Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense Lawyers Serving all of Louisiana

The Oberheiden & McMurrey, LLP is a national defense law firm comprised of experienced defense attorneys and former federal prosecutors. Our Health Care Fraud Defense Group is headed by senior attorney Dr. Nick Oberheiden, who brings decades of experience to representing health care service providers and others facing Medicare fraud investigations in Louisiana. If you are under government scrutiny, or if you have already been charged with Medicare fraud, we urge you to contact us immediately so that we can begin building your defense.

This page is intended as a resource for individuals and health care companies facing Medicare fraud investigations in Louisiana. The information presented here will help you understand:

  • What constitutes Medicare fraud;
  • The civil and criminal penalties in Medicare fraud;
  • Key defense strategies for Medicare fraud investigations;
  • How to choose the best lawyer to represent you;
  • What distinguishes Oberheiden & McMurrey, LLP

Are You Facing a Medicare Fraud Investigation in Louisiana?

The federal government has long focused on deterring Medicare fraud through aggressive enforcement methods, including both civil and criminal investigations. Each year, Medicare and other government benefit programs pay millions of dollars in false claims. In 2016, the Department of Justice released statistics related to their investigations. False claims totaled more than $900 million.

Currently, Louisiana is among the federal government’s top priorities when it comes to fighting Medicare fraud. Due to the volume of Medicare reimbursements health care providers in Louisiana bill on a daily basis, it is one of only nine areas nationwide where the government has permanently deployed a team from its “HEAT” task force. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is a coordinated effort of the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies that has been specifically tasked with investigating and prosecuting local health care providers suspected of Medicare fraud.

Medicare Fraud: An Overview

Medicare fraud implicates a number of federal statutes, including the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Laws (Stark Law), the Social Security Act, and the U.S. Criminal Code. There are many forms of Medicare fraud, but the underlying allegation in any Medicare fraud investigation involves the illegal receipt of money from the federal government as a result of submitting a false or fictitious claim for reimbursement to the Centers for Medicare and Medicaid Services (CMS).

Some of the most common forms of Medicare fraud include:

  • Phantom billing – billing for services never performed;
  • Billing for medically unnecessary services;
  • Billing for supplies and equipment that were never ordered;
  • Billing for medically unnecessary supplies and equipment ;
  • Obtaining certification for medically unnecessary services (common in Home Health and Hospice Fraud Investigations);
  • Obtaining certification for medically unnecessary supplies (including Durable Medical Equipment (DME));
  • Double billing, upcoding, and unbundling services;
  • Overuse of services and equipment; and
  • Offering and accepting kickbacks.

While health care service providers in Louisiana who treat Medicare beneficiaries are entitled to seek payment for qualifying services, supplies, and equipment from the CMS, widespread abuse of the Medicare system has led to the government taking a skeptical view of any provider that submits a high volume of reimbursements. In addition, the Department of Justice has recently announced that it fully intends to prosecute both companies and individuals suspected of Medicare fraud.

As a result, physicians, executives, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, and other health care service providers in Louisiana are potential targets for federal government investigations.

Civil and Criminal Penalties for Medicare Fraud

The laws listed above impose severe penalties for those found guilty of Medicare fraud. These include liability recoupment requests, civil fines of up to $11,000 per false claim, treble damages, federal attorney fees, and criminal fines. Those convicted or held civilly liable for Medicare fraud can also face non-payment of claims and exclusion from future participation in Medicare and other federal health care programs, and medical professionals can face licensing actions and loss of hospital privileges, as well.

In a criminal case, a conviction can also carry a sentence which includes federal imprisonment:

  • Medicare fraud: Up to 10 years in prison for per count;
  • Medicare fraud resulting in serious bodily injury: Up to 20 years in prison; or
  • Medicare fraud resulting in death: Life imprisonment.

Key Defense Strategies for Medicare Fraud Investigations in Louisiana

At Oberheiden & McMurrey, LLP we have handled hundreds of health care proceedings and conducted several criminal trials in Louisiana and nationwide. Through this experience, we have identified four key defense strategies that have consistently proven to be effective in securing favorable results for our clients. These are:

  • Early intervention;
  • Exposing the government’s lack of evidence;
  • Establishing a lack of criminal intent; and
  • Asserting specific defenses under applicable health care laws.

