Phoenix Medicare Fraud Defense Attorney
Phoenix Medicare Defense
Team Lead
Contact Nick4435 E. Chandler Blvd. Suite 200
Phoenix, AZ 85048
888-680-1745
Medicare fraud is a federal crime that can devastate your Phoenix medical practice or business. If you’ve been accused of Medicare fraud, contact the Phoenix Medicare fraud defense attorneys at Oberheiden, P.C. Our firm is skilled in defending healthcare providers in audits under federal healthcare programs, developing Medicare fraud defense strategies, asset protection, qui tam defense, OIG subpoena responses, grand jury subpoena responses, federal criminal defense, and internal investigations. Our team of Phoenix Medicare fraud defense lawyers includes a former Chief Healthcare Fraud Coordinator from the U.S. Attorney’s Office, former federal healthcare prosecutors, and former federal senior U.S. Department of Justice (DOJ) trial attorneys.
What Is Medicare Fraud?
Medicare fraud is a violation of federal law. It can have civil or criminal consequences depending on the circumstances involved. It happens when one or more claims are filed with Medicare by healthcare providers, businesses, or entities that do not comply with the Medicare billing regulations or federal law. These accusations can result in an investigation into potential violations of statutes including following:
- Anti-Kickback Statute;
- False Claims Act;
- Stark Law;
- Social Security Act;
- U.S. Criminal Code
Medical providers, pharmacies, and other medical entities are investigated for Medicare fraud in Phoenix, Arizona more often than most other cities. This is because Phoenix is one of nine locations in the nation with a larger number of Medicare beneficiaries than in other areas. This causes more federal claims to be filed, and this increase in claims makes the federal government believe that there is also a higher likelihood of Medicare fraud in the area.
Phoenix, Arizona and the surrounding areas are monitored by the federal government’s Medicare Fraud Strike Force at all times. This Strike Force is made up of prosecutors and investigations from several federal agencies. You may be contacted by the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, or the IRS. If you’re contacted by any representative of a federal agency about Medicare fraud, you should contact an experienced Phoenix Medicare fraud defense lawyer immediately.
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)
What You Need to Know About Medicare Fraud Investigations in Phoenix
Medicare fraud investigations in Phoenix and the surrounding areas usually start with allegations related to an unauthorized service or medical equipment, an inaccurate charge, or an excessive number of requests for reimbursement. Some of the most common inaccuracies found in Phoenix Medicare fraud cases include:
- Billing for services that weren’t performed (phantom billing);
- Double billing for equipment or services;
- Claims made for medically unnecessary medical services or equipment;
- Claims made for medically unnecessary supplies;
- Claims made for medically unnecessary certification (such as hospice or home healthcare );
- Charges that are inflated;
- Up-coding;
- Overuse of medical services or equipment;
- Providing or accepting kickbacks.
Individual medical providers, physicians who own businesses, nursing facilities, registered care workers and facilities, hospitals and clinics, pharmacies, DME providers, DNA testing labs, and cancer centers are some of the most commonly targeted for Medicare fraud investigations in Phoenix, Arizona and the surrounding areas. If you have been accused of fraud, contact our Phoenix Medicare fraud defense attorneys today to learn how we can defend you.
Medicare Fraud Has Civil and Criminal Consequences in Phoenix
Medicare fraud in Phoenix and the surrounding areas have civil and criminal consequences. Civil consequences can include:
- Repayment of claims that are investigated;
- Future claims will not be paid;
- Fine of up to $11,000 per false claim;
- Exclusion from federal healthcare programs;
- Treble damages; and,
- Attorney fees.
You could also be forced to appear in front of the state disciplinary or licensing board. This could mean that you lose your professional license or your hospital privileges.
The criminal consequences of Medicare fraud 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;
- A 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.
How to Choose a Phoenix Medicare Fraud Attorney
Defending against allegations of Medicare fraud requires experienced legal representation. These allegations often include serious federal criminal charges like tax fraud, wire fraud, mail fraud, and money laundering. Do your research to make sure that you hire an attorney who can handle the unique circumstances of Medicare fraud cases.
