiding criminal charges or costly civil liability. At Oberheiden, P.C., our Miami False Claims Act Defense Lawyers developed a proven defense strategy. We emphasize early intervention to prevent cases from reaching the point where the government presses charges. This strategy is built on three key goals:

• Keep the Case Civil. Our first priority is always to keep our clients’ cases civil. We do not want you facing criminal charges.

• Prevent the Government from Intervening. In qui tam litigation, we take aggressive action in order to prevent the government from intervening. This includes pointing out flaws in the relator’s allegations and trying to damage their credibility.

• Negotiate Strategically for a Favorable Settlement. If civil liability appears certain, we will center on negotiating a settlement that reduces your exposure to a fraction of the government’s initial demand.

If civil liability appears certain, we try to negotiate a settlement reducing your liability to a fraction of the government’s demand.

To get started on your False Claims Act defense in Miami, FL, contact Oberheiden, P.C. for your free consultation.

Our Miami False Claims Act Defense Attorney is available to discuss your case. Call us directly or complete our contact form to schedule your free, confidential case evaluation today.

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