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90%+ SUCCESS RATE
AVOIDING CRIMINAL CHARGES

Dr. Nick Oberheiden
Founder

Aaron Wiley
Former State &
Federal Prosecutor

S. Amanda Marshall
Former U.S. Attorney

Lynette Byrd
Former Assistant
U.S. Attorney

  • Federal Criminal Defense
  • Federal Trial Lawyers
  • Search Warrant Defense
  • Grand Jury Subpoenas
  • OIG Subpoenas
  • Whistleblower Cases
  • FBI, DEA, IRS, OIG, HHS Cases

Michigan Health Care Fraud Defense Attorneys

Michigan Office

500 Griswold St #2450
Detroit, MI 48226
313-462-7972
(Meeting location by appointment only)

Oberheiden, P.C. vigorously defends clients in Michigan against allegations of health care fraud. Our Health Care Fraud Defense Team is headed by Dr. Nick Oberheiden, one of the country’s most demanded media legal experts, who offers Michigan clients decades of valuable insights from his previous positions to supervise civil and criminal health care fraud investigations on behalf of the Department of Justice. We help Michigan clients with the following:

  • OIG & Grand Jury Subpoenas
  • Medicaid Audits (esp. Dentists)
  • Medicare & Tricare Audits
  • Defending Fraud Allegations
  • Internal Investigations
  • Compliance Programs
  • Qui Tam Defense
  • Criminal Defense
  • Jury Trials

Clients all across Michigan, including those located in Detroit, Grand Rapids, Sterling Heights, Ann Arbor, Lansing, and Flint, who are interested in discussing their situations should speak directly to managing partner Dr. Nick Oberheiden. If your case is an emergency, you should not hesitate to call us immediately, including on weekends. All calls are free and confidential.

What Constitutes Health Care Fraud?

Health care fraud against the federal government includes attempts or actions taken for monetary or pecuniary gain from a federal government program (e.g. Medicare, Medicaid, or Workers’ Compensation (under the Department of Labor)) through false and fraudulent representations. Although that definition serves as the overarching litmus test of what constitutes health care fraud, the government further defines the matter through a vast number of laws and regulations that prohibit providers from engaging in certain activity. Following are some of the most commonly prosecuted forms of health care fraud:

Anti-Kickback Violations

The Anti-Kickback Statute (AKS) is codified in 42 USC § 1320a-7b(b) of the United States Code. Under the statute, all persons – including health care providers, marketers, or related business owners – are prohibited from giving or receiving any form of remuneration in order to secure patient referrals. Any person that violates the statute can be subject to health care fraud prosecution. The statute includes a number of safe harbors of protected activity. It is important for Michigan providers that are charged with health care fraud to rely on legal counsel that has profound knowledge about the safe harbors and where they might apply.

Stark Law Violations

The Stark Law is similar to the AKS in the sense that both the AKS and Stark seek to prevent referrals made on the basis of monetary incentive. Stark specifically prohibits physicians from referring their patients to any designated health services entity that the physician (or an immediate family member) owns or has invested in, or has a compensation arrangement with. The Stark Law does not apply if any one of the statutory exceptions applies to the particular relationship.

False Claims Act Violations

The False Claims Act (FCA) is codified in 31 U.S.C. §§ 3729–3733 of the United States Code, and for purposes of health care fraud, applies to any provider that submits a claim for reimbursement by a federal program such as Medicare or Medicaid. The elements of a FCA claim are stated in the case of United States v. The Boeing Company as follows: (1) that Defendant made a claim, or made a statement in order to get the Government to pay money on a claim; (2) that the claim or statement was false or fraudulent; and (3) that Defendant knew that the claim or statement was false or fraudulent. Where the government finds that a false claim was in fact submitted, it can choose to seek either civil or criminal penalties, or both.

Prescription Fraud

Michigan physicians that prescribe an unusually high number of narcotic prescriptions often become subject of government investigation and prosecution. Specifically, such providers are investigated for committing insurance fraud and DEA violations, as opposed to what is typically referred to as health care fraud.

Billing Fraud

Billing fraud is one of the most active areas of government investigations and prosecution. The government is particularly stringent in its review of providers who are alleged to be fraudulently billing. Specific billing fraud that often triggers government investigation are billing for medically unnecessary services, billing for services that were never provided, billing for patients that do not exist, and using billing codes with a higher reimbursement than the codes for the services that were actually performed.

