What Are the Penalties for Medicare Fraud in Michigan?

Find Out (For Free) Why Michigan Health Care Providers Want Attorney Dr. Nick Oberheiden on Their Defense Team: (214) 692-2171

It’s not easy to be a Medicare provider in Michigan. Despite all intentions to do it right and to serve the community, more and more doctors in Detroit and throughout Michigan find themselves exposed to allegations of fraud and Medicare audits.

Many of these doctors and Medicare business owners turn to Oberheiden, P.C. and attorney Dr. Nick Oberheiden. In hundreds of federal civil and federal criminal Health Care fraud investigations, Nick and his team have shown that there is a big difference between being accused and being convicted of Medicare fraud.

If your business is under audit, investigation, or if the government accuses you of a wrongdoing, please don’t make the mistake and think the problem will improve or go away by sitting idle. Act, get an immediate free consultation and find out why the worst thing you can do is wait and the second worst thing you can do is expect an inexperienced attorney to accomplish wonders for you. Call experience, call attorney Dr. Nick Oberheiden directly at (214) 692-2171.

What Are the Penalties for Civil Medicare Fraud in Michigan?

Michigan Medicare fraud cases that lack criminal intent may be investigated civilly. The U.S. Attorney’s Office in Detroit together with the U.S. Department of Health and Human Services, and the Office of Inspector General have the authority to subpoena businesses and providers accused of fraud.

If your practice received such a subpoena stating that you are under audit for Stark Law violations, Medicare Fraud, illegal kickbacks, you must know that your liability can be immense if you don’t find the right defense strategy. With monetary penalties beginning at more than $ 10,000 per false claim submission, for example, you will understand that a Medicare fraud investigation, civil or criminal, is not a matter to experiment with.

In dozens and dozens of civil health care fraud cases, attorney Nick Oberheiden has avoided liability for clients. Call him directly and today at (214) 692-2171 to hear what he would do to protect your business and your assets.

What Does the Government Have to Prove in a Michigan Medicare Fraud Case?

Medicare Fraud as a federal criminal offense is regulated in 18 U.S.C. 1347. The government must prove beyond a reasonable doubt that each of the following elements of the offense are met.

  • The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a health care benefit program or obtain money or property from a health care benefit program by means of false or fraudulent pretenses, representations, or promises;
  • The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the health care benefit program; and
  • The defendant acted with the intent to defraud the health care benefit program.

What Are the Penalties for Criminal Medicare Fraud in Michigan?

The sentencing in Michigan Medicare Fraud cases largely depends on the calculated recommendations under the Federal Sentencing Guidelines. Generally speaking, the higher the damage amount to Medicare/CMS, the higher the sentence. Per statute 18 U.S.C. 1347, a defendant guilty of Medicare fraud must expect up to 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment. The following real-life examples are Medicare Fraud cases investigated by the FBI, the Office of Inspector General, and the U.S. Attorney’s Office in Detroit, Michigan.

If you have any questions or concerns or need to better understand the penalty calculation for Medicare Fraud in Detroit or other parts of Michigan or need guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends at (214) 692-2171.

  • Two Michigan men who owned home health care agencies pleaded guilty to defrauding Medicare. According to the plea agreement, both individuals admitted to paying illegal bribes in order to get Medicare patients for their home health agency. The two individuals also admitted to submitting fraudulent claims to Medicare for services that were never provided to their patients. The two men each pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive health care kickbacks. One of the men was sentenced to six years in prison and the other man sentenced to 10 years in prison for their roles in the scheme.
  • A patient recruiter in Michigan was found guilty by a federal jury for her role in a scheme to defraud Medicare. According to evidence presented at trial, the patient recruiter was paid kickbacks from owners of a home health care agency in exchange for finding Medicare beneficiaries to refer to the home health agency. The home health agency then submitted claims to Medicare for services provided to the illegally referred patients. As a result of the scheme, Medicare paid $1.1 million based on the claims for services submitted.
  • The owner of two Detroit are clinics pleaded guilty to her role in a scheme involving submitting fraudulent claims to Medicare. According to the plea agreement, the owner of the clinics was involved in submitting for reimbursement to Medicare claims for services to patients at her clinics that were not medically necessary, not provided, and not provided by a licensed physician. As a result of the scheme, Medicare paid almost $9 million for the fraudulent services. the owner of the clinics pleaded guilty to one count of conspiracy to commit health care fraud and one count of health care fraud. The owner was sentenced to 160 months in prison for her role in the offense.
  • A Michigan woman was found guilty by a federal jury for her role in a scheme to defraud Medicare. According to evidence presented at trial, the woman was unlicensed, but acted as a physician for a home health company. The woman held herself out as a physician to patients at the home health company and provided services to patients that were not medically necessary. The services were then billed to Medicare as if they had been provided by a licensed medical professional. Evidence further showed that the woman paid kickbacks to patient recruiters to refer Medicare beneficiaries to the home health agency. The woman was found guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive health care kickbacks, and five counts of health care fraud.
  • A Detroit area doctor was found guilty by a federal jury for his role in defrauding Medicare. According to evidence presented at trial, the doctor worked for a physician home visit company that provided home health services to Medicare beneficiaries. The doctor submitted fraudulent bills to Medicare for services provided to patients that did not qualify for home health services. Evidence further showed that the doctor would up-code the services he provided so he could bill for the highest paying service. As a result of his role in the offense, the doctor was sentenced to 24 months in prison.

What Is the Statute of Limitations for Medicare Fraud in Michigan?

In Detroit federal criminal health care fraud investigations, the Statute of Limitations is typically five years. However, 18 U.S.C. 3282 is subject to various exceptions that can prolong the allowable prosecution phase, in particular if the case is charged as a federal health care fraud conspiracy.

Call Oberheiden, P.C. (214) 692-2171 and Secure Proven Health Care Fraud Defense Experience

Oberheiden, P.C. has successfully represented:

  • Mobile Ambulance Transportation Cases
  • Mobile Radiology Services
  • Home Health Care Agency (Form 485 Cases)
  • Hospice Care Representation
  • Illegal Kickbacks
  • Any Form of Medicare Fraudulent Billing
  • Mental Health Care Providers
  • Cardiologists
  • Urologists
  • Dialysis Centers
  • Dentists
  • Family Medicine Doctors
  • Internal Medicine Specialists
  • Pain Management Doctors
  • Psychologists
  • Psychiatrists
  • Medicare Clinic Owners
  • Nurses
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