What Are the Penalties for Medicare Fraud in Ohio?

Find Out (For Free) Why Ohio Healthcare Providers Hire Oberheiden, P.C.: 888-680-1745

Healthcare providers and business owners in Ohio have seen an increase in federal Medicare, Medicaid, and billing fraud allegations. Federal prosecutors paint many of these respected individuals as lawbreakers. In this climate of aggressive enforcement, physicians and business owners need proven lawyers. Our team has shown in hundreds of cases how to convince the government, judges, or juries that medical billing fraud allegations are false.

Lawyers Dedicated to Defending Ohio Healthcare Providers

When you face audits or find yourself in the middle of a federal investigation, Oberheiden, P.C. is on your team. Our firm has a long record of protecting physicians against unjust fraud charges and license sanctions. Our attorneys have shown their ability to resolve career-threatening Medicare and Medicaid fraud, referral kickbacks, opioid prescription misuse, and other fraud allegations. If your freedom is on the line, call 888-680-1745. Do what so many clients before you have done. Trust Oberheiden P.C. and let us accomplish your goals. We have successfully represented:

• Mobile Ambulance Transportation Cases
• Mobile Radiology Services
• Home Healthcare Agency (Form 485 Cases)
• Hospice Care Representation
• Illegal Kickbacks
• Any Form of Medicare Fraudulent Billing
• Mental Healthcare Providers
• Cardiologists
• Urologists
• Dialysis Centers
• Dentists
• Family Medicine Doctors
• Internal Medicine Specialists
• Pain Management Doctors
• Psychologists
• Psychiatrists
• Medicare Clinic Owners
• Nurses

What Are the Penalties for Civil Medicare Fraud in Ohio?

Medicare fraud can be civil and criminal. In civil cases, the Office of Inspector General (OIG), a federal agency that investigates healthcare fraud with the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ), has jurisdiction. These agencies have may impose civil penalties on providers and companies receiving Medicare funds by fraud.

Civil violations include submitting false and fraudulent claims, physician self-referrals, kickbacks, drug price reporting, and other violations done without criminal intent.

Most civil investigations begin with a subpoena from the HHS-OIG. Many of these cases involve whistleblowers. They are often former employees who report fraud in order to collect a reward under the False Claims Act.

Recent changes in legislation have doubled the already huge fines attached to civil healthcare fraud. For example, certain Civil Monetary Penalty Law (CMPL) violations increased from $10,000 to today’s $20,000 per false claim.

What Does the Government Have to Prove in Ohio Medicare Fraud Cases?

Medicare Fraud as a federal crime is regulated in 18 U.S.C. 1347. The statute says a person is guilty of healthcare fraud in Ohio federal court if the government prosecutors can prove beyond a reasonable doubt:

• The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare benefit program by means of false or fraudulent pretenses, representations, or promises;
• The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the healthcare benefit program; and
• The defendant acted with the intent to defraud the healthcare benefit program.

Because healthcare and Medicare fraud are federal offenses, violations are mostly handled by Ohio-based federal law enforcement agencies. Included are the Federal Bureau of Investigation (FBI), the OIG, and the Ohio Medicaid Fraud Control Unit (MFCU). Offenses are prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office in Cleveland, Columbus, Akron, or Cincinnati.

What Are the Penalties for Criminal Medicare Fraud or Medical Billing Fraud in Ohio?

Federal prosecutors target business owners and physicians in a variety of fraud cases. The following examples demonstrate the level healthcare fraud enforcement has reached in Ohio.