A Phoenix Medicare fraud defense attorney will understand the implications of federal criminal charges and the intricacies of healthcare law. Watch for these traits:
- Successful handling of previous Medicare fraud cases;
- Knowledge of Medicare and healthcare fraud laws and regulations;
- Deep understanding of statutory exceptions;
- Litigation and federal jury trial practices.
Additionally, you should ask the following questions to learn more about their skills:
- How many Medicare fraud cases have you handled throughout your career?
- How many of those resulted in no civil or criminal charges or in dismissals for your clients?
- How many of those cases were tried in court?
Medicare Fraud Defense Strategies for Phoenix Healthcare Providers
Our Phoenix Medicare fraud lawyers take the time to look at each case to determine the most effective defense strategies for our Phoenix, AZ clients. We have represented hundreds of clients, and our Healthcare Fraud Defense Team is led by a former Chief Healthcare Fraud Coordinator with the U.S. Attorney’s office. Several members of our team are also former DOJ federal trial lawyers and prosecutors.
Here are some key considerations for building an effective defense strategy:
Reaching out to the federal government. The main objective is to lessen the likelihood of criminal charges against our Phoenix clients. We reach out to the federal government immediately after we are retained by our clients. This gives us the opportunity to 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?
Because of our open lines of communication with the federal government, we are usually able to get those questions answered within just a few hours. If you’re in Phoenix or the surrounding area, call Oberheiden, P.C. right away.
Evidence must meet a high burden of proof. All criminal investigations rely on evidence. All evidence must meet certain legal standards known as a burden of proof. In this type of investigation, the federal government’s evidence must meet a legal standard known as “beyond a reasonable doubt.” Our experienced Phoenix Medicare fraud defense lawyers look at the evidence to determine if the federal government will be able to meet that burden of proof. Relying on this strategy has given us the following results on a regular basis:
- Charges against our clients are dismissed;
- Clients do not face criminal charges;
- Clients usually keep their professional license;
- Clients receive a civil fine, but no criminal plea;
- Reduction of a felony to a misdemeanor;
- No prison sentence.
Proving a mistake was made. Additionally, federal investigators must prove that you acted with criminal intent. Criminal intent, in relation to Medicare fraud, means that you made a conscious decision to try and scam a federal healthcare program. This is difficult for the investigators to prove since most Medicare fraud investigations in Phoenix and the surrounding areas begin as a result of a mistake. These mistakes most often affect the billing or the coding process. The most common mistakes that cause a Medicare fraud investigation include:
- 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.
While these mistakes should be corrected, they aren’t crimes. Oberheiden, P.C. works to prove that you made a mistake that you are willing to address and correct.
Medicare fraud exceptions as defenses. Medicare and other healthcare laws have exceptions and loopholes. Oberheiden P.C. analyzes each case to determine if exceptions may be used to defend our clients in Phoenix. One of our clients was recently accused of providing fraudulent certification for home healthcare services. We proved that our client was legally 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.
About Oberheiden, P.C.
Oberheiden, P.C. provides legal representation for Phoenix, Arizona and the surrounding area for individual medical providers, entities, business owners and executives, attorneys, hospitals, clinics, pharmacies, labs, and other related medical businesses being investigated for fraudulent billing, illegal kickbacks, and allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. Additionally, we are able to assist you with healthcare fraud defense needs, creating and implementing compliance programs, internal investigations, protection of your assets, state licensure or disciplinary proceedings, and federal jury trials.
Our Phoenix Medicare fraud defense lawyers are available to help individuals, entire healthcare systems, and other medical entities in Phoenix, Arizona or the surrounding areas. If you’re under investigation by the DOJ, the Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Strike Force, the IRS, Phoenix or Arizona state law enforcement, contact us immediately. The call is free and confidential.
Our Track Record
- Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
Result: No civil or criminal liability.
- Defense 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.
- Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Healthcare Fraud.
Result: No civil or criminal liability.
- Defense of nationally operating healthcare company against an investigation by the Department of Defense for alleged Tricare fraud.
Result: No civil or criminal liability.
- Defense of healthcare marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
Result: No civil or criminal liability.
- Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
Result: No civil or criminal liability.
- Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
Result: No civil or criminal liability.
- Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
Result: No civil or criminal liability.
- Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
Result: No civil or criminal liability.
- Defense of healthcare management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
Result: No civil or criminal liability.
- Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
Result: No civil or criminal liability.
Frequently Asked Questions
What is Medicare fraud?
Medicare fraud is a general term used to describe any situation in which a healthcare provider, medical device manufacturer, or other related party submits a false, fraudulent, or exaggerated claim for reimbursement to Medicare. Some of the most common examples of Medicare fraud include:
- Billing for services that were not performed;
- Billing for services that were not medically necessary;
- Billing for supplies or equipment that were never ordered;
- Billing for supplies or equipment that were not medically necessary;
- Certification for services or supplies that were not medically necessary;
- Double billing, up-coding, and inflating bills; and
- Overutilization of services or equipment.
Medicare fraud is the most common type of healthcare fraud, and federal agencies are constantly on the lookout for providers who submit false, non-existing, excessive, or unauthorized claims for reimbursement. If your business or practice is under investigation for Medicare fraud, reach out to a respected Phoenix, Arizona federal healthcare fraud defense attorney today.
Can whistleblowers bring federal healthcare charges?
Yes, an individual who has knowledge of a potential violation of federal healthcare fraud laws can bring a whistleblower lawsuit under the False Claims Act. However, often, the whistleblower will first approach federal prosecutors to determine if the federal government wants to adopt or intervene in the case. If so, the federal government takes over. If federal prosecutors decline to prosecute, the whistleblower can proceed on their own on behalf of the government. The incentive for whistleblowers is they can recover a whistleblower’s reward, which can be as much as 30 percent of the amount recovered. If you learned that a whistleblower is making allegations of healthcare fraud against you or your practice, it is important you take the allegations seriously and contact a Phoenix federal healthcare fraud defense attorney.
What charges might I face if I am alleged to have engaged in healthcare fraud?
There are many federal crimes that healthcare providers and medical businesses could face depending on the specific facts and circumstances. Some of the statutes federal prosecutors might use include but are not limited to the following:
- Stark Law: The Stark Law is a civil statute that forbids doctors from referring Medicare or Medicaid patients to an entity providing designated health services if the physician (or a family member) has a financial relationship with the entity. If a defendant is found civilly liable under this statute, the individual will be compelled to pay back any amount obtained in violation of this mandate. Penalties as high as $15,000 per service also can be imposed. Our Phoenix, AZ federal criminal defense attorney has successfully advocated for clients under this law based on several statutory exceptions.
- False Claims Act: While the DOJ often pursues civil actions under this law that are initiated by “whistleblowers,” this statute also can be the basis for imposing criminal liability. Even if you are facing an action for civil liability under the statute, the financial consequences can be staggering. This statute authorizes treble damages and a civil penalty of $21,563 per false claim. A key reason clients give for retaining our law firm includes the fact not one of our clients has been subject to civil or criminal liability under the FCA after retaining our law firm.
- Criminal Healthcare Fraud Statute: Healthcare providers and suppliers can be criminally liable for defrauding a healthcare benefit program or using misrepresentations to obtain this result. Conviction under this statute carries a punishment of up to 10 years in prison and a fine of $500,000 or double the amount obtained illegally.
- Anti-Kickback Statute: This federal law forbids promising or providing any form of compensation for Medicare or Medicaid business. Violation of this law constitutes a felony punishable by up to a five-year period of incarceration and a $25,000 fine. Our law firm might defend against allegations under this statute by arguing the conduct at issue is protected under the statute’s “safe harbor” provisions.
Medicare Fraud Defense Lawyers Serving Phoenix, Arizona
Nick Oberheiden is a Harvard-trained and internationally educated healthcare fraud defense attorney. Dr. Oberheiden has successfully represented healthcare executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. He is most known for stopping federal investigations before criminal charges can be filed. In addition to his healthcare defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.
Our Phoenix Medicare fraud attorneys are available every day of the year. Call, complete our contact form, or email us directly to schedule a free consultation as soon as possible.
Including Weekends
Oberheiden, P.C.
Serving Phoenix, Arizona and Surrounding Areas
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