Michigan Healthcare Fraud Defense Lawyers - Oberheiden, P.C.
WSJ logo
Forbes logo
Fox News logo
CNN logo
Bloomberg logo
Los Angeles Times logo
Washington Post logo
The Epoch Times logo
Telemundo logo
New York Times
NY Post logo
NBC logo
Daily Beast logo
USA Today logo
Miami Herald logo
CNBC logo
Dallas News logo

Michigan Healthcare Fraud Defense Lawyers

Dr. Nick Oberheiden
Attorney Nick Oberheiden
Michigan Healthcare Defense
Team Lead envelope icon Contact Nick
Michigan address – by appointment only:
220 West Congress St. 2nd Floor
Detroit, MI 48226
313-462-7972

Oberheiden, P.C. vigorously defends clients in Michigan against allegations of healthcare fraud. Our Healthcare Fraud Defense Team is headed by Dr. Nick Oberheiden. Dr. Oberheiden is one of the country’s most in demand legal experts. He offers Michigan clients insights from his previous positions supervising civil and criminal healthcare fraud investigations on behalf of the Department of Justice. Our firm helps Michigan clients with the following:

  • OIG & Grand Jury Subpoenas
  • Medicaid Audits (esp. Dentists)
  • Medicare & Tricare Audits
  • Defending Fraud Allegations
  • Internal Investigations
  • Compliance Programs
  • Qui Tam Defense
  • Criminal Defense
  • Jury Trials

Clients across Michigan who are interested in discussing their situations should speak directly to managing partner Dr. Nick Oberheiden. If your case is an emergency, don’t hesitate to call us right away, including weekends. Initial calls are 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)

What Constitutes Healthcare Fraud?

The following statement serves as the overarching definition of healthcare fraud. Healthcare fraud against the federal government includes attempts or actions taken for monetary or other gain from a federal program (e.g. Medicare, Medicaid, or Workers’ Compensation) through false and fraudulent means. The government further defines federal healthcare fraud through a number of laws and regulations prohibiting providers from engaging in certain activities. Following are some of the most commonly prosecuted types of healthcare fraud:

Anti-Kickback Violations

The Anti-Kickback Statute (AKS) is listed in 42 USC § 1320a-7b(b) of the United States Code. Those who work in the healthcare field, including healthcare providers, marketers, or related business owners, are prohibited from giving or receiving any form of payment to gain patient referrals. Any person who violates the statute is subject to healthcare fraud charges and prosecution. The statute does include a number of safe harbors of protected activity. It is important for Michigan providers charged with healthcare fraud to rely on an attorney with profound knowledge of safe harbors and where they may apply.

Stark Law Violations

The Stark Law is similar to the AKS. Both seek to prevent referrals made on the basis of monetary incentives. Stark prohibits physicians from referring patients to any designated health service the physician (or an immediate family member) owns, has invested in, or has a compensation arrangement with. Stark Law does not apply if any one of the statutory exceptions applies to the particular relationship.

Federal False Claims Act Violations

The Federal False Claims Act (FCA) is codified in 31 U.S.C. §§ 3729–3733 of the United States Code, and for purposes of healthcare fraud, applies to any provider that submits a claim for reimbursement by a federal healthcare benefit program such as Medicare or Medicaid. The elements of an FCA claim are stated in the case of United States v. The Boeing Company as follows:

  • (1) that Defendant made a claim, or made a statement in order to get the Government to pay money on a claim;
  • (2) that the claim or statement was false or fraudulent; and
  • (3) that Defendant knew that the claim or statement was false or fraudulent.

If in a healthcare fraud investigation the government finds a false claim was in fact submitted, it can choose to seek either civil or criminal penalties, or both.

Prescription Fraud

Michigan physicians who prescribe an unusually high number of narcotics are often subject to government fraud investigation and prosecution. Such providers are investigated for committing insurance fraud and DEA violations, as opposed to what is typically referred to as federal healthcare fraud.

Billing Fraud

Billing fraud is one of the most active areas of government investigation and prosecution. The government is stringent in its review of providers alleged to be fraudulently billing federal programs. Types of billing fraud that often trigger government interest are:

  • Billing for medically unnecessary services,
  • Billing for services that were never provided,
  • Billing for patients that do not exist, and
  • Using billing codes with a higher reimbursement than the codes for the services that were actually performed.

Certification Errors

Certification error is an area of healthcare fraud that applies to home health and hospice providers. Providers face issues with the government when they are suspected of falsely certifying a patient as home bound or terminally ill. Being home bound qualifies the person for home healthcare. If a patient is terminally ill, the person qualifies for hospice care. The fraud is in billing a federal program when the patient is in fact, not home bound, nor terminally ill and therefore doesn’t qualify for the services billed. Recently, the government has increased its focus on investigating and prosecuting this type of healthcare fraud.