• An Ohio CEO and four doctors were indicted for their alleged roles in a Medicare fraud scheme where several clinics prescribed illegal medications. Charges allege the CEO owned and operated pain clinics in Ohio and conspired with clinic doctors to prescribe and sell opioids for cash. The CEO and doctors prescribed medically unneeded Oxycodone and Hydrocodone to Medicare patients. They then split the proceeds after Medicare reimbursed the fraudulent prescriptions. The doctors also sold these opioids on the street for cash payments. The CEO and four doctors were charged with conspiracy to commit healthcare fraud, money laundering, and wire fraud. All defendants have pleaded not guilty.
• An owner of several substance abuse treatment centers throughout Ohio is under investigation by the Ohio MFCU for a multi-million-dollar fraud scheme. The complaint says the owner allegedly had his employees bill Medicaid for services not properly documented. In addition, the owner directed staff to bill for inflated services more costly than those provided. The complaint also alleges unethical treatment of patients admitted to the recovery centers. Given unauthorized drugs for withdrawal symptoms, patients often had to wait days before seeing a doctor. This case is ongoing.
• Five people in Ohio were indicted for their roles in defrauding Medicaid and Medicare in a home healthcare conspiracy. The five people owned and operated several home health agencies throughout Ohio. They allegedly billed Medicare and Medicaid for services not performed. Charges allege the owners forged medical records to show services provided that were, in fact, not provided. The five people charged allegedly caused $7 million in losses to Medicare and Medicaid.
• Two owners of an Ohio based home health agency were found guilty of Medicaid fraud. According to evidence, the owners ordered employees to falsify patient records to qualify them for home health services to which they were not entitled. The forged medical records resulted in over $100,000 in fraudulent home health services billed to Medicaid for payment. The owners were found guilty of felony counts of Medicaid fraud and tampering with evidence.
• Convicted by a federal jury in a scheme to over-bill Medicare, a cardiologist performed numerous procedures that weren’t medically necessary. Patients had potentially dangerous medical tests in order to submit more bills for payment. The doctor wrote false symptoms on patient charts. He then lied to patients telling them they had cardiac issues they really didn’t have. Using fraudulent symptoms, the heart specialist performed nuclear stress tests, cardiac caths, and inserted cardiac stents – all without need. The doctor billed the medically unnecessary procedures to Medicare. He used his falsified patient records as rationale for the procedures. As a result of this scheme, Medicare paid out $5.7 million. The cardiologist was sentenced to 20 years in prison for his role.
• An Ohio man who pretended he was a doctor pleaded guilty to defrauding Medicare. According to the plea agreement, he worked for a home health agency and acted as the agency’s licensed physician. He was not, in fact, a medical professional. The man saw patients and represented himself as a doctor. He certified patients for home health services with these false credentials. The fraudulent services provided based on the certifications were then billed to Medicare for payment. As a result of the scheme, Medicare paid out more than $6 million.
• An Ohio based hospital agreed to a monetary settlement for its alleged role in Medicare fraud. According to the settlement, the hospital knowingly approved medically unneeded spinal surgeries. The cost of the fraudulent surgeries was billed to Medicare for payment. The surgeon who performed the surgeries was indicted for his role in the scheme. However, following his arraignment, he fled the United States and remains a fugitive. To settle the allegations, the hospital agreed to pay $4.1 million back to Medicare. Since this case ended with a settlement, there has been no finding of liability against the hospital.
• An Ohio hospital and an Ohio Heart Center agreed to a monetary settlement with the United States for their alleged roles in submitting false Medicare claims. The settlement shows the hospital and the heart center had allegedly been performing unnecessary heart procedures on Medicare patients. Angioplasties and stent placements were performed on patients who did not have the medical symptoms to support these procedures. The medically unnecessary cardiac procedures were then billed to Medicare for payment. To settle these allegations, the hospital will pay $3.8 million back to Medicare. The heart center will pay around $500,000 back to Medicare. Since these allegations ended with a settlement, there has been no finding of liability against the hospital or heart center.

The sentencing in Ohio Medicare Fraud cases depends on the calculated recommendations under the Federal Sentencing Guidelines. Generally speaking, the higher the damage amount to Medicare/CMS, the higher the sentence.

If you have any questions or concerns, need to better understand the penalty calculation for Medicare Fraud in Ohio, or need to get guidance for an upcoming sentencing hearing—call Oberheiden, P.C. today for a free and confidential consultation. We are also available on weekends. Reach us at 888-680-1745

Don’t Let the Government Take Your License or End Your Career

If you are concerned about a healthcare investigation in Ohio, don’t delay and give the government more time to investigate you. Speak with qualified lawyers who can give advice on how to build a defense based on hundreds of cases like yours. Your life, your reputation, and your time with your family is at stake. Carefully interview attorneys to identify those with real experience in defending physicians, business owners, and other members of the healthcare industry. As a suggestion, ask the following three questions:

• Which lawyer will handle my case?
• How many cases has that lawyer handled that are like my situation?
• Do you have flexible payment terms?

Call Oberheiden, P.C. Today and speak to senior counsel rather than secretaries, paralegals, or lawyers who will delegate your important case to someone else once you sign the retainer contract. Call 888-680-1745 to get the answers you deserve.