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Oberheiden Attorneys

Miami, Florida Medicare Fraud Legal Defense Lawyers

Health care practitioners and facilities accused of Medicare fraud in Miami, Florida need the assistance of an experienced team of health care fraud defense attorneys. The Oberheiden & McMurrey, LLP has extensive experience with Miami and Florida health care fraud investigations and concluded a great number of these matters with no civil and no criminal liability outcomes for its clients. Oberheiden & McMurrey, LLP is comprised of former Medicare Fraud Strike Force prosecutors, former civil and criminal health care fraud prosecutors from the Department of Justice, as well as other highly experienced attorneys, such as Dr. Nick Oberheiden, a recognized fraud defense attorney.

What Is Medicare Fraud?

Medicare fraud in Miami, Florida doesn’t just cover Medicare. It may also refer to the submission of false or fictitious claims related to other government health care programs. That could be Medicaid, Tricare, federal workers’ compensation, or Medicare. In Miami, Florida, Medicare fraud is a serious charge.

Laws Related to Medicare Fraud

Medicare fraud may also constitute a violation of several laws:

  • False Claims Act
  • Anti-Kickback Statute
  • Stark Law (Physician Self-Referral Law)
  • Social Security Act
  • U.S. Criminal Code

Although all of these laws are different, they all have one thing in common: they forbid health care providers and entities from receiving illegal payments from a federal health care program.

Medicare Fraud and Miami

Miami, Florida is often seen as a breeding ground for Medicare fraud. The large number of retirees means that there are more allegations of Medicare fraud. Because of the large number of Medicare recipients in Miami, the Centers for Medicare and Medicaid Services (CMS) closely watches the use of Medicare and other government related health care claims made.

Aggressive Allegations of Medicare Fraud

Businesses and individuals in Miami that provide health care related services and goods could become a target of aggressive tactics used by government entities if they are accused of committing Medicare fraud. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is a federal task force made up by members of several other prosecutorial government agencies:

  • Department of Justice
  • Department of Health and Human Services
  • Office of the Inspector General
  • Federal Bureau of Investigation

Understanding Medicare Fraud

It is extremely important that Miami health care providers and businesses understand the basics of what can cause an allegation of Medicare fraud. As previously mentioned, Medicare fraud involves the filing of false or fictitious claims related to any government health care program. If you provide health care services or products, there are some billing practices that you should be aware of because even if they are done accidentally, it could trigger an allegation of Medicare fraud. This list is not all-inclusive. It is a representation of the most common actions that may cause you to face a charge of Medicare fraud.

  • Phantom billing – billing for services that were never performed
  • Billing for medically unnecessary services
  • Billing for unordered supplies or equipment
  • Certification for medically unnecessary services, such as home health or hospice
  • Certification for supplies that are not medically necessary, such as DME
  • Overuse of services or equipment
  • Providing or accepting kickbacks

Doctors, home health facilities, hospice care, nursing homes, nurses, registered care, hospitals, pharmacies, laboratories, medical device providers, physician syndicates, DNA centers, cancer centers, DME companies, and other health service providers are some of the most commonly targeted entities for Medicare fraud investigations.

Penalties for Medicare Fraud

The penalties for Medicare fraud are no laughing matter. They can destroy your future goals. You may be required to pay recoupment requests. You may not be able to get paid on future claims. Civil fines can cost you as much as $11,000 per false claim. You may be excluded from federal health care programs. You may be hit with treble damages and attorney fees. Criminal fines, a criminal indictment, or prison time are also possible penalties. Being sentenced to prison could mean up to 10 years for each count of fraud or up to 20 years in prison if the fraud resulted in serious bodily injury (such as the use of counterfeit or excessive medication). If the patient dies, you could receive a life sentence.

You Must Choose the Right Defense Lawyer

Because of the serious repercussions from Medicare fraud, it is imperative that you understand how to choose the right Miami defense lawyer. Do not rely on a beginner. Choose a lawyer that understands how to plan and execute complex health care defense strategies.

Should You Choose a Health Care Lawyer?

Allegations of Medicare fraud make many people believe that they need a health care lawyer. Medicare fraud is generally alleged in combination with other charges such as mail fraud, wire fraud, tax evasion, and money laundering. While a health care lawyer may understand laws related to health care , they may not have the training or experience in the criminal elements of these charges. A health care lawyer may not be able to provide you with the best health care fraud defense against federal prosecutors.

Should You Choose a Criminal Defense Lawyer?

Since Medicare fraud often carries criminal charges with it, individuals and facilities may be compelled to consider working with a criminal defense lawyer. Yet, this presents another problem. Many criminal defense lawyers center on DUIs, crimes like rape, or drug offenses. They may not have the experience of handling complex health care fraud allegations. They also may not be readily familiar with the rules related to medical billing, coding, or service utilization.

