What To Do in Los Angeles Medicare Fraud Investigations
12400 Wilshire Blvd #1180
Los Angeles, CA 90025
(Meeting location by appointment only)
Oberheiden, P.C. represents clients in Los Angeles and surrounding areas that are accused of Medicare Fraud. We are a team of former Department of Justice Trial Attorneys, former Assistant and Special Assistant United States Attorneys and former federal prosecutors previously in charge of health care fraud investigations at the U.S. Attorney’s Office. As experienced Los Angeles health care fraud attorneys, we handle both civil (False Claims Act) and criminal (pre-indictment and indictment) health care fraud investigations in Los Angeles and we are proud of our track record of successful case outcomes.
Why Do Los Angeles Clients Trust Oberheiden, P.C.?
Oberheiden, P.C. is a health care fraud defense law firm. Our attorneys have handled hundreds of civil and criminal health care investigations throughout our careers. Many of our attorneys come from senior positions within the Department of Justice and share their experience, insights, and contacts as former federal prosecutors in charge of health care matters.
- Experience: More than 1,000 health care fraud investigations
- Experience: More than 1,000 grand jury investigations
- Former DOJ Health Care Fraud Prosecutors
Business owners and medical providers in Los Angeles trust Oberheiden, P.C. because they know that they will receive reliable and proven advice on the correct course of action in Medicare audits, appeals, and civil and criminal government investigations. Our clients include physicians, business owners, marketing groups, hospices, home health agencies, hospitals, chiropractors, nurse practitioners, nurses, and other members of the health care industry in all aspects of health care fraud cases, including Medicare fraud, allegations of kickbacks, Stark law violations, and False Claims Act cases throughout the United States, including Los Angeles.
Who Will Handle My Health Care Fraud Case At Oberheiden, P.C.?
At Oberheiden, P.C., our clients are represented by senior attorneys with years of experience in Medicare audits and health care fraud proceedings. In Los Angeles, we represent clients who believe they are under investigation by the federal government and those who are already facing federal criminal or civil charges. We do not use junior lawyers or paralegals. When you hire us, you hire “One Team.” All of our attorneys have years, if not decades, of experience in cases like yours.
Medicare Fraud in Los Angeles
When someone submits a false claim to any government health care program, such as Medicare, Medicaid, Tricare, or the federal workers’ compensation programs managed by the Department of Labor, that person commits Health Care Fraud. Indeed, Health Care Fraud includes violations of the Stark Act, the Anti-Kickback Statue, the False Claims Act and various sections of the criminal code. Health Care Fraud cases often involve a business or medical provider illegally receiving money from a government health care program.
As one of the most populous cities in the United States, Los Angeles houses a large number of Medicare beneficiaries. This is due in large part to the high number of retirees that receive Medicare benefits in the region. Not surprisingly, the Centers for Medicare and Medicaid Services (CMS) keeps a focused watch over Medicare providers in this region. In fact, Los Angeles is allocated significant manpower dedicated to Medicare fraud investigations.
A few years ago, the federal government set up special task forces to detect, investigate, and prosecute Medicare fraud in nine “hot spot” locations. Los Angeles is one of these “HEAT” cities with the most intense Medicare fraud law enforcement activity. HEAT stands for Health Care Fraud Prevention and Enforcement Action Team. HEAT’s presence in Los Angeles means that Medicare Fraud prosecutions, federal health care fraud prosecutions in general, will be more aggressive and more prevalent in the Los Angeles area than in other parts of the country. As a medical business owner or provider in Los Angeles, you should be aware of HEAT and know what to do if you are the target of an investigation or prosecution. The HEAT Task Force is made up of agents, prosecutors, and investigators from a number of federal agencies, including the Federal Bureau of Investigation (FBI), the Department of Justice (DOJ), the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG), and others.
Medicare Fraud Accusations
As described above, Medicare Fraud occurs when a person or entity submits false, fictitious, and/or fraudulent claims to Medicare. Common allegations of Medicare fraud include requests for reimbursements for services that were unauthorized, unnecessary, excessive, or never provided. Medicare Fraud may also arise from incorrect billing practices. The following allegations are among the most commonly seen in Medicare Fraud cases:
- Offering or Accepting Kickbacks;
- Up-Coding or Incorrect Coding;
- Bundling or Unbundling;
- Double Billing;
- Inflating Bills;
- Billing for Services that Were Medically Unnecessary;
- Billing for Services Never Performed (also called “Phantom Billing”);
- Billing for Supplies and Equipment that were Medically Unnecessary;
- Billing for Supplies and Equipment that were Never Ordered;
- Overutilization of Services or Equipment;
- Certification for Supplies that were Medically Unnecessary (particularly DME); and,
- Certification for Services that Were Medically Unnecessary (especially in Home Health or Hospice areas).
Medicare Fraud investigations target all types of health care businesses and all types of medical service providers, including physicians, nurses, cancer treatment centers, DNA testing centers, pharmacies, hospitals, DME companies, toxicology laboratories, home health care agencies, hospice providers, medical device companies, physician syndications, rehabilitation centers, and nursing homes.
What Are the Penalties for Medicare Fraud?
Medicare Fraud is a serious offense and, if charged criminally, it is a felony. In civil case, persons or entities found liable for Medicare fraud will face demands of recoupment, refusal to pay future claims, exclusion from all Federal health care programs, fines of up to $21,916 per false claim, treble damages, and lawyer’s fees. Criminal penalties are even harsher – in addition to fines and indictment, a criminal conviction can result in the following sentences in federal prison:
- 10 years in prison for each count of fraud;
- 20 years in prison if the fraud resulted in serious bodily injury; or
- A life sentence if the fraud resulted in the patient’s death.