Healthcare Fraud Investigations in Michigan

Michigan Healthcare Fraud Defense Lawyers

Providers in Michigan have recently been targets of healthcare fraud investigations and prosecution. This is especially true of providers in Detroit where the federal government has created a task force to monitor, investigate, and prosecute Medicare Fraud. The government’s Healthcare Fraud Prevention and Enforcement Action Team (HEAT) lead these efforts. HEAT is a federal task force of prosecutors from the DOJ, HHS, OIG, FBI, and others. Our team of defense lawyers are prepared to assist clients across Michigan, including those located in the following counties: Wayne, Oakland, Macomb, Kent, and Genesee.

Oberheiden, P.C. has a long and esteemed history of helping clients avoid criminal charges. If you or your practice are under investigation, or if you want to explore your next steps, speak with one of the former prosecutors and an experienced healthcare fraud attorney at Oberheiden, P.C. today. All calls are free and confidential.

What are the Potential Penalties?

Healthcare fraud is a unique offense in that it can result in civil penalties, criminal penalties, or both. Civil penalties exist within a range depending on the type of fraud charges brought. The criminal healthcare fraud statute codified in 18 U.S.C. 1347 of the United States Code states criminal penalties as:

  • Up to 10 years in prison for each count of healthcare fraud;
  • Up to 20 years in prison if the fraud resulted in serious bodily injury; or
  • Life in prison if the fraudulent scheme resulted in a patient’s death.

We know from experience in dealing with these cases that criminal prosecution depends on multiple factors. What makes Oberheiden, P.C. unique is our expertise as former healthcare prosecutors and renowned defense attorneys. Our group has a long and distinct history of avoiding criminal prosecution. If you are a Michigan resident under investigation or if you simply want to discuss your case directly with one of our experienced Michigan healthcare fraud defense lawyers, contact Oberheiden, P.C. today. All calls are free and confidential.

What Constitutes Criminal Healthcare Fraud?

Many factors like the severity of the offense, the prosecutor’s judgment, and the type of alleged healthcare fraud determine if the government will seek criminal prosecution. With early intervention and proven defense strategies, Oberheiden, P.C. is very successful in avoiding criminal charges for its clients. If you are a Michigan physician or provider and believe your practice is under investigation, you should speak with an experienced healthcare fraud defense attorney from our firm today. Together, we can discuss your situation and develop a defense plan.

Because the U.S. Attorney’s Office prosecutes both civil and criminal cases, a prosecutor’s involvement doesn’t always mean the target will be charged with a criminal offense. Likewise, communication from an OIG or FBI agent doesn’t always mean the target is subject to a criminal case. OIG and FBI agents are also the government’s investigative bodies for civil matters. From our own experience as federal civil healthcare prosecutors, however, we know cases that start as a civil investigation can turn into a criminal matter if poorly defended. Therefore, anyone who receives notice of investigation by these agencies should retain legal counsel as early as possible. Our team of attorneys has profound skill in determining if the government intends to seek civil or criminal penalties, or both. A few indicating factors include:

  • Search warrants,
  • Seizure warrants,
  • Arrest warrants,
  • Issuance of target letters,
  • Involvement of criminal prosecutors,
  • Involvement of the IRS, or
  • Issuance of grand jury subpoenas.

If you have questions, please call us directly. Our clients range from individual providers to entire healthcare systems. We represent clients in Michigan who are under investigation by the:

  • Department of Justice,
  • Department of Defense,
  • Federal Bureau of Investigation,
  • Drug Enforcement Administration,
  • Office of Inspector General,
  • Medicaid Fraud Control Unit,
  • Detroit and Michigan law enforcement, or
  • Internal Revenue Service.

Defending Healthcare Fraud

Oberheiden, P.C. is a healthcare fraud defense law firm. We have handled over 2,000 healthcare matters and tried more than 200 criminal cases in court. Many of our attorneys were previously in charge of healthcare audits and fraud investigations at the Department of Justice and they now offer their insights and experience with our clients. Our team is prepared to help clients across Michigan, including those in Detroit, Grand Rapids, Sterling Heights, Ann Arbor, Lansing, and Flint, who are faced with healthcare fraud allegations.

Our Top Priority

Our number one goal in every investigation is to avoid criminal charges. Based on our experience and success, we understand that the best way to avoid criminal prosecution is to act quickly. Don’t let the government build its case. Intervene early in the case while there is still room to impact the investigation. From the moment you engage our services, we will work to protect your freedom and your livelihood. Within the first hours of hire, we are often able to answer the most pressing questions:

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

Strongly Defending on the Basis of No Intent

The U.S. Constitution requires that for conviction, the government must prove criminal intent beyond a reasonable doubt. We enforce that high standard against all government threats of criminal prosecution. We know from experience that innocent mistakes happen and such mistakes do not equate to fraudulent intent. We reinforce that fact against prosecutors who point to mistakes in billing records to prove a defendant’s intent. Oberheiden, P.C. successfully defends clients across the country by explaining that any misinformation in their billing records resulted from organizational or human error, not from intent to defraud. Oversights such as unqualified staff, delegation and outsourcing errors, and insufficient supervision, in addition to complex and frequently changing billing rules may all lead to errors. But, errors do not equate to criminal intent. Michigan residents charged with healthcare fraud should call immediately to speak with our group of former healthcare prosecutors and investigations. Our attorneys are prepared to help clients across the state of Michigan.