Early Intervention

In any type of federal investigations, early intervention by an experienced Louisiana health care fraud defense lawyer is crucial. When clients get us involved early, we are able to open dialogues with our government contacts and implement strategies designed to keep our clients from facing civil and criminal charges. In every Medicare fraud case that we handle, we seek to quickly get answers to the key questions that will shape our defense strategy:

  • What is the investigation about?
  • What prompted it?
  • Is the case civil or criminal?
  • Which agencies are involved?
  • Who else is under investigation?

Whenever possible, we strive to provide our clients these answers within the first hours of our engagement.

Exposing the Government’s Lack of Evidence

In order to obtain a conviction, federal prosecutors must prove that you are guilty beyond a reasonable doubt. This includes proving both that you committed an illegal act and that you did so with criminal intent. This requires a substantial amount of evidence. We will work to expose the government’s lack of evidence in order to either stave off criminal charges entirely or prevent you from getting convicted at trial.

Establishing Lack of Criminal Intent

Since the federal government has the burden of proving that you acted with criminal intent, a key strategy in many Medicare fraud investigations is to establish that any alleged fraudulent practices were actually the result of simple organizational and human errors. These errors are frequently byproducts of issues such as:

  • The use of unqualified staff;
  • Supervision errors;
  • Delegation or outsourcing;
  • Structural deficits;
  • Simple oversight;
  • Lack of an effective compliance program; and
  • Constantly changing Medicare rules.

While these may be issues that need to be addressed, they do not rise to the level of criminal intent. In our experience, intentional Medicare fraud is rare in Louisiana. We can use our experience to help explain any billing errors without exposing you to criminal prosecution.

Asserting Specific Defenses Under Applicable Health Care Laws

The fourth key defense strategy involves identifying any defenses that may be available under the applicable health care laws. For example, in one recent Medicare fraud case, we were able to successfully argue that a delegation exception protected our client from liability for an alleged fraudulent certification. In another Medicare fraud case, we used a safe harbor provision to insulate our client from liability. These are just two examples of the numerous defenses that you may have available.

How to Choose the Best Lawyer to Represent You

With all that is at stake in a Medicare fraud investigation, it is critical that you hire a qualified defense team as soon as possible. To give yourself the best chance of avoiding civil and criminal liability, your top priority should be putting experience on your side.

Put an Experienced Team of Health Care Fraud Defense Lawyers on Your Side

If you are facing a Medicare fraud investigation, the best choice for your legal representation is a team of experienced health care fraud defense lawyers.

At Oberheiden & McMurrey, LLP, our Health Care Fraud Defense Group brings decades of experience to helping clients fight their federal charges. Our lawyers have:

  • A proven track record of success;
  • Industry knowledge;
  • Intimate familiarity with federal health care and criminal laws; and
  • Litigation & trial experience.

Unlike other defense firms, at Oberheiden & McMurrey, LLP we take a team approach to defending our clients. As a result, you will benefit from the collective experience of all members of our Health Care Fraud Defense Group. We have represented numerous clients in Louisiana and throughout the country in Medicare fraud investigations, and this is the type of experience that you need when your future is on the line.

About Oberheiden & McMurrey, LLP

At Oberheiden & McMurrey, LLP, we represent business owners, health care executives, lawyers, health care providers, hospitals, pharmacies, laboratories, and other entities in the health care industry in all types of health care fraud investigations. This includes cases involving allegations or suspicion of illegal kickbacks, fraudulent billing practices, rending medically unnecessary services, and engaging in unlawful joint ventures involving referring physicians and ancillary-income businesses. We have specific experience defending clients in investigations conducted by:

  • The Department of Defense;
  • The Department of Justice;
  • The Drug Enforcement Administration;
  • The Federal Bureau of Investigation;
  • The Internal Revenue Service;
  • The Medicaid Fraud Control Unit;
  • The Office of Inspector General;
  • Louisiana law enforcement; and
  • Other state and federal agencies

With so much at stake, you cannot afford to put an inexperienced team on your side. To meet with the members of our Health Care Fraud Defense Group, request a free case evaluation today.

Our Track Record

  • Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of a health care 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.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged health care fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.

Louisiana Medicare Fraud Defense Attorneys

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has provided successful representation nationwide for health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, in allegations of political corruption, government investigations, and assisted with media campaigns, including 60 Minutes. Dr. Oberheiden is well-known for stopping federal investigations before criminal charges can be filed. In addition to his health care defense practice, Nick leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Louisiana clients benefit from Ms. Byrd’s experience of formly working with the Department of Justice where she prosecuted health care fraud, Anti-Kickback violations, violations of the False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd regularly argues federal matters for her clients.

We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form to request a free consultation.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving the State of Louisiana and Surrounding Areas
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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