Oberheiden, P.C.’s team of health care defense lawyers provides strategic and proactive legal representation for Medicare-participating providers that are being targeted in federal fraud investigations. If your Nebraska medical practice or health care business is under investigation, call 888-519-4897 now for a free and confidential case assessment.
The federal definition of “Medicare fraud” is much broader than most people realize. Although the media coverage of the federal government’s efforts to combat Medicare waste and abuse typically focuses on investigations targeting large-scale scams, the majority of the government’s investigations target legitimate providers who are doing their best to comply with the Medicare program billing regulations.
For health care providers in Nebraska, this means a couple of things. First, it means that if your business or practice is being targeted in a Medicare fraud investigation, you are not alone. Federal agencies including the Centers for Medicare and Medicaid Services (CMS), Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Office of Inspector General (OIG) routinely launch new investigations based upon automated reviews of program billing data, and no Medicare-participating provider is immune from falling within the government’s crosshairs.
Second, it means that you need to take the government’s investigation very seriously. Despite the common connotations of the word, “fraud,” providers do not need to intentionally overbill Medicare in order to face charges. “Medicare fraud” includes both intentional and unintentional billing errors, and the majority of federal Medicare fraud investigations focus on violations that are the result of honest human error.
Medicare Fraud Defense Attorneys for Nebraska Health Care Providers
Our Medicare fraud defense attorneys bring centuries of combined legal experience to representing Nebraska health care providers in government investigations. We handle cases involving all federal agencies and task forces and all types of Medicare fraud allegations. We have resolved the majority of our clients’ investigations without charges being filed, and we have an extensive track record of protecting Medicare-participating providers against civil and criminal liability.
Our Medicare Fraud Defense Practice
Medicare Fraud Investigations Involving All Federal Agencies and Task Forces
Depending upon the specific allegations involved and the original source of the government’s information, Medicare fraud investigations can potentially involve a variety of different federal agencies and task forces. We have extensive experience in cases involving:
- Centers for Medicare and Medicaid Services (CMS) – CMS handles investigations triggered by ZPICs, RACs, and other “fee-for-service” audit contractors’ determinations of liability and other sources. It has the authority to directly impose penalties for civil Medicare fraud violations.
- Department of Justice (DOJ) – The DOJ handles civil and criminal Medicare fraud investigations, and its prosecutors litigate cases with the potential for civil and criminal penalties.
- Department of Health and Human Services Office of Inspector General (OIG) – The OIG is the law enforcement division of the Department of Health and Human Services (DHHS). It investigates cases involving allegations of fraud targeting Medicare and other federal health care benefit programs.
- Federal Bureau of Investigation (FBI) – The FBI has jurisdiction over Medicare fraud cases as well, and its agents often work in concert with agents and prosecutors from other agencies.
- Internal Revenue Service (IRS), Drug Enforcement Administration (DEA), and Others – Depending upon the specific allegations involved, the IRS, DEA, and various other federal agencies can get involved in Medicare fraud investigations as well.
Medicare Fraud Investigations Involving All Allegations of Waste and Abuse
In Medicare fraud investigations, allegations can range from inadvertently submitting inaccurate reimbursement requests to intentionally billing Medicare for services not provided. Our attorneys have experience successfully defending health care providers against allegations including:
- Billing for services or tests that do not meet the criteria for “medically necessary” under the Medicare program billing guidelines.
- “Double-billing” Medicare and/or another government benefit program or private insurer for services, supplies, or durable medical equipment (DME).
- Offering or accepting “kickbacks” or other forms of improper payment for referrals involving Medicare beneficiaries or payment with Medicare-reimbursed funds.
- “Phantom billing,” or billing for services, supplies, or equipment not actually rendered, used, or purchased.
- “Unbundling,” or billing for services, supplies, or equipment at their individual rates rather than a prescribed bundles rate.
- “Upcoding,” or billing for services, supplies, or equipment at higher rates than the one allowed.
Potential Defenses and Penalties in Federal Medicare Fraud Cases
Potential Defenses in Medicare Fraud Investigations
During Medicare fraud investigations, our attorneys utilize a variety of defenses in order to combat the government’s allegations and seek to resolve our clients’ cases without a grand jury subpoena or formal charges being filed. Once you engage our defense team to represent you, our attorneys will work closely with you to identify which potential defenses you have available. Depending upon the circumstances involved in your investigation, these defenses may include:
1. Inadequate Evidence of Billing Violations
While some allegations of fraud will be supported by admissible evidence, many Medicare fraud investigations are misguided. The Medicare billing regulations and federal health care fraud statutes are extraordinarily complex, and we have succeeded in defending many providers by convincing prosecutors that they do not have the evidence they need to pursue charges.
2. Inadequate Evidence of Intent
In cases involving a risk of criminal prosecution, a core component of a comprehensive defense strategy will often be to challenge the government’s evidence of intent. Intent is required for prosecution of most federal criminal offenses, and challenging this element of the government’s case alone can be enough to protect health care providers against a criminal Medicare fraud conviction.
3. Anti-Kickback Statute and Stark Law Safe Harbors
Cases involving allegations of illegal offering, payment, solicitation, and receipt of improper kickbacks and referral fees can trigger civil or criminal penalties under the Anti-Kickback Statute or civil penalties under the Stark Law. However, the prohibitions in both of these statutes are subject to a laundry list of safe harbors, and in many cases asserting a statutory safe harbor will be an efficient and effective defense strategy.
4. Unlawful Search, Seizure or Interrogation
Even if you or someone else within your business or practice overbilled Medicare (which is not something that should be assumed under any circumstances), if federal agents or prosecutors unlawfully obtained evidence against you, this evidence may be inadmissible at trial. Without admissible evidence, prosecutors should not be able to obtain a conviction regardless of the facts at hand.
In all cases, when asserting these defenses, it is crucial to address the potential for prosecutors to pursue charges for related offenses, and in particular the federal crimes of conspiracy and attempt. Even if you did not overbill Medicare, it is still possible to face charges for conspiring or attempting to “defraud” the government, and the federal conspiracy and attempt statutes give prosecutors extremely broad authority to pursue charges under a wide range of circumstances.
Potential Penalties for Medicare Fraud
Just as the potential defenses to Medicare fraud will depend upon the particular facts at hand, the potential penalties are dependent upon a number of different factors as well. This includes: (i) whether your case is civil or criminal in nature, (ii) the specific allegations involved, and (iii) the volume of the allegations against you. In general terms, the potential penalties in civil and criminal Medicare fraud cases are as follows:
Civil Medicare Fraud Penalties
- Recoupment of overbilled amounts
- Denial of pending claims
- Pre-payment review of future claims
- Civil fines
- Treble (triple) damages
- Attorneys’ fees
- Exclusion from Medicare participation
Criminal Medicare Fraud Penalties
- Criminal fines
- Federal imprisonment (including the potential for life imprisonment in cases