The Villages Healthcare Attorneys
The Villages Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
Healthcare providers, businesses, and entities in The Villages, Florida or in the surrounding area have a higher risk of facing an allegation of healthcare fraud. Oberheiden, P.C. has tremendous experience in
healthcare fraud defense, medical malpractice, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG, and grand jury subpoenas, criminal defense, and internal investigations.
Our Healthcare Fraud Defense Team includes such talent as a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, several former healthcare fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. Our healthcare fraud and medical malpractice lawyer serves clients in The Villages and the rest of Florida.
If you’re under investigation for federal healthcare fraud in The Villages, Florida, or the surrounding area, you need a healthcare fraud defense attorney. Call us today. Ask to speak with a member of our Healthcare Fraud Defense Team. Initial calls with our The Villages medical malpractice lawyer are free and confidential.
The Villages, Florida Is Closely Watched by the Federal Government
In the United States, there are nine areas that are closely watched by the federal government for healthcare fraud. The Villages, Florida is one of those areas. It is monitored by the Medicare Fraud Strike Force. It is a team of federal prosecutors and investigators from several federal agencies.
The Villages is monitored because of the large number of people covered by federal healthcare programs. This causes the filing of more claims for payment from the federal government. An increase in the number of claims makes the government believe that there is a higher likelihood of healthcare fraud. In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year. OIG, HHS.
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)
Defining Healthcare Fraud
Federal healthcare fraud is defined as an attempt to receive payment from a federal government healthcare program for medical services or equipment from incorrect or misleading claims. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It incorporates at least one of the following elements:
- The Anti-Kickback Statute. Federal law restricts the exchange of money or other valuables for patient referrals. Anyone may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
- Stark Law. Stark Law is more commonly known as the Self-Referral Law. It bars physicians from referring patients to certain healthcare entities if the physician or an immediate family member has an ownership or investment interest in the entity. Or, if there is a compensation arrangement between the providers. There are statutory exceptions to this law.
- False Claims Act. If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an inquiry into your billing practices under the criminal provisions of the Act.
- Prescription Fraud. Prescribing a high volume of narcotics is closely monitored by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA dispensing rules.
- Billing Fraud. One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates:
- Allegations of phantom billing (services not provided),
- Ghost patients (patients who do not exist), and
- Billing for medically unnecessary services or equipment.
- Certification Errors. The federal government pays close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.
Oberheiden, P.C. strives to help our clients avoid the possibility of criminal charges when faced with healthcare fraud allegations. If you’re being investigated for healthcare fraud or medical negligence in The Villages, FL, or the surrounding area, don’t wait to call our The Villages healthcare lawyer. The initial call is free and confidential.
Civil and Criminal Penalties of Healthcare Fraud
Healthcare fraud has both civil and criminal penalties. In civil court, you could be ordered to repay the federal claims in question, lose the ability to be reimbursed for future claims, and you could be barred from participating in federal healthcare programs.
If you face serious injury and criminal charges, you could end up with a criminal record, huge fines, or even a federal prison sentence of:
- Up to 10 years for each count of healthcare fraud
- Up to 20 years for each count of fraud that resulted in serious bodily injury
- Life sentence if the healthcare fraud resulted in death
Healthcare providers, businesses, and entities in The Villages, Florida have one pressing question. What is the worst-case scenario for healthcare fraud allegations? The answer is criminal charges and a federal prison sentence. If you will be charged criminally or receive a prison sentence depends on several factors. The injuries suffered by the affected patients, whether the prosecutor sees an advantage in pursuing criminal charges, and why the investigation began are some of these factors.
Oberheiden, P.C. serves The Villages, Florida healthcare providers, entities, and businesses who have been accused of federal healthcare fraud. Our previous experience as healthcare prosecutors for the federal government in addition to our experience as defense attorneys gives us a unique view of how these cases should be handled.
Is the Investigation Against You Criminal?
Healthcare fraud investigations can be civil or criminal. They often start off as civil and then become criminal. This highlights the importance of contacting The Villages healthcare fraud defense attorneys from Oberheiden, P.C. as soon as you’re alerted to the investigation.
Healthcare fraud investigations can be civil or criminal. They often start off as civil and then become criminal. This is why you should contact Oberheiden, P.C. as soon as you can after discovering that you’re being investigated.
Being contacted by a prosecutor is not an indicator determining the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor alone as an indicator. Rather, signs of a criminal investigation may include:
- Search warrants,
- Seizure warrants,
- Arrest warrants,
- Target letters,
- Contact from a federal criminal prosecutor,
- Involvement from the IRS, or
- Receipt of a grand jury subpoena.
Frequently Asked Questions
What is a qui tam lawsuit?
