New York City Healthcare Fraud Defense Lawyer - Oberheiden, P.C.
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New York City Healthcare Fraud Defense Lawyer

New York City address – by appointment only:
30 Wall Street, 8th Floor
New York, NY 10005
212-970-9468
John W. Sellers
Attorney John W. Sellers
New York City Healthcare Fraud Defense Team Lead
Former DOJ Trial Attorney envelope icon Contact John
Nick Oberheiden
Attorney Nick Oberheiden
New York City Healthcare Fraud Defense Team Lead envelope icon Contact Nick
Will Newman
Attorney Will Newman
New York City Healthcare Fraud Defense Team Lead
Litigation Counsel
Roger Bach
Roger Bach
New York City Healthcare Fraud Defense Team
Former Special Agent (DOJ)

Healthcare fraud allegations in New York, New York, or the surrounding areas can devastate your career. Call Oberheiden, P.C. if you’re being investigated by the federal government. Ask to speak with a New York City Healthcare Fraud Defense Lawyer. Your initial call is free and confidential.

Our Healthcare Fraud Defense Team includes such talent as a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, several former healthcare fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. Oberheiden, P.C. has skills in:

  • Healthcare fraud defense,
  • Medicare and Tricare audit,
  • Protection of assets,
  • Compliance programs,
  • Jury trials,
  • Fraud allegation defense,
  • Qui tam defense,
  • OIG, and grand jury subpoenas,
  • Criminal defense, and
  • Internal investigations.

New York City Is Always Monitored by the Federal Government

In the United States, there are nine regions that undergo close scrutiny by the federal government for healthcare fraud. New York is one of those areas. New York, New York is watched by the Medicare Fraud Strike Force. This is a team of federal prosecutors and investigators from several federal agencies.

New York and the surrounding areas are monitored because of the number of people who rely on federal healthcare programs. This causes more claims to be filed with the federal government. The federal government sees the increase in claims as an increase in healthcare fraud.

In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year. OIG, HHS

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 Is Federal Healthcare Fraud?

Federal healthcare fraud occurs when one or more fraudulent claims are filed for payment with a federal healthcare program such as Medicaid, Medicare, Tricare, or federal workers’ compensation. These claims are filed with the federal government for medical services or equipment. It includes a violation of at least one of the following laws:

  • The Anti-Kickback Statute. Federal law restricts the exchange of money or other valuables for patient referrals. Anyone may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
  • Stark Law. Stark Law is more commonly known as the Self-Referral Law. It bars physicians from referring patients to certain healthcare entities if the physician or an immediate family member has an ownership or investment interest in the entity. Or, if there is a compensation arrangement between the providers. There are statutory exceptions to this law.
  • False Claims Act. If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an inquiry into your billing practices under the criminal provisions of the Act if you file such claims.
  • Prescription Fraud. Prescribing a high volume of narcotics is closely monitored by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA dispensing rules.
  • Billing Fraud. One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates:
    • Allegations of phantom billing (services not provided),
    • Ghost patients (patients who do not exist), and
    • Billing for medically unnecessary services or equipment.
  • Certification Errors. The federal government pays close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.

Oberheiden, P.C. works to protect our clients from criminal charges. If you’re being investigated for healthcare fraud in New York, New York or the surrounding areas, call our New York City healthcare fraud defense attorney immediately. Your initial call is free and confidential.

The Civil and Criminal Penalties of Healthcare Fraud in New York

New York Healthcare Fraud Defense Lawyer Healthcare fraud often results in civil and criminal penalties in New York. In civil court, you could be ordered to repay the federal claims in question, lose the ability to be reimbursed for future claims, and you could be barred from participating in federal healthcare programs.

If you face criminal charges, you could end up with a criminal record, huge fines, or even a federal prison sentence:

  • Up to 10 years for each count of healthcare fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury
  • Life sentence if the healthcare fraud resulted in death

One of the most common questions clients ask us in New York is what the worst-case scenario could be for healthcare fraud. The answer is criminal charges and a federal prison sentence. If you will be charged criminally or receive a prison sentence depends on several factors. The injuries suffered by the affected patients, whether the prosecutor sees an advantage in pursuing criminal charges, and why the investigation began are some of these factors.

Oberheiden, P.C. provides healthcare fraud defense strategies for clients in New York, New York and the surrounding areas. Our knowledge as former healthcare prosecutors for the federal government, in addition to our practice as defense attorneys, gives us a unique view of how these cases should be handled.

Is the Investigation Against You Criminal?

Healthcare fraud allegations in New York, New York and the surrounding areas most often start out as civil inquiries. However, they can quickly turn criminal. In order to protect yourself or your business, you should contact New York City healthcare fraud defense attorneys Oberheiden, P.C. as soon as you know that you’re being investigated.

