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New Mexico Hospice Fraud Defense Lawyers

The U.S. government began intensifying its hospice fraud investigations in 2015. Hospice providers in New Mexico and across the country are facing accusations of criminal conduct and the potential for civil penalties. The government believes many hospice providers are committing healthcare fraud by billing their dying patients for unneeded services. As a federal felony, you could be facing years in prison. If you have received a subpoena or are under investigation for hospice fraud contact Oberheiden, P.C. today.

The last thing you want is the government branding you a criminal or imposing fines and penalties that cost you your business. Our former federal prosecutors and experienced defense lawyers will help you protect your legal rights. Call Oberheiden, P.C. today at 888-680-1745 to speak with a former federal prosecutor. Initial calls are free and confidential.

You Have Been Accused of Hospice Fraud. What Now?

The federal healthcare fraud statutes cover any person or business that directly or indirectly contracts with the United States government. Hospices and their owners, executives and employees can suffer criminal penalties and civil liability for hospice fraud. At some point, almost every for-profit hospice company in New Mexico will be accused of fraud.

Booming Business

Federal agencies have been carrying out criminal search warrants against hospices with increasing frequency. Recent statistics show that more than half of all Medicare patients die while under in-patient or at-home hospice care. As a result, hospice care is a booming business, and this gets the government’s attention. Sadly, it also means that more and more hospices are charged with fraud.

Example: In 2015, a federal appeals court upheld a 15-year prison sentence and $16.2 million restitution order for a home hospice owner found guilty of paying for referrals and paying doctors and nurses to falsify patient records.

Certification Errors and Unnecessary Services Lead Hospice Fraud Accusations

Falsifying records and paying or receiving kickbacks are common accusations in charges for healthcare fraud. However, the most common fraud charges against hospices center on a Medicare rule. The rule states hospice care should only be provided if a physician certifies the patient has six months or fewer to live. Lack of certification, false certifications, and failure to release patients when their life expectancy improves are common accusations.

The federal government files fraud charges against providers for ordering medications not for pain or symptom relief, but for treating a patient’s underlying condition. In a hospice setting, patients must agree to cease medical treatment and accept only palliative care. The government also accuses hospices of ordering unneeded or redundant medical equipment, such as wheelchairs or walkers. Most of the time, these cases are chosen based on nothing more than data analytics. When numbers suggest certain hospices are “outliers” in terms of claims for payment, they fall under suspicion of fraud. Cap repayments, live discharges, elevated levels of care, length of stay, and use of particular diagnostic codes are all tracked to show possible fraudulent billing.

What Are the Penalties for Hospice Fraud?

You don’t have to intend to commit hospice fraud to violate the law. In fact, the government doesn’t need to prove you had any knowledge of the wrongfulness of the action to obtain a conviction.

If found guilty, you could be exposed to:

  • Recoupment requests,
  • Civil fines of $11,000 per false claim,
  • Criminal fines,
  • Non-payment of future claims,
  • Exclusion from federal healthcare programs,
  • Treble damages,
  • Attorneys’ fees, and
  • Incarceration in federal prison.

The potential of facing charges for Medicare, Medicaid, Tricare, and other types of healthcare fraud should motivate you to invest time and resources in working with an experienced New Mexico hospice fraud defense attorney. Your attorney will help you develop a strategic and thoughtful defense plan.

Government Investigation: Civil or Criminal?

Hospice fraud is investigated by the:

  • Office of Inspector General (OIG),
  • Department for Health and Human Services (HHS),
  • Department of Justice (DOJ),
  • Federal Bureau of Investigation (FBI),
  • Medicaid Fraud Control Units (MFCUs), and State Medicaid Agencies in cooperation with the Healthcare Fraud,
  • Prevention and Enforcement Action Team (HEAT),
  • General Services Administration (GSA), and
  • Centers for Medicare and Medicaid Services (CMS).

One of the first questions to answer is whether the investigation is civil or criminal. Healthcare fraud statutes offer both and the type of investigation you face will determine how your lawyer defends you. At Oberheiden, P.C., we can figure out if you are facing civil allegations or criminal charges and respond accordingly.

How do we do this? We rely on years of experience and the insight and knowledge of former government officials to spot key details. These may include:

  • How you were notified about the investigation.
  • Which agent and which federal agency contacted you.
  • The government official in charge of the investigation.

Note, the involvement of a prosecutor or a federal agency doesn’t always mean your case is a criminal matter.

How We Defend Against Accusations of Hospice Fraud

When you hire the attorneys and former government officials at Oberheiden, P.C., one of the first things to notice is that we know your industry and how the government is building its case against you.

When you work with our New Mexico hospice fraud defense lawyers at Oberheiden, P.C., you get:

  • Industry Knowledge. Hospice fraud charges often stem from billing and coding errors. Thus, it is critical for your attorneys to have a thorough understanding of CMS protocols. Don’t let misreadings of coding policies or missed updates to billing changes expose your business. Our attorneys have analyzed, reviewed, and defended close to 500,000 billed claims. If you are accused of certification errors, you need lawyers who understand the requirements of hospice certifications to get your case dismissed.
  • Government Experience. The difference between guilt and simple human error is often a fine line. Explaining it requires convincing negotiation skills and an attention to detail. The lawyers and former government officials of Oberheiden, P.C. have proven healthcare and law enforcement prowess. Our attorneys have extensive experience handling all types of fraud allegations in the healthcare industry. Take a look at our track record to see for yourself.
  • Aiming to Avoid Criminal Charges. We want to keep investigations civil and take criminal prosecution off the table. Our New Mexico defense attorneys can often persuade the government that errors were not intentional. They were honest mistakes and human error. Keeping the government focused on a civil result is critical. In each fraud case, prosecutors have two choices. They can conduct a civil investigation for recoupment, or they can prosecute criminally for imprisonment. The law provides for both.

Our “Emergency Defense Package”

If accused of hospice fraud, there’s no time to waste. Our “Emergency Defense Package” has been featured in news and media across the country. It’s a tool to provide immediate help to clients under federal scrutiny. The “Emergency Defense Package” was developed over years of federal criminal practice to address your most pressing questions:

  • Is the investigation civil or criminal?
  • Should I talk to the government?
  • Do I have a duty to talk to federal agents?
  • What should I tell my employees?
  • Can I continue my business?
  • What happens next in my case?

The “Emergency Defense Package” was developed by our defense attorneys and former government officials. It is designed to provide instant assistance for hospice owners facing federal allegations. The “Emergency Defense Package” explains several steps to help you take control of the situation. It can help you from becoming a victim to government tactics during investigations. Call us today to find out how our “Emergency Defense Package” will make a difference in your case.

A Team You Can Trust

New Mexico Hospice Fraud Defense LawyersThe attorneys at Oberheiden, P.C. have successfully defended clients against Medicare, Medicaid, and Tricare fraud, as well as, Anti-Kickback, and False Claims Act accusations. We have concluded many healthcare fraud cases with no civil or criminal penalties for our clients. We represent clients in civil and criminal investigations throughout New Mexico.

Call us today to discuss your case with one of our attorneys. All initial assessments are free and confidential. Let our New Mexico hospice fraud defense lawyer show you how we can fight to help you. Above all, we want to avoid federal charges or have your charges dismissed.

Our Track Record

  • Investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services and the Office of Inspector General for alleged Healthcare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General for alleged healthcare fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability, case dismissed.
  • 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, case dismissed.

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