Certification Errors

Certification errors is an area of health care fraud that applies particularly applies to home health and hospice providers. Specifically, these providers run in to trouble with the government when the government suspects that physicians and nurses certify that a patient is homebound, thereby qualifying for home health care, or that a patient is terminally ill, thereby qualifying for hospice care, when the patient is, in fact, not. Recently, the government has increased its focus on investigating and prosecuting such occurrences.

Health Care Fraud Investigations in Michigan

Providers in Michigan have recently been highly susceptible to becoming a target of a health care fraud investigation or prosecution. This is particularly true of providers in Detroit where the federal government has created a special task forces to monitor, investigate, and prosecute Medicare Fraud. The investigation efforts are led by the government’s elite Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and others. Our team of attorneys are prepared to assist clients all across Michigan, including those located in the following counties: Wayne, Oakland, Macomb, Kent, and Genesee.

Oberheiden, P.C. has a long and distinct track record of avoiding criminal charges. If you or your practice are under investigation, or if you want to find out what to do next, you should speak with one of the former prosecutors and experienced defense counsel of Oberheiden, P.C. today. All calls are free and confidential.

What are the Potential Penalties?

Health care fraud is a unique offense in that it can result in civil monetary penalties, criminal penalties, or both. Civil penalties can be within a variety of ranges depending on the type of health care fraud claim brought against a party. The criminal health care fraud statute codified in 18 U.S.C. 1347 of the United States Code states the criminal penalties as follows: (1) Up to 10 Years in Prison for Each Count of Health Care Fraud; (2) Up to 20 Years in Prison If the Fraud Resulted in Serious Bodily Injury; or (3) Life in Prison If the Fraudulent Scheme Resulted in the Patient’s Death.

Whether or not the government seeks criminal prosecution depends on a multitude of factors that are learned from experience in dealing with these cases. What makes Oberheiden, P.C. unique in its representations in health care fraud cases is our dual expertise as former health care prosecutors and renowned defense attorneys. Our group has a long and distinct track record of avoiding criminal prosecution. If you are a Michigan resident who is under investigation or if you simply want to discuss your case directly with one of our experienced attorneys, you should contact Oberheiden, P.C. today. All calls are free and confidential.

What Constitutes Criminal Health Care Fraud?

Many factors such as the severity of the offense, the prosecutor’s judgment, and the type of alleged health care fraud together determine whether or not the government seeks criminal prosecution for health care fraud. By early intervention and unique, tested defense strategies, Oberheiden, P.C. has been extraordinarily successful in avoiding criminal charges for its clients who are subject to health care investigations. If you are a Michigan physician or provider and believe your practice is being investigated, you should speak with our experienced attorneys immediately to discuss your situation and to develop an effective defense plan.

Because the U.S. Attorney’s Office prosecutes both civil and criminal cases, a prosecutor’s involvement does not necessarily mean that the target is being charged with a criminal offense. Likewise, communication from an OIG or FBI agent does not necessarily mean that the target of the communication is subject to a criminal case, as OIG and FBI agents are also the government’s investigative bodies for civil matters. Nonetheless, from our own experience as federal civil health care prosecutors, we know that cases that start as a civil investigation can turn into a criminal matter, if defended poorly. Therefore, anyone who receives notice of investigation by any of these agencies should retain experienced legal counsel as early as possible. Our team of attorneys has profound skill in determining whether or not the government is intending on seeking civil or criminal penalties or both. Some of the indicating factors include the execution of search warrants, seizure warrants, arrest warrants, issuance of target letters, the involvement of criminal prosecutors, the involvement of the IRS, or the issuance of grand jury subpoenas.

If you have questions, please call us directly. Our clients range from individual providers to entire health care systems. We represent clients in Michigan who are under investigation by the Department of Justice (DOJ), the Department of Defense (DOD), the Federal Bureau of Investigation (FBI), Drug Enforcement Administration (DEA), the Office of Inspector General (OIG), the Medicaid Fraud Control Unit, Detroit and Michigan law enforcement, or the Internal Revenue Service (IRS).

Defending Health Care Fraud

Oberheiden, P.C. is a health care fraud defense law firm. Throughout our careers, we have handled over 1,000 health care matters and tried more than 200 criminal cases in court. Many of our attorneys were previously in charge of health care audits and fraud investigations at the Department of Justice and they now offer their valuable insights and extraordinary experience with our clients. Our team is prepared to help clients all across Michigan, including those in Detroit, Grand Rapids, Sterling Heights, Ann Arbor, Lansing, and Flint, who are faced with health care fraud allegations.