Legal Defenses

In addition to having trial and negotiation skills to defeat a government case, the Michigan healthcare fraud defense attorneys of Oberheiden, P.C. also have the specific healthcare law knowledge to use legal defenses from the language of the law and statutory loopholes. We have won many cases by showing how exceptions, for example in the context of the Stark Law or medical necessity certifications, apply to our clients’ cases. Our arguments can often mitigate or entirely eradicate the government’s fraud case.

Protecting Your Reputation

We are committed to defending our Michigan clients against unfounded allegations of fraud. We understand individuals placed in such situations are concerned about their reputation. The media is a powerful tool that can ruin someone’s name or spread rumors about wrongdoings by presenting biased reports Our attorneys respond to slanderous reporting. They obtain coverage and look for opportunities to correct errors by presenting the truth to the public. This strategy is effective in defending both in the courtroom and the community.

Oberheiden, P.C. has appeared in healthcare proceedings across the country to help clients fight fraud charges. Call us today to discuss your situation with an experienced healthcare fraud defense attorney. We offer an initial free and confidential assessment to see the clearest path ahead for you and your business.

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.

Frequently Asked Questions

What Are Common Healthcare Fraud Charges in Michigan?

Detroit, Michigan is one of the country’s most heavily watched regions with respect to Medicare and Medicaid fraud. The types of healthcare fraud investigations are mainly targeted against:

  • Prescribers of opioids,
  • Physicians and business owners in the context of home health and hospice agencies,
  • Medicaid providers,
  • Cases involving billing fraud,
  • False Claims Act,
  • Civil Investigative Demand matters,
  • Violations of illegal kickbacks to referring physicians, and
  • Healthcare fraud bribery.

What is a Whistleblower?

A whistleblower is someone who provides evidence of healthcare fraud and other white collar crimes to the federal government. Whistleblowers can be current or former employees, business associates, patients, customers, or anyone else who comes across information they believe shows a healthcare provider violated a federal law. All whistleblower claims are brought under the False Claims Act, however, the alleged violation can be based on any federal healthcare fraud statute. When a whistleblower notifies federal investigators, the government determines if it will intervene in the case. If so, federal prosecutors, such as those in the Healthcare Fraud Unit of the DOJ, will formally bring the case. If the government decides it will not intervene, the whistleblower is still able to pursue the case. Whistleblowers who successfully bring a case, on their own or after the government intervenes, are entitled to a percentage of the amount recovered. This always raises some suspicion about the information whistleblowers provide. The accusations, while suspect, are taken seriously. Any healthcare provider facing healthcare fraud charges regarding a violation of the False Claims Act should quickly contact a Michigan federal healthcare fraud defense attorney.

What Are Michigan DEA Opioid Investigations All About?

Michigan, like the rest of the country, suffers from an opioid addiction crisis. To combat this crisis, the DOJ instructed federal prosecutors across the United States to target and prosecute physicians who allegedly prescribed too many opioids, benzodiazepines, stimulants, sedatives, and muscle relaxants between 2014-2018. The government’s contention is that healthcare providers operated pill mills and contributed to the addiction of thousands of patients throughout Michigan. Hundreds of physicians have been prosecuted and are awaiting trial on charges of healthcare fraud and violations of the Controlled Substances Act for practicing outside the accepted standards of medicine.

What Are the Penalties for Opioid Prescription Fraud?

Criminal violations of the Control Substances Act are subject to 21 U.S.C. 841 and, if charged as a conspiracy with co-defendants, to 21 U.S.C. 846. These two statutes authorize federal prosecutors to petition the court for up to ten years of federal prison for each criminal violation. If the alleged misconduct led to the death of a patient, a life sentence may be imposed.

  • 21 U.S.C. 846: Conspiracy to Distribute Controlled Substances
  • 21 U.S.C. 841: Criminal Violation of the Controlled Substances Act
  • 18 U.S.C. 1347: Healthcare Fraud

Don’t let this happen to you. If the DEA is investigating you or if your practice has been shut down by a DEA search warrant, immediately consult with an experienced lawyer to protect your rights and avoid being found guilty. Most DEA cases can be resolved positively. It’s your life, your livelihood. Choose the right attorney and fight back.


Michigan Healthcare Fraud Defense Attorney

Nick Oberheiden has represented clients in Qui Tam, False Claims Act, Medicare and Medicaid Fraud, Tricare Fraud, Stark Law, and anti-kickback proceedings. He has appeared before virtually all federal agencies including, but not limited to, the OIG, the HHS, the DOD, the DOJ, and the DOL. Dr. Oberheiden is trained in negotiations by Harvard Law School and holds a Juris Doctor as well as a Ph.D. in law.

Clients all across Michigan, including those in Wayne, Oakland, Macomb, Kent, and Genesee counties can call us today and speak to one of our experienced attorneys directly. A Michigan healthcare fraud defense lawyer is available to discuss your situation in a free and confidential call, including on weekends.

888-680-1745
Including Weekends

Oberheiden, P.C.
Serving Detroit & Michigan
888-680-1745
Federal-Lawyer.com

Additional Pages for Michigan

WordPress Lightbox