Illinois Health Care Fraud Defense
It Will Be Hard to Find a More Experienced Health Care Fraud Defense Attorney Serving Illinois
Although there truly is no shortage of lawyers in Illinois, few attorneys can say of themselves that they dedicate their practice to the defense of medical providers and health care businesses — like Illinois health care fraud defense attorney Dr. Nick Oberheiden.
With hundreds of health care fraud cases handled — many of which resulted in no civil and no criminal liability for his clients — Nick knows why a classic criminal defense approach will never work when the U.S. Attorney’s Office, the FBI, the OIG, or the DEA takes over an investigation: put simply, you won’t convince a trained health care prosecutor or a jury if you yourself don’t master the underlying health care rules and regulations. Doing murder trials and representing DUI offenders just does not give you that type of specific experience to understand why, for example, a perceived kickback can be justified under a safe harbor provision, or, why not every False Claims Act allegation really constitutes a false claim in the first place.
Featured by media stations across Illinois, Nick is the go-to lawyer when your livelihood and your freedom are challenged by allegations of Medicare fraud, Medicaid fraud, medical billing fraud, or illegal kickbacks. Don’t let the government ruin your life. Speak to Nick, free and confidential, and see how he avoided criminal charges and civil liability for so many other clients before you.
Do You Need Help with Your Case?
Are you under health care fraud investigation? Is your business under audit? Did you receive a ZPIC notice or Medicare audit? Have investigators served you with a Civil Investigative Demand, a grand jury subpoena, an OIG subpoena, or did they try to interview you about a case? Did your practice go through a DEA or FBI search warrant? If you are looking for effective and reliable help, consider the following examples and speak to Nick today. Nick will not hand your case to junior lawyers and no secretary will block you off. Call (214) 692-2171 today and get a free and confidential assessment from a true health care fraud defense attorney.
- DEA Opioid Investigation. The DEA investigated Nick’s client for medically unnecessary opioids and potential patient overdoses while these patients were under the medication management care of the targeted physician. The government threatened Nick’s client with “life in prison” and subpoenaed his office to obtain a number of patient charts. Nick and his team stepped in to defend the doctor and to protect his medical license. In a series of negotiation rounds with the DEA agents, Nick and his team was able to enter an agreement with the DEA (1) to not produce any patient charts, (2) to not hand over any financial documents, (3) to not suspend or disbar the doctor, (4) to not press civil or criminal charges against him. Very happy client!
- DEA Opioid Investigation. The DEA showed up with a search warrant at the pharmacy ready to seize hundreds of files and essentially disrupt the pharmacy’s operations to a point of expected bankruptcy. The DEA also demanded a surrender of all DEA privileges. Nick and his team intervened into the investigation and, after a quick analysis of the facts and the allegations, determined that there are no grounds for a DEA investigation, let alone a voluntary license revocation. A series of (tough) conversations with the DEA convinced the government that there was in fact no drug diversion issue at the pharmacy and that there was no legal need to take the pharmacy’s DEA privileges. The client continues its business!
- Grand Jury Investigation. The Department of Defense, the Department of Justice, the DEA, and the FBI accused Nick’s client to have violated the Controlled Substances Act and have received illegal kickbacks for referrals. Nick knew that he had to convince the government that his client’s prescriptions fell within the accepted standards of medicine and thus did not violate 21 U.S.C. 841. Similarly, Nick was able to introduce information and health care defenses that demonstrated that alleged kickbacks, even though they appeared illegal on the surface, were in fact defendable and justifiable under pertinent rules in light of the overall context of the business relationship between the parties. Instead of facing criminal charges and potential jail time, Nick’s client went back to taking care of his patients without his employer ever knowing that the physician was only inches away from an indictment. Client is thrilled!
- Grand Jury Investigation. The Department of Justice and the FBI accused Nick’s client, a health care business, of Medicare fraud and illegal kickbacks. Nick took on the representation, studied the file, listened to his client’s version of the story, and began negotiations with the U.S. Attorney’s Office, the OIG, and the FBI. As it turns out during the investigation, the government misconstrued the facts based on discredited witnesses and overzealous agents. Agreeing with Nick’s arguments, the prosecutor in charge discontinued its investigation of Nick’s client. Client is stoked!