Being contacted by a prosecutor is not necessarily an indication the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor alone as an indicator. Rather, signs of a criminal investigation may include:

  • Search warrants,
  • Seizure warrants,
  • Arrest warrants,
  • Target letters,
  • Contact from a federal criminal prosecutor,
  • Involvement from the IRS, or
  • Receipt of a grand jury subpoena.

Fundamental Legal Defenses to Healthcare Fraud

Oberheiden, P.C. is a healthcare fraud defense firm serving New York, New York and the surrounding areas. We analyze each case to determine the right defenses for each client. We’ve helped hundreds of clients. Many of our lawyers held former positions as healthcare prosecutors and auditors for the federal government. We use the skills acquired to develop fundamental legal defenses for our clients facing healthcare fraud allegations.

Immediate legal advocacy with the federal government. Our main objective is to protect our clients against criminal clients. Once we are retained, we promptly contact the federal government to start legal advocacy on your behalf. This immediate contact reduces the amount of time the federal government has to pursue the investigation. This is extremely important to your case. If the federal government has too much time to investigate you, you could face criminal charges. Our goal is to get answers to the most important questions within hours:

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

Proving a lack of criminal intent. The federal officials must meet a high burden of proof to prove that you not only committed a crime, but acted with criminal intent. We evaluate the government’s evidence to determine if they are able to meet that burden of proof. Often, the federal government will point to billing errors to show you committed a crime. Yet, we’ve found that these issues occur not because of fraud, but because of a mistake. While these mistakes should certainly be addressed and corrected, they shouldn’t cause you to face criminal charges. The most common mistakes causing these allegations include:

  • Use of unqualified workers,
  • Delegation errors,
  • Outsourcing errors,
  • Lack of oversight,
  • Insufficient supervision, and
  • Frequently changing laws and rules in healthcare billing.

Using applicable defenses. Oberheiden, P.C. analyzes the facts in each case to determine applicable defenses. This may include the use of statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a healthcare fraud case.

Defending your professional reputation with the media. One of the biggest concerns of our clients is how their professional reputation will be affected by fraud allegations. Oberheiden, P.C. works to preserve your stature in the community. Our lawyers will watch for opportunities to correct misinformation, and we address slanderous commentary from the media.

If you’re being investigated for healthcare fraud in New York, New York or the surrounding areas, you should contact Oberheiden, P.C. now. The initial call is free and confidential.

Frequently Asked Questions

How can a New York City federal healthcare defense attorney help me with a healthcare fraud case?

 

A skilled New York City federal healthcare fraud defense attorney will have a history of successfully resolving cases. For example, the first thing a lawyer will do is help you keep from making matters worse. For example, an attorney can advise you on how to speak with investigators so additional suspicions are not aroused. From there, your attorney will contact investigators. Not only will this slow the investigation, but it will provide you with information about the government’s case. You and your attorney will develop an in-depth understanding of the case. Then, the two of you will work together to develop an effective defense strategy. While every case is different, the typical approach is to first determine whether criminal charges are likely. Then, do everything possible to avoid them. To learn more about the best way to defend against healthcare fraud charges, contact a New York City federal healthcare fraud defense attorney.

When should I contact an NYC federal healthcare fraud defense attorney?

 

Once you are aware of the investigation for healthcare fraud, you should contact a federal healthcare fraud defense attorney in New York City quickly. By retaining an attorney early in the process, you and your attorney can follow the case’s progression from the outset. This gives federal investigators less time on their own to investigate and come to their own conclusions. In some instances, an attorney can convince federal investigators their initial impressions were incorrect, and charges are not warranted. Even if civil or criminal charges are filed, however, your attorney is a valuable ally in the process. If you are under investigation for healthcare fraud, contact a New York City federal healthcare fraud defense attorney as soon as possible.

What is the Anti-Kickback Statute?

 

The Anti-Kickback Statute (AKS), codified in 42 U.S.C. §1320a–7b, is a federal law placing limits on medical providers’ ability to engage in kickback arrangements. The statute prohibits a medical provider from offering, paying, soliciting, or receiving money (or anything else of value) in exchange for patient referrals when the patient is covered by any federally funded program. Most violations of the AKS cases involve Medicaid or Medicare. While most cases also involve the payment of money for referrals, other kickbacks may include vacations, favors, meals, or even employment. The AKS is a criminal law, and a conviction carries potential jail time and other criminal sanctions. However, those in violation may also face civil liability under the False Claims Act. If you are facing a violation under the Anti-Kickback Statute, it is crucial you protect yourself by speaking with a dedicated New York City federal healthcare fraud defense attorney today.


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.
 

Our New York City healthcare fraud defense lawyers are available every day of the year. You can call us directly or complete our contact form.

 

Additional Pages for New York City, New York

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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