Ohio Medicare Fraud Attorneys

Oberheiden, P.C. is a healthcare law defense firm that specializes in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our firm has talented attorneys with years of relevant experience and education from the country’s best schools, such as Harvard and Yale Law Schools. Our attorneys serve clients in Ohio and surrounding areas.

Health care providers and related businesses in Ohio risk facing allegations of Medicare fraud. If you’re under investigation for Medicare fraud, you need an experienced team of legal advocates. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and Oberheiden, P.C managing partner.

What You Need to Know About Medicare Fraud in Ohio

Medicare fraud is a federal offense with civil and criminal penalties. It occurs when a false claim is submitted to the government for illegal reimbursement. However, Medicare fraud includes more than just Medicare. It also covers Medicaid, Tricare, and federal workers’ compensation. When accused of Medicare fraud, you’re being accused of breaking at least one of these federal laws:

• Physician Self-Referral Law (also known as Stark Law)
• False Claims Act
• Anti-Kickback Statute
• U.S. criminal code
• Social Security Act

Ohio has more Medicare fraud investigations than the majority of the United States. Ohio is one of nine areas in the U.S. closely monitored by a Medicare Fraud Strike Force for False Claims Act violations. Ohio receives such scrutiny because of a large population with benefits from a federal healthcare program. In areas with a great number of beneficiaries, more claims are filed. More claims lead the federal government to believe Medicare fraud is likely taking place. The Medicare Fraud Strike Force watches these areas closely to identify, investigate, and prosecute fraud offenses.

The Medicare Fraud Strike Force and Medicaid Fraud Control Unit are a federal team from several federal agencies. Investigations for Medicare fraud in Ohio may bring you into contact with agents of the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. Other federal agencies may also be involved.

What Causes Most Medicare Fraud Investigations in Ohio?

One of the most commonly asked questions that we hear is what causes Medicare fraud investigations in Ohio. Billing mistakes by medical providers cause most of the Medicare fraud investigations that occur. These mistakes are noticed by the government and labeled as fraudulent billing practices or reimbursement requests. They often include what the government believes to be fraudulent, unauthorized, or excessive charges. Health care fraud occurs by:

• Phantom billing (billing for services that weren’t performed)
• Billing for medically unnecessary services or equipment
• Billing for equipment or services that weren’t ordered
• Certifications for medically unnecessary supplies or services (such as medical devices or hospice care)
• Charge inflation
• Double billing for equipment, services, or treatment

• Upcoding for equipment, medical services, diagnoses, or treatment

• Overuse of services or equipment
• Providing or accepting kickbacks

We are also routinely asked who is most likely to be investigated in Ohio. The fact is, any healthcare provider or company can come under suspicion of a government agency. Our Ohio Medicaid fraud lawyer can help identify your risks and find ways to avoid them.

Serious Civil and Criminal Liabilities

Medicare fraud in Ohio is serious. There are both civil and criminal penalties for those who committed health care fraud. In some cases, you may face both. If you’re in Ohio and under investigation for Medicare fraud, call Oberheiden P.C. right away.

Civil penalties may include one or more of the following:

• Assessment of treble damages
• Civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future claims
• Exclusion from federal healthcare programs
• Assessment of attorney fees
• State disciplinary action
• Loss of professional license
• Loss of hospital privileges

Criminal penalties can damage your livelihood and possibly, your freedom. One or more of the following are possible when it ends on a health care fraud conviction:

• A criminal record
• Heavy fines
• 10 years in federal prison for each count of Medicare fraud for which you are convicted
• 20 years for each count of Medicare fraud if it resulted in serious bodily injury to the patient
• A life sentence if the Medicare fraud resulted in the death of the patient

Ohio Medicare Fraud Defense Requires the Right Attorney

Medicare fraud allegations are very serious. You need an Ohio Medicare fraud attorney. One who can plan and present a successful defense based on the facts of your case. An attorney with the necessary skills and experience to guide you is vital for criminal and civil cases.