- OIG Subpoena. The Department of Health and Human Services (HHS) and the Office of Inspector General (OIG) subpoenaed Nick’s client, a large health care conglomerate, to establish violations of the federal False Claims Act and Medicare Fraud. Sensing that this was a whistleblower case brought by a former employee of the company, Nick immediately began an internal investigation and presented his compliance efforts and findings to the U.S. Attorney’s Office. Nick’s compelling presentation there and the information he was able to gather in connection with consultants and experts convinced the government not to intervene and to end the investigation. Client is relieved!
10 Important Questions About Health Care Fraud Investigations in Illinois
Q: What Is the False Claims Act?
The False Claims Act is a federal civil and criminal statute that imposes liability for Illinois individuals or businesses for submitting incorrect, false, or fraudulent claims to Medicare and Medicaid. Because the False Claims Act offers rewards for anyone reporting alleged federal health care fraud, the statute is frequently used in whistleblower cases brought by former employees against successful health care businesses. It is important to understand that civil liability under the act does not require intentional or willful misconduct. If, for example, your business submits wrong-coded claims to Medicare, the mere submission can be enough for liability since all that is required to violate the statute is a showing that you should-have-known that the code was incorrect.
Q: What Is a Whistleblower Case?
A whistleblower lawsuit is typically brought by an individual, referred to as the “relator,” who reports violations of federal health care statues to the U.S. Attorney’s Office in Illinois. While the provision for bringing a whistleblower case stands in the federal False Claims Act, the actual underlying misconduct reported in the complaint can be any violation of federal health care laws such as Medicare fraud, Medicaid fraud, or illegal kickbacks provided that such violations resulted in damages to the federal government. Because whistleblower cases involve an incentive and financial reward for the whistleblower, they are frequently filed nowadays in an effort to challenge well-operating health care businesses. If your company experiences such a challenge, you should contact whistleblower defense attorney Dr. Nick Oberheiden, J.D. Ph.D. and find out how to effectively discredit the witness and the investigation without paying astronomical penalties to the government.
Q: Our Business Received a CID or OIG Subpoena: What Now?
If your Illinois business receives a Civil Investigative Demand (CID) or an OIG subpoena, chances are high that you are under investigation for alleged False Claims Act violations. Because the government has an obligation to investigate whistleblower claims, prosecutors assigned to the matter will frequently issue subpoenas requesting documents and information to verify the fraud claims in the original whistleblower complaint. The tools to do so are CIDs and OIG subpoenas. Attorney Nick Oberheiden has successfully resolved many government subpoena investigations and he understands the importance of entering a dialogue with the government to secure an extension and to begin negotiations for a case resolution early on rather than just producing requested information. The advantage of this proactive and interactive approach is to educate the prosecutor and to clarify facts and, ultimately, to convince the government to cease its investigation. Illinois companies affected by a CID or DOJ subpoena should request a free consultation to explore the nature of the investigation and to hear about proven defense techniques that have worked for Nick’s clients in dozens and dozens of cases before.
Q: Do I Go to Jail If I am Accused of Illegal Kickbacks?
Violating the Anti-Kickback Statute and being found guilty or convicted are not always the same things. Although the federal AKS contains draconian penalties such as incarceration for years, each case is different. Anti-Kickback defense attorney Dr. Nick Oberheiden has represented a large number of individuals and companies—from individual physicians, to home health care centers, hospitals, pharmacies, and business owners—in grand jury investigations, OIG subpoenas, and other federal investigations involving alleged illegal kickbacks and concluded the vast majority of these cases without his client being charged or indicted or ending up in jail.
Q: Do I Go to Jail If I am Accused of Drug Diversion and Opioid Abuse in Illinois?
