St. Louis Medicare Fraud Attorneys

Oberheiden, P.C. is a healthcare law defense firm with experience in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our firm has talented St. Louis Medicare fraud attorneys with years of relevant experience and education from the country’s best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in St. Louis as well as throughout Missouri.

Healthcare providers and companies in St. Louis are at risk of investigation for Medicare fraud. Healthcare entities in St. Louis have a higher risk of being deemed in violation of Medicare fraud laws than the national average. If you are under investigation, you need a legal team with expertise in Medicare fraud who provide services to St. Louis and the surrounding area. Dr. Nick Oberheiden is a Harvard-trained healthcare fraud defense attorney and managing partner of Oberheiden, P.C.

Defining Medicare Fraud

Medicare fraud is a serious federal offense. Charges of alleged False Claims Act carry with them both civil or criminal liability. Medicare fraud is not restricted exclusively to Medicare. It involves the submission of false claims to any federal government healthcare program. It includes but is not limited to Tricare, Medicaid, and federal workers’ compensation. It may also include a violation of one or more of the following federal statutes:

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

Medicare fraud happens when the federal government makes an illegal payment to a provider, facility, or business after they file a false claim.

St. Louis and its surrounding areas are plagued by a much higher risk of investigation than is usual based on the fact that St. Louis is one of fifteen locations in the United States closely scrutinized by a Medicare Fraud Strike Force. Increasing the government’s interest are the sheer number of federal healthcare program beneficiaries, thereby increasing the number of claims filed through CMS. The goal of the Medicare Fraud Strike Force is to monitor, investigate, and prosecute Medicare fraud.

The Medicare Fraud Control Unit is a collective team of investigators and prosecutors from a group of federal agencies, including, but not limited to, DOJ, DEA, DOD, the Department of Health and Human Services Office, the Office of Inspector General, the FBI, and the IRS. Throughout the course of an investigation, you will likely come into contact with one or more representatives from each agency.

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)

Billing Mistakes in St. Louis: The Main Cause of Medicare Fraud Investigations

Most Medicare fraud investigations initiated in St. Louis are launched because the federal government has reason to believe that an individual or business is using fraudulent billing methods or reimbursement requests. These methods can include fraudulent charges, unauthorized charges, and excessive charges. The most common issues in St. Louis include:

• 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, services, disorders, or treatment
• Overuse of services
• Overuse of equipment
• Providing or accepting kickbacks

Potential Civil and Criminal Penalties for Medicare Fraud

Alleged healthcare fraud is a serious matter. They are notorious for carrying severe civil and criminal penalties. If you are under investigation for Medicare fraud, you need to call healthcare fraud defense attorneys at Oberheiden, P.C., as soon as possible. Civil penalties can include any 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

Criminal penalties are also very serious. They may include one or more of the following:

• A criminal record
• Huge 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 resulting in serious bodily injury
• A life sentence if the Medicare fraud resulting in death

Planning Your Strategic Defense

Alleged Tricare fraud, alleged Medicare fraud or alleged Stark Law violations have the power to affect your professional life in an adverse way. In addition to the previously listed penalties, you may also have your license revoked. It is possible that you will face with disciplinary proceedings. You may lose your hospital privileges. Knowing what is at risk if these penalties are enforced, it is absolutely critical to hire a skilled and experienced St. Louis Medicare fraud defense attorney. You should seek a defense attorney who has the expertise that is vital for the best possible outcome.

Many medical practitioners operating in the St. Louis area are convinced they should employ the services of a healthcare lawyer. Once allegations of Medicare fraud are levied, you run the risk of facing additional federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. A healthcare attorney may be well-versed in and have an adequate understanding of healthcare law, but he or she may not have the appropriate experience in federal criminal defense you need. In addition, they might not have the negotiation skills necessary to face the federal government or to deal with federal prosecutors in court.

Many others opt for a defense attorney because they fear criminal charges. However, most St. Louis criminal defense attorneys do not have the knowledge required to properly manage federal criminal matters. Moreover, they also might not have experience with or knowledge of the complexities of billing, coding, and medical utilization rules.

• A proven record of success in Medicare fraud cases
• Industry knowledge
• Deep familiarity with healthcare laws and their exceptions
• Litigation and trial experience

Once you’ve narrowed your options, you should ask a few more questions to know if the law firm has the experience in Medicare fraud that you need.

• 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?

Proven Strategic Medicare Fraud Defenses

Oberheiden, P.C. creates and provides proven and powerful defense strategies for our clients in St. Louis. A sizable number of our Healthcare Fraud Defense Team are former senior prosecutors for federal healthcare programs. We combine this advantage with our experience as St. Louis Medicare fraud attorneys so we can put forth a winning defense. Our primary objective is to avoid criminal charges.

Due to our extensive work in Medicare fraud defense, we know that one of the most effective ways to assist our clients is to get in contact with the federal government as early as possible. If the government has enough time to launch a full investigation into your practice, there is a much higher chance you will be confronted with criminal charges. We exert our greatest effort to get into contact with all relevant federal agencies in order to get you answers to such questions as:

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

We keep the lines of communication open with the government, meaning that we can normally get answers to these questions within hours.

Lack of evidence. The federal government must present convincing evidence to prove that you are guilty of committing a crime. The evidence must meet a Constitutional standard known as ‘beyond a reasonable doubt.’ We assess the government’s evidence in each case and question its validity. Thanks to this powerful strategy, we consistently observe the following outcomes:

• 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

Lack of criminal intent. Not only is the government obligated to provide evidence that you committed a crime, the government is required to prove that you intended to commit a crime. This frequently proves difficult to prove because the majority of St. Louis Medicare fraud investigations happen due to an honest mistake. The most frequently made mistakes 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

Truthfully, St. Louis and surrounding areas see a negligible amount of true Medicare fraud. In spite of this, many of those with allegations due to a mistake simply assume they must have committed a crime and need to accept the penalties as a result. Unfortunately, many can no longer work in their profession.

Oberheiden, P.C. works to find any lack of criminal intent. We make every effort to prove to that, in spite of having made a mistake, your actions had no criminal intent.

Development of applicable defenses. Every Medicare fraud case is unique. But, they do have some common aspects. The St. Louis Medicare fraud defense attorneys at Oberheiden, P.C. examine each case carefully to formulate a winning defense strategy. We recently had a Medicare fraud case where the government accused our client of falsely certifying home healthcare services. We proved to the government that our client was protected by a recognized delegation exception rendering the certification fully legal. In another case, we refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. provides aggressive Medicare fraud defense for St. Louis healthcare businesses, providers, and companies under investigation for illegal kickbacks and fraudulent billing practices. We also help those involved with allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. We can help you with:

• 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 St. Louis. If you’re under investigation for Medicare fraud by federal agencies, call us immediately. Your initial consultation with a St. Louis Medicare fraud lawyer is free of charge and confidential.

Our St. Louis Medicare fraud defense lawyers are available every day of the year. You can call us directly or complete our online contact form.