Our Top Priority

Our number one goal in every investigation is to avoid criminal charges. Based on our experience and our success rate, we understand that the best way to avoid criminal prosecution is not to wait and let the government build its case, but to intervene early in the case while there is still room to impact the investigation. From the moment you engage our services, we will work relentlessly to protect your freedom and your livelihood. Within the first hours of an engagement we are often able to answer the most pressing questions: What is the case about? What is the purpose of the investigation? How long will it take? What is the likely outcome?

Strongly Defending on the Basis of No Intent

The U.S. Constitution requires that to convict someone of a crime, the government must prove criminal intent beyond a reasonable doubt. We enforce that high standard against any of the government’s threats of criminal prosecution. Based on our experience, we know that innocent mistakes happen and such mistakes do not equate to fraudulent intent. We reinforce that understanding against prosecutors who point to inaccuracies in billing records to prove a defendant’s intent. Oberheiden, P.C. has successfully defended clients across the country by demonstrating that any misinformation in their billing records resulted from organizational or human error and not from fraudulent intent. In our experience, simple oversights such as unqualified staff, delegation and outsourcing errors, and insufficient supervision, in addition to constantly complex and frequently-changing billing rules may all lead to errors, but they should not lead to criminal liability. Michigan residents charged with health care fraud should call us immediately to speak with our group of former health care prosecutors and investigations. Our attorneys are prepared to help clients all across the state of Michigan.

Legal Defenses

In addition to having the trial and negotiation skills needed to defeat a government’s case, the attorneys of Oberheiden, P.C. also have the specific health care law expertise to introduce applicable legal defenses drawn from the language of the law and statutory loopholes. We have won many cases by demonstrating how exceptions, for example in the context of the Stark Law or medical necessity certifications, apply to our clients’ case and either mitigated or entirely eradicated the government’s fraud case.

Protecting Your Reputation

We are committed to defending our Michigan clients against unfounded allegations of fraud. We understand individuals placed in such situations are equally concerned about their reputation and their perception in the public. The media is a powerful tool that can ruin someone’s reputation or spread rumors about wrongdoings by presenting biased and prejudicial news reports to its audience. Our attorneys routinely intervene into slandering reporting and obtain news spots and opportunities to correct and rectify errors by educating the audience about the truth. This strategy is effective in defending both in the courtroom and in the community.

Oberheiden, P.C. has appeared in health care proceedings across the country to help clients fight fraud charges. Call us today to discuss your situation with our experienced attorneys in a free and confidential conversation.

Our Track Record

The commitment of Oberheiden, P.C. is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former health care prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home health care entities, and many other health care organizations against any form of alleged health care fraud. Here are some recent examples of our case outcomes.

  • Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation 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.
  • Representation of a Health Care Marketing Group Against an Investigation by the Office of Inspector General for Alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation of Health Care Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
    Result: No civil or criminal liability.

Health Care Fraud Defense Attorneys Serving Michigan

Nick Oberheiden has represented clients in Qui Tams, False Claims Act, Medicare Fraud, Tricare Fraud, Stark Law, and anti-kickback proceedings before virtually all federal agencies including but not limited to the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL). Dr. Oberheiden is trained in negotiations by Harvard Law School and holds a Juris Doctor as well as a Ph.D. in law.

Clients all across Michigan, including those in Wayne, Oakland, Macomb, Kent, and Genesee counties can call us today and speak to one of our experienced attorneys directly. We are available to discuss your situation in a free and confidential call, including on weekends.

1-800-810-0259
Including Weekends

Oberheiden, P.C.
Serving Detroit & Michigan
(800) 810-0259
(214) 469-9009
Federal-Lawyer.com

Who Will Handle Your Case

When you hire us, you will not work with paralegals or junior lawyers. Each lawyer in our Health Care Practice Group has handled at least one hundred (100) matters in the health care industry. So, when you call, you can expect a lawyer that immediately connects with your concerns and who brings in a wealth of experience and competence.

Dr. Nick Oberheiden

Dr. Nick
OBERHEIDEN

Lynette S. Byrd

Lynette S.
BYRD

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