Drug diversion and opioid prescriptions issues are top priority federal health care fraud concerns. Illinois is no exception. When it comes to effective defense strategies against unjust prescription fraud allegations, it is critical for an attorney to understand the scope and definitions under the Controlled Substances Act. For example, the government will claim that certain medications were medically unnecessary or, as prescribed, stand outside the accepted scope of customary and ordinary pain management procedures. DEA defense attorney Nick Oberheiden, sometimes with experts and sometimes without consultants, has repeatedly defeated such allegations by confronting prosecutors with clarifying information and compliance updates. In this process, Nick has reviewed thousands of patient charts and understands what the government is looking for and how to present strong files and strong defense cases in diversion and opioid investigations. If you have questions or concerns about compliance issues, do not hesitate to call Nick directly to get reliable advice from an experienced attorney—to avoid charges and jail time.
Q: Do I Go to Jail If I am Accused of Medicare Fraud in Illinois?
Medicare fraud investigations in Illinois are arguably more tenacious than elsewhere due to the presence of the Medicare Fraud Strike Force in Chicago, Illinois. The Strike Force is a conglomerate of federal agencies and prosecutors tasked to investigate businesses with predominantly Medicare patients such as home health care agencies, hospice agencies, hospitals, cardiologists, and other Illinois Medicare providers. Not every Medicare violation, let alone allegation, is a crime and experienced Medicare fraud defense attorney has proven over and over that original suspicion of fraud rarely ends up as charges—provided that an experienced attorney has a chance to intervene early and fix things before the case takes a course of its own.
Q: What Are the Stages of a Health Care Fraud Investigation in Illinois?
Most clients first learn about a health care fraud investigation against their business when they receive correspondence from the U.S. Attorney’s Office (e.g. a grand jury subpoena, a target letter, an OIG subpoena, a Civil Investigative Demand) or when they hear about agents trying to interview staff members. If this happens to you, please call qualified counsel right away. This is your opportunity to stop the investigation before it gets to the next step. The next level of a federal health care fraud investigation can entail a search warrant, an arrest warrant, or an indictment. All three require that a decision maker (federal judge for search and arrest warrant and a grand jury for an indictment) see probable cause that the target committed a crime or helped someone else commit a crime. Following an indictment, the government is mandated to share its file and evidence with the defendant and his/her counsel before a decision is made whether to plead guilty or to defend a strong case at trial. All federal criminal trials are jury trials.
Q: What Does the Federal Stark Law Prohibit?
Health care providers in Illinois are expected to comply with all federal rules and regulations, including Stark Law. Under Stark Law, a physician is prohibited to refer certain designated health care services (e.g. radiology, physical therapy) to an entity in which the physician or the physician’s immediate family member (e.g. wife, children, parents) has a financial interest. For example, a surgeon is not allowed to refer (Medicare) physical therapy patients to a physical therapy entity, in which that physician has an ownership or other financial interest. Stark Law violations are civil in nature, but can turn into criminal cases under the criminal portion of the False Claims Act. Call Illinois Stark Law attorney Nick Oberheiden today to find out how he has resolved Stark Law cases in the past by applying some of the existing exceptions to the transaction in question.
Q: How Would It Work to Switch Lawyers to Nick?
The easiest step in the entire process is to call Nick and get a free and confidential case assessment. All calls at (214)692-2171 go into his mobile phone and will be answered by Nick directly. If you are currently represented, Nick will gladly share his opinion and the experience of hundreds of health care fraud cases handled to help you determine whether or not transitioning the case is in your best interest.
Q: How Much Does It Cost to Hire Nick Oberheiden?
Every client’s financial resources are different. Nick and his team will work with you and offer a tailored approach— whether that is a reasonable hourly fee or predetermined fixed fee that will give you predictability with respect to your legal costs. One advantage to large law firms is that you will not have to pay for partners and associates alike because Nick will not delegate your case and there are no associates, paralegals, or secretaries to pay for.
Call Nick Now to Defend Your Future
Nick Oberheiden does not practice Illinois state law. Nick is licensed in the Northern and the Central District of Illinois and he limits his practice to federal law, in particular federal health care fraud defense cases. If you need health care fraud defense in Illinois, get an appointment with him by contacting him online, or calling (214)692-2171 to speak to Nick directly today!