The term “qui tam” refers to a whistleblower claim filed under the False Claims Act. The Act is unique among federal statutes as it allows a private citizen with knowledge of healthcare fraud to bring suit against a provider. Usually, the whistleblower first goes to the federal government with information to see if it wants to intervene. If so, the federal government takes over the investigation. If the federal government determines that more charges are appropriate, it may add them to the complaint. In other words, the government is not bound by the exact claims brought by the informant. If the federal government does not intervene, the informant is permitted to bring the case alone. Qui tam lawsuits are quite common because whistleblowers can recover up to 30 percent of the amount recovered in a lawsuit. At the same time, this gives informants perhaps too much incentive to come forward with suspect evidence. If you recently learned that someone is accusing you or your practice of healthcare fraud, contact a The Villages, Florida federal healthcare fraud defense attorney now.
What is Medicare fraud?
Medicare fraud is an umbrella term used to describe any situation where a healthcare provider, medical device manufacturer, or other related party submits a false, or fraudulent claim to Medicare for payment. The following are some of the most common examples of Medicare fraud:
- 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
- Overutilization of services or equipment
Medicare fraud is the most common type of healthcare fraud. Federal agencies are always on the lookout for providers who submit false, excessive, or unauthorized claims for payment. If your business or practice is suspected of Medicare fraud, speak to a respected The Villages, Florida federal healthcare fraud defense attorney today.
What is the Stark Law?
The Stark Law (42 U.S.C. § 1395nn) is a federal statute that limits when a physician can make a referral for certain services paid by Medicare. The law bars a healthcare provider from referring patients to another provider with whom the referring physician has a “financial relationship.” For example, a doctor who is a co-owner of a lab needs to be careful when referring patients to the lab. However, not all of these referrals are prohibited under the Stark Law. Some important exceptions apply. To learn more about creating a legitimate referral program, contact a The Villages, Florida federal healthcare fraud defense attorney today.
Critical Healthcare Fraud Defenses
Oberheiden, P.C. is a healthcare fraud defense law firm. We provide crucial healthcare fraud defense strategies to individual healthcare providers, entire healthcare systems, and businesses in The Villages, Florida, and the surrounding areas. Our healthcare fraud and medical malpractice attorney defended hundreds of people facing this allegation. Several of our attorneys have experience as former healthcare auditors and as healthcare fraud prosecutors with the Department of Justice and the Medicare Fraud Strike Force. We use this experience to develop strategic defenses for each of our clients.
Contacting the federal prosecutor. The main priority of our firm and medical malpractice lawyers is to help our clients avoid criminal charges. Once retained, we immediately contact the federal prosecutor. This lessens the time that the federal government has to investigate you without interruption. This is important. You could face criminal charges if the federal government has too much time to investigate you. Our goal is to get answers to the most important questions within hours:
- What is the investigation about?
- What is the purpose of it?
- How long will the investigation take?
- What is the most likely outcome?
Proving our clients did not commit a crime. The federal government must meet a high burden of proof to show that you committed a crime and acted with criminal intent. We evaluate the evidence the federal government gives to determine if they can meet that burden of proof. The federal government often points to billing inaccuracies to say that you committed a crime. Yet, we’ve found that these inaccuracies occur not because of fraud but because of a mistake. While these mistakes should certainly be addressed and corrected, they shouldn’t cause you to face criminal penalties. Mistakes often occur when healthcare practices or businesses grow quickly or because someone makes a mistake. The most common mistakes that cause a medical malpractice case include using unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules involved in healthcare.
Developing defenses for each client. The Villages healthcare attorneys at Oberheiden, P.C. examines the facts in each case to develop the right defenses for each client. Often, this includes the use of statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. We will point to these exceptions where applicable to mitigate or entirely resolve a healthcare fraud case.
Preserving your professional reputation. One of the most common concerns of our clients is how their professional reputation will be affected by this allegation. Oberheiden, P.C. works to preserve your professional reputation. Our The Villages healthcare lawyers will watch for opportunities to correct misinformation, surgical errors, birth injuries, or medical errors, and we will also address slanderous commentary from the media.
If you’re in The Villages, Florida, or the surrounding areas and are being investigated for healthcare fraud or facing medical malpractice cases, call Oberheiden, P.C. This call is a free consultation and confidential as per the attorney-client relationship.
Our Track Record
The commitment of Oberheiden, P.C. is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. Here are some recent examples of our case outcomes.
- Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
Result: No civil or criminal liability.
- Representation 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.
- Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud.
Result: No civil or criminal liability.
- Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
Result: No civil or criminal liability.
- Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability. - Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
Result: No civil or criminal liability.
We are available every day of the year. You can call us directly or complete our contact form or by emailing us directly.
Including Weekends
Oberheiden, P.C.
Serving The Villages, Florida and Surrounding Areas
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