What Are the Penalties for Medicare Fraud in Philadelphia?

Find Out (For Free) Why Philadelphia Healthcare Providers Want Oberheiden, P.C. On Their Team: 888-680-1745

It’s not easy to be a doctor in Philadelphia. You want to help patients and improve lives, then you learn federal prosecutors from the U.S. Attorney’s Office in Philadelphia are after you. In fact, the United States Justice Department (DOJ) declared Pennsylvania one of the key locations to combat Medicare fraud. A Medicare Fraud Strike Force has been installed in Philadelphia to increase and expand healthcare fraud prosecutions. If anything, things are getting worse for doctors.

Oberheiden, P.C. is unlike other law firms. We focus our practice on defending healthcare providers and business owners. In hundreds of federal cases, we demonstrate that this special attention works. We don’t take drunk driving cases, we won’t assist you in legal problems other than protecting you, your license, and your freedom when under investigation. When the FBI, OIG, and DOJ allege Medicare fraud, Medicaid fraud, kickback allegations, False Claims Act matters and the like, we take it seriously. Call us today to experience what a difference we can make in defending you against possible charges or penalties for healthcare fraud in Philadelphia. 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 Pennsylvania?

Federal prosecutors in Pennsylvania employed by the U.S. Attorney’s Office in Philadelphia prosecute Medicare fraud as both civil and criminal matters. Most civil cases begin with a subpoena from the OIG requesting patient files, corporate documents, and financial information. If this happens to your business, be aware that many civil fraud cases originate from whistleblowers. These individuals report alleged fraud to federal authorities and file a federal civil complaint. Whistleblowers are most often attracted by the possible monetary rewards at stake by making such reports.

If not represented appropriately, your practice can quickly reach the stage of bankruptcy in such a case. Effective defense against a penalty such as tens of thousands of dollars for a single false claim requires a mastery of healthcare laws and significant federal defense experience.

Oberheiden P.C.’s lawyers have defended clients against civil fraud allegations in most states in the nation. Call us at 888-680-1745 to see how we would protect your business and your future.

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

Medicare Fraud is a classic federal healthcare law offense. Criminal statute 18 U.S.C. 1347 explains that a person is guilty of healthcare fraud in Philadelphia federal court if the government can prove beyond a reasonable doubt that the following elements exist:

• 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 fraud and Medicare fraud are federal offenses, violations are typically investigated by federal law enforcement agencies such as the FBI, the OIG, or the New Jersey Medicaid Fraud Control Unit (MFCU). Offenses are prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office in Philadelphia.

What Are the Penalties for Criminal Medicare Fraud in Philadelphia?

A defendant guilty of Medicare fraud in Philadelphia, PA and all other states, will be ordered to not more than 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment. In healthcare cases, the exact penalty depends on the alleged damage amount and the calculated sentencing recommendations based on Federal Sentencing Guidelines. Let us help you avoid these outcomes, call 888-680-1745.

• Five doctors in Pennsylvania were indicted for a scheme to defraud Medicare. The indictment alleges the doctors worked as contractors at various pain management clinics in Pennsylvania and prescribed medically unnecessary drugs. The doctors allegedly billed Medicare for reimbursement for the unauthorized prescriptions. If convicted, each doctor could face a maximum of 10 years in prison.
• A Pennsylvania man was indicted for his role in a scheme to defraud Medicare. He owned an ambulance company and allegedly billed Medicare for transports when the patients were not eligible for them. The indictment states the man used his ambulances to transport dialysis patients who could walk, then created fake run sheets to suggest the patients were bedridden. The cost of the medically unnecessary transports was then billed to Medicare for reimbursement. As a result of the scheme, Medicare paid $5.5 million based on fraudulent transports.
• A medical device company in Pennsylvania agreed to a settlement with the United States for allegations it defrauded Medicare. It was alleged the medical device company provided kickbacks to Durable Medical Equipment (DME) companies in exchange for the DME companies selling the device company’s sleep apnea mask. The device company provided free services to the DME company as long as the DME company exclusively sold the device company’s mask. If the DME company did not exclusively sell the device company’s mask, the DME company would have to pay a monthly fee to the device company. As a result of the settlement, the device company will pay $34 million to resolve the allegations. Since the device company agreed to settle, there was no finding of liability.
• A PA healthcare company agreed to settle with the United States for claims of Medicare fraud. The healthcare corporation allegedly billed Medicare for medically unnecessary services provided at its Long Term Care Hospitals (LTCH). The corporation certified patients for long-term care when these patients were not qualified to receive such care. The corporation is also alleged to have ignored its own clinicians’ judgment and kept patients in long-term care even when a physician recommended discharge. The services provided to patients who were not eligible to receive long-term care were billed to Medicare. As a result of this settlement, the corporation will pay $32 million back to Medicare.
• A federal jury in Pennsylvania convicted a nurse of healthcare fraud for her role in billing fraudulent services to Medicare. Evidence at trial showed that the nurse was director at a home health agency and provided skilled nursing services to patients who were not eligible to receive home health services under Medicare guidelines. These services were then billed to Medicare as authentic charges. The jury convicted the nurse of four counts of healthcare fraud.

Do you have questions or concerns, or need to better understand the penalty calculation for Medicare fraud in PA? Do you need guidance for an upcoming sentencing hearing? Call Oberheiden, P.C. today for a free and confidential consultation. We are also available on weekends. Call 888-680-1745.