In addition to the above penalties, civil liability or criminal conviction could lead to suspension or loss of licenses and hospital privileges for medical professionals. Let’s make sure that’s not the case!
Choosing the Right Defense Lawyer
The question is: What type of attorney should you select? If your livelihood depends on your lawyer, you simply must expect that lawyer to be profoundly familiar with your industry and the type of problem that you are facing. Put differently, if your lawyer does not understand all nuances of Medicare law, he or she will never convince a jury in trial or a health care prosecutor in negotiations. To find out if your candidate has the necessary experience to protect you simply ask these questions:
- How many Medicare Fraud cases have you handled?
- How many of those Medicare cases resulted in no civil liability, no criminal charges, or outright dismissals for your client?
- How many Medicare Fraud trials have you handled?
If you have been accused of Medicare Fraud, you should seek a law firm that has been involved in hundreds and hundreds of health care fraud cases and hundreds of government investigations. Lawyers like the attorneys at Oberheiden, P.C. with the following qualifications:
- Knowledge and experience of the health care industry;
- A proven record of success;
- Trial and litigation experience, including in federal court and in criminal cases; and,
- Solid understanding of health care laws and regulations.
Before investing your hard-earned money in legal representation, you should ask any potential lawyer pointed and detailed questions about their resume. We suggest that you include at least these three questions:
Proven Defense Strategies
Our Firm has years of experience in health care fraud cases and a proven track-record across the country, including in Los Angeles and California. In their careers, our attorneys have handled over 1,000 health care fraud cases and conducted hundreds of trials, in front of both judges and juries. In fact, some of our lawyers joined our firm directly from senior positions as Assistant U.S. Attorneys in the Department of Justice’s health care fraud division. Now they share their experience, contacts, and insight with our clients and us. While every case is different, we have found that many Medicare Fraud investigations can be resolved without any criminal charges being filed when the following strategies are employed:
- Early Intervention
- Demonstrating Lack of Evidence
- Showing Lack of Intent
- Asserting Relevant Defenses
Early Intervention. If you have been accused of Medicare Fraud, you have no time to waste: You must find a good attorney to represent you and get involved in your case as soon as possible. Without the involvement of defense counsel early on in the government’s investigation, criminal charges are likely to be brought against you. Once that happens, you may be a day late and a dollar short. Do not give the government ample, uninterrupted time to build a case against you. Quickly hire attorneys who know enough to ask – and get answers to – the important questions early, such as: Why is this investigation taking place? What is it about? Does it appear to be civil or criminal in nature? Which agencies are participating? What does the government want? Is there a way to resolve this quickly? Our law firm can get you answers to these questions within hours of our retention.
Demonstrating Lack of Evidence. As in every criminal case, criminal Medicare Fraud must be proven by the government beyond a reasonable doubt. The government must prove both that the act in question was committed and that the person who committed the act had the required criminal intent. At Oberheiden, P.C., we know how to hold the government to their burden in every case, and we routinely achieve successful outcomes for our clients against accusations of health care fraud. Our goal is to obtain the best possible result for our clients in every case, whether that means outright dismissal, maintenance of their license, no criminal charges, civil fines only, no jail time, reducing the charge to a misdemeanor instead of a felony or winning at trial.
In our experience, Medicare Fraud investigations usually occur because of simple mistakes or organizational failure, not from criminal intent. Health care providers are naturally focused on treating patients, not billing or business issues, which may allow such administrative mistakes to go unnoticed. Also, the government’s attention is drawn to health care businesses that are growing and expanding quickly. These two factors combined can often lead to mistakes cause by negligent oversight or organizational deficit. In our experience, most mistakes are caused by:
- Structural Deficits
- Organizational Mistakes
- Human Error
- Lack of Oversight
- Overwhelmed Employees
- Improperly Supervised Staff
- Unqualified or Untrained Staff
- No Compliance Program
- Delegation & Outsourcing of billing
- Constantly Changing Regulations
Showing Lack of Intent. Intentional Medicare fraud is rare; most errors truly are the result of simple human error. However, being investigated by the government is frightening, and honest people often agree to accept fines and penalties even when they are guilty of nothing more than a mistake or oversight. Common mistakes in a busy health care practice should not lead to a conviction or civil liability for health care fraud. We insist that the government prove the level of intent required by the statute under which they are proceeding.
Including Relevant Defenses. Many of the cases brought against our clients by the federal government are defensible once you understand the limits of the law. This proved true in two of our recent cases. In the first case, we successfully demonstrated that our client acted within a safe harbor exception and thus did not commit Medicare Fraud. In the other, we proved that a recognized delegation exception authorized a certification for home health care services that the government had claimed was fraudulent.
100 Years of DOJ-Experience
At Oberheiden, P.C., we take on the government on behalf of many types of health care entities as well as individual providers. Our clients include doctors, nurses, business owners, lawyers, health care executives, toxicology laboratories, pharmacies, hospitals, hospices, and home health care providers. We have and do represent clients in all aspects of health care law and Medicare Fraud, including against accusations of illegal kickbacks, fraudulent billing, unlawful joint ventures, medically unnecessary services, and services not provided. We have experience in jury trials, non-jury trials, health care fraud defense, and licensure and disciplinary proceedings, as well as in asset protection, qui-tam defense, internal investigations, and compliance programs.
No client is too small or too big; we have represented entire health care systems as well as individual providers. In Los Angeles, we represent clients who are under investigation by any of a number of government agencies, including state or federal law enforcement, the IRS, the FBI, the Department of Defense (DOD), the DOJ, the DEA, the OIG, and the Medicare Fraud Control Unit.
We are available every day of the year, seven days a week. You can call us directly, complete our contact form, or email us.
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Serving Los Angeles