The Villages Medicare Fraud Defense Lawyer

The Oberheiden, P.C. is a Medicare fraud defense law firm serving The Villages, Florida and the surrounding areas. If you’re being investigated for Medicare fraud, call us right away. We are knowledgeable in qui tam defense, jury trials, federal investigations, and federal audits. We also assist our clients who need federal compliance programs. Oberheiden, P.C.’s attorneys have legal education backgrounds and former involvement as former federal healthcare prosecutorial and senior federal trial attorneys.

Medicare Fraud Is a Federal Offense

Medicare fraud is a federal offense that can cause you to lose your entire career. Medicare fraud is when an inaccurate claim is filed with a federal healthcare program. Medicare fraud is a broad term. It also includes Medicaid, Tricare, and federal workers’ compensation. These claims are filed by medical professionals, businesses, and other healthcare entities that file claims with the federal government to receive reimbursement for medical services or equipment. This allegation means that you’re being investigated for violating at least one of the following statutes:

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

The Villages, Florida is one of nine regions in the nation that is under constant surveillance by the Medicare Fraud Strike Force. This is because of the number of residents in the area that rely on a federal healthcare program. This increases the number of claims filed with the federal government for reimbursement. The job of the Medicare Fraud Strike Force is to monitor, investigate, and prosecute instances of Medicare fraud.

The Medicare Fraud Strike Force is a team of investigators and prosecutors from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. However, other federal agencies can be involved. If you’re being investigated by the Medicare Fraud Strike Force or if you’re contacted by a member from a federal agency, contact The Villages Medicare fraud defense attorneys Oberheiden, P.C. right away. Initial consultations are free.

Medicare Fraud Investigations in The Villages, Florida

Claims with mistakes are the reason why Medicare fraud investigations are generally started. The mistake is noticed by the federal healthcare program and they begin to investigate. Usually, the claim has an entry for an unauthorized charge, an excessive charge, or an incorrect amount listed as a charge. The main mistakes that start a Medicare fraud investigation include:

• 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 or services;
• Providing or accepting kickbacks.

Nursing professionals, doctors, physician-owned entities, nursing homes, and registered care facilities in The Villages are commonly investigated for Medicare fraud. Keep in mind that other entities and individuals can also be investigated if they file claims with a federal healthcare program.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former Department of Justice

Brian J. Kuester

Former U.S. Attorney
Former DA

John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach

Former Special Agent (OIG)

Michael Koslow

Former Supervisory Special Agent (FBI)

Chris Quick

Former Special Agent (FBI & IRS-CI)

Ray Yuen

Former Supervisory Special Agent (FBI)

What Are the Civil and Criminal Penalties of Medicare Fraud?

Allegations of Medicare fraud can cause you to face civil or criminal penalties. The civil penalties are:

• 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

Additionally, you could lose your professional license or lose your hospital privileges.

Criminal penalties may mean that you face:

• 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.

Four Key Traits of The Villages Medicare Fraud Defense Attorney 

The Villages Medicare fraud defense lawyer is more commonly known as a healthcare fraud defense lawyer. This type of attorney can help you in both the healthcare aspect and the potential criminal charges that you may also face. Look for these four key traits in a healthcare fraud defense attorney:

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

Next, you should learn more about the skills the healthcare fraud attorney has. To do this, you can ask these three questions:

• 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?

We contact the federal prosecutor immediately. Our defense team’s first move is to immediately contact the federal prosecutor after we are retained. 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?

We use this strategy because we’ve found that it helps reduce the likelihood that our clients will face criminal charges. We are often able to get the answers in just a few hours after we are retained.

Reviewing federal evidence. The government must meet a legal standard known as “beyond a reasonable doubt” when they present evidence to attempt to prove that you committed a crime. We review the evidence. This is an important strategy that 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.

Proving that our client made a mistake. Additionally, the federal government must prove that you acted with criminal intent. However, most Medicare fraud allegations don’t start because someone wanted to defraud the government. These investigations mostly start because of a mistake. The most common mistakes in The Villages, Florida 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.

Mistakes of this nature should certainly be addressed and corrected, but they don’t make you a criminal. Our The Villages Medicare fraud defense attorneys priority is to prove to the federal government that you made a mistake that you’re willing to correct.

Individualized defenses. Since we analyze the facts in each case, we are able to determine the right defenses for each client. Recently, one of our clients faced an accusation 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. provides Medicare fraud defense strategies in The Villages, Florida and the surrounding areas. Our The Villages Medicare fraud defense lawyers work with individual providers, entities, business owners, executives, lawyers, clinics, pharmacists, pharmacies, and other related medical entities under investigation 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

Oberheiden, P.C. represents both individuals and entire healthcare systems or businesses in The Villages, Florida and the surrounding areas. If you’re contacted by the DOJ, Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Control Unit, the IRS, The Villages or Florida law enforcement, call Oberheiden P.C. Initial consultations are free and confidential.

We are available every day of the year. Call us directly or complete our contact form.

Additional Pages for The Villages, Florida

• The Villages healthcare fraud defense