Choosing the Right Health Care Fraud Defense Lawyer

If you’re facing allegations of Medicare fraud in Miami, you need to choose the right health care fraud defense lawyer. We suggest four considerations to ask your lawyer:

  1. Do they have a proven track record in complex health care fraud cases?
  2. Do they have intimate knowledge of the industry?
  3. Do they have an immense understanding of health care laws?
  4. Do they have litigation and trial experience?

If those questions are answered with a yes, then you need to ask four specific questions related to Medicare fraud:

  1. How many Medicare fraud cases have you handled during your career?
  2. How many of those cases resulted in no civil or criminal charges?
  3. How many of those cases resulted in a dismissal for your clients?
  4. How many Medicare fraud cases have you tried in court?

Compelling Defense Strategies

Oberheiden & McMurrey, LLP prides itself in its experience handling Medicare fraud cases throughout the United States. We’ve handled more than 1,000 health care fraud cases through the country and conducted more than 200 criminal trials. Thanks to the experience many of our attorneys have from working in senior positions within the Department of Justice, we are able to use this insight to develop compelling defense strategies. Although every case is different, our defense strategies have successfully resolved Medicare fraud investigations and help our clients avoid criminal charges.

Proactive Intervention

By getting involved in Medicare fraud allegations early, we are able to proactively assist you before the allegations become a serious problem. The more time that the government has to investigate you, the more likely it is that you will face criminal charges. Hiring a lawyer to act as an intermediary between you and the government can help you get the answers that you need. You’ll be able to find out what caused the allegations, whether it is civil or criminal, which agencies are involved, who all is being investigated, the ultimate goal of the government, and how the allegations can be resolved. We may be able to get these answers for you within hours of beginning your engagement with our law firm.

A Lack of Evidence

In the U.S. court system, there is a heavy burden of proof placed upon the government. For you to be found guilty of Medicare fraud, the government must show beyond a reasonable doubt that you committed an illegal act with criminal intent. This is a Constitutional standard that we will use in your defense. It can result in having your case dismissed, being able to avoid criminal charges, retaining your license, civil fines, reducing a felony to a misdemeanor, and no prison sentence.

We’ve realized that many Medicare fraud claims start because of a business or human error and without criminal intent. These mistakes happen for a variety of reasons. While that may be negligent oversight, it’s not criminal. The most common errors include:

  • Staff members who are unqualified or inadequately trained
  • Errors made because of a lack of supervision
  • Outsourcing work
  • Improper delegation
  • Business errors
  • Human errors
  • Overwhelmed staff members
  • Human oversight
  • No compliance program in place
  • Lack of enforce guidelines or procedures

No Criminal Intent

Intentional Medicare fraud doesn’t happen often. Yet, many health care professionals, facilities, and businesses simply accept the penalties if they face this allegation simply because of a mistake. Yet, mistakes are common and should not result in convictions or liabilities. When there is a lack of criminal intent, it means that the individual(s) or business involved had an intentional desire to perpetuate a fraud. Intention separates mistakes from criminal activity.

The Use of Applicable Defenses

It’s important that the appropriate defenses be used against your allegations. Applicable defenses are defenses that make sense for your particular case. Recently, we handled a Medicare fraud case in which the government alleged that our client fraudulently certified a need for home health care. Our applicable defense involved a delegation exception that made the certification compliant with the law. In a separate case, we refused to admit liability and proved to the prosecutors that our client acted within a safe harbor exception.  Because no two Medicare fraud cases are the same, applicable defenses are a necessity.

Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP provides representation to businesses, health care executives, attorneys, health care providers, hospitals, laboratories, pharmacies, and other health-related entities who are being investigated for illegal kickbacks, allegations of medically unnecessary services, fraudulent billing, services not rendered, or unlawful joint ventures between physicians and ancillary income businesses. We can help with:

  • Compliance programs
  • Defenses for health care fraud allegations
  • Internal investigations
  • Qui tam defense
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

We provide representation to clients in Miami, Florida who are being investigated by the Department of Justice, Department of Defense, FBI, DEA, Office of the Inspector General, Medicaid Fraud Control Unit, Miami or Florida law enforcement, or the IRS.

Our Track Record

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

Miami Medicare Fraud Defense Attorneys

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Nick has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, scores of political corruption, government investigations, and media campaigns, including 60 Minutes. He is most 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). Clients greatly benefit from Lynette’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Lynette has immense experience with health care law enforcement and she regularly argues federal matters for her clients.

Oberheiden & McMurrey, LLP can be reached directly by completing our contact form, or via email to get more information and get your questions answered.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving Miami, Florida 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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