Philadelphia, Pennsylvania Medicare Fraud Defense Attorney

Oberheiden, P.C. is a Medicare fraud defense law firm serving Philadelphia and the surrounding areas. We are legal advocates for individuals, facilities, and businesses under investigation by the federal government, involved in a qui tam lawsuit, named in a jury trial, or those involved in a federal audit. Our skilled defense team also provides planning for federal compliance programs to help clients avoid potential issues. Oberheiden, P.C. is a team of attorneys that includes former healthcare fraud prosecutors. Initial consultations are free and confidential.

Defining Medicare Fraud

Medicare fraud is a federal violation. It involves claims that are filed with federal healthcare programs such as Medicare, Medicaid, Tricare, or federal workers’ compensation. When a claim has an error or looks suspicious, you may find yourself under investigation for Medicare fraud. If the federal government accuses you of Medicare fraud, you’re being accused of violating at least one of the following statutes or laws:

• Anti-Kickback Statute;
• False Claims Act;
• Stark Law;
• Social Security Act;
• S. Criminal Code

There are nine locations in the United States that undergo constant surveillance by the federal government for Medicare fraud. Philadelphia is one of those areas. Philadelphia, Pennsylvania has a large population that relies on a federal healthcare program. That means more claims are filed in the area. The increase in claims leads the federal government to believe that there are also more instances of Medicare fraud.

The federal government uses a hybrid team of investigators and prosecutors known as the Medicare Fraud Task Force. This team is made up of representatives from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. This list is not all-inclusive. Other federal agencies can be involved. If you’re under investigation by the Medicare Fraud Strike Force or if you’ve been contacted by a federal agency, call Oberheiden, P.C. Initial consultations are free and confidential.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Medicare Fraud Investigations in Philadelphia

Philadelphia Medicare fraud investigations often begin because of a mistake made on a federal healthcare claim. The mistake most often occurs during coding or billing. Common billing mistakes include an unauthorized charge, an incorrect charge, or an excessive charge. Common mistakes on claims from Philadelphia are:

• Phantom billing – billing for services that were never performed;
• Double billing for medical equipment or services;
• Submitting a claim for medically unnecessary medical services or equipment;
• Submitting a claim for medically unnecessary medical supplies;
• Submitting a claim for a medically unnecessary certification (including a claim for hospice or home healthcare);
• Inflating charges;
• Up-coding;
• The overuse of medical equipment of services;
• Providing or accepting kickbacks.

In Philadelphia, the most commonly investigated targets are doctors, nurses, pharmacists, pharmacies, and nursing homes. Keep in mind that any person, business, or facility that files a claim with a federal healthcare program can be investigated.

Medicare Fraud: Civil and Criminal Penalties

Medicare fraud includes civil and criminal charges. These lawsuits, regardless of whether they are civil or criminal, are filed in federal court. Federal civil penalties may include:

• Repayment of claims in question;
• Future claims aren’t paid;
• A fine of up to $11,000 per false claim;
• Exclusion from federal healthcare programs;
• Assignment of treble damages;
• Attorney fees

You could also lose your hospital privileges and your professional license.

Federal criminal penalties include:

• Fines that cost you hundreds of thousands of dollars, even for a misdemeanor;
• A criminal record;
• A federal prison sentence of up to 10 years for each count of Medicare fraud for which you are convicted;
• Federal prison sentence of up to 20 years for each count of Medicare fraud that resulted in serious bodily harm to the patient or patients;
• A life sentence in federal prison for Medicare fraud that results in the death of a patient.

Finding a Medicare Fraud Defense Lawyer Serving Philadelphia

In Philadelphia, a Medicare fraud investigation can include criminal charges. You need a healthcare fraud defense attorney in order to navigate both the healthcare law aspect and the potential criminal charges that may be associated with it. Choose a healthcare fraud defense attorney who has:

• A successful record when handling Medicare fraud cases;
• Knowledge of the Medicare and healthcare fraud laws and regulations;
• Knowledge of statutory exceptions;
• Both litigation and jury trial experience.

You should then ask the healthcare fraud defense attorney the following questions:

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

Medicare Fraud Strategies for Philadelphia Clients

Oberheiden, P.C. is a Medicare fraud defense firm. We’ve helped hundreds of clients settle their cases or go to trial. We have used our skills to develop Medicare fraud strategies that we implement for our Philadelphia clients.

Contacting the federal government. Our lawyers immediately contact the federal government to begin the process of resolving the allegations. To start, we ask the important questions:

• What is the investigation about?
• What prompted the investigation?
• Is the investigation civil or criminal?
• Which federal agencies are involved?
• What is the ultimate goal of the government?
• How can this matter be resolved?

Getting answers to these questions can help us plan your defense, and it can mean the difference between a civil settlement and criminal charges. Often, we get answers to those questions in just a few hours.

Reviewing the evidence provided by the federal government. We analyze and question the evidence used by the federal government. This one strategy often results in:

• Dismissal of charges;
• No criminal charges;
• Client retains professional license;
• Civil fine with no criminal plea;
• Reducing a felony to a misdemeanor;
• No federal prison sentence.

Lack of criminal intent. Additionally, the federal government must prove that you acted with criminal intent. This is hard for them to prove since most Medicare fraud cases start because of a mistake. The most common mistakes in Philadelphia are:

• Using unqualified staff;
• Inadequate supervision;
• Inappropriate delegation and outsourcing;
• Structural errors;
• Human errors;
• Oversight;
• Employees who are overwhelmed;
• No Medicare compliance program in place;
• The changing healthcare laws and rules.

Our objective is to show that you admit to making a mistake and you are willing to correct it.

Using the right defense strategies. Our defense team takes time to analyze the facts involved in each case. This enables us to use custom Medicare fraud defense strategies. One of our recent clients was accused of providing a fraudulent certification for home healthcare services. We were able to prove that our client was protected by a recognized delegation exception and that the certification was compliant within the law. In another recent case, we refused to admit liability on behalf of our client. Instead, we proved to the federal prosecutor that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. serves Philadelphia and the surrounding areas. We provide legal defense and advocacy for individuals, business owners, entire entities, attorneys, executives, hospitals, pharmacists, and pharmacies that are investigated for fraudulent billing, illegal kickbacks, allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. We can help you in many areas, including:

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

If you’re being contacted by the DOJ, Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Control Unit, the IRS, Philadelphia or Pennsylvania law enforcement, contact Oberheiden, P.C. right away. The initial call is free and confidential.

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