Medicare fraud allegations lead many to believe the best legal choice is an Ohio healthcare lawyer. Although healthcare attorneys know laws in their industry, they may not be prepared to manage federal criminal charges. Charges such as wire fraud, mail fraud, tax evasion, and money laundering require specific expertise. In addition, a healthcare attorney may lack negotiation and defense skills, which can only be gained through trial experience.

The mention of criminal charges leads many people to hire an Ohio criminal defense attorney. However, most criminal defense attorneys don’t have experience handling federal criminal charges. It is unlikely that they will know healthcare laws, billing, coding, and medical utilization rules.

You need someone who can handle both healthcare and federal criminal charges. You need an Ohio healthcare fraud defense attorney. As you seek an attorney, watch for these four traits:

• A proven record of success in health care fraud cases

• Industry knowledge
• Expertise in healthcare laws and their exceptions
• Litigation and trial experience

After you’ve collected a list of potential lawyers, you must closely review their experience. To decide if they can help you on your alleged health care fraud, ask the following questions:

• How many Medicare fraud cases have you handled during your career?
• How many of those cases resulted in neither civil nor criminal charges, or in dismissals?
• How many Medicare fraud cases have you tried in court?

Medicare Fraud Defenses for Ohio

Oberheiden, P.C. uses proven and strategic Medicare fraud defenses for our Ohio clients. Many of our Ohio Medicare fraud lawyers are former federal prosecutors. With their expertise, we’ve developed some basic principles to develop defense strategies. The goal behind these principles is to reduce the risk of criminal charges.

Contact with investigators happens promptly. Experience shows that contacting federal investigators early is one of the best ways to protect our clients. The more time the federal government has to investigate, the more likely you’ll face criminal charges. We contact the federal government as early as possible to get answers to important questions like:

• What is the investigation about?
• What prompted the investigation?
• Is this civil or criminal?
• Which federal agencies are involved in the investigation?
• Who is being investigated?
• How can the matter be resolved?

We are often able to get answers within a few hours of our hire. The answers also help us determine what is needed to best defend our clients.

First, evidence must be presented to show that a crime was committed. Second, the government must prove beyond a reasonable doubt that you committed the crime. We analyze the evidence presented for each case to decide if the government can reach this standard. Based on this strategy, our Ohio Medicare fraud attorneys regularly achieve the following results:

• Case dismissal
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reducing a felony to a misdemeanor
• No prison time

No criminal intent. In addition to showing that you’ve committed a crime, the federal government must prove criminal intent. Not an easy process as few cases come about because someone intentionally defrauded the government. Rather, these cases often begin with an honest mistake. The most common mistakes resulting in Medicare fraud cases in Ohio include:

• Relying on unqualified or untrained staff
• Inadequate supervision of staff
• Delegation and outsourcing of work to unqualified entities
• Business errors
• Human error
• Oversight
• Overwhelmed staff
• Lack of a Medicare compliance program
• Failure to keep up with changing healthcare laws and rules

Ohio healthcare providers and others accused of Medicare fraud often accept the penalties. They assume that they must have committed a crime. They don’t realize that the government must prove they acted with criminal intent. Mistakes need correction, but they are not criminal acts and shouldn’t be treated as such.

Oberheiden, P.C. strives to show the government that our clients did not act with criminal intent.

Developing and using applicable defenses for each Ohio client. Oberheiden, P.C. examines each case to determine the best strategic defenses available for our clients. We handled a Medicare fraud case that accused our client of fraudulently certifying home healthcare services. We proved that our client had the protection of a recognized delegation exception. The exception rendered the certification completely legal. In another case, we refused to admit responsibility. We proved to federal prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. provides superior Medicare fraud defense for Ohio healthcare providers and businesses. We provide counsel in cases of illegal kickbacks and fraudulent billing practices, as well. In addition, our Ohio Medicare fraud lawyers can assist with allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. Our services don’t stop there. We have expertise in the following:

• Healthcare fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

Oberheiden, P.C. provides legal representation for providers, businesses, and facilities in the State of Ohio. If you’re under investigation by the federal government, call us immediately. Initial consultations are free of charge and confidential.

We are available every day of the year. You can call or email us directly, or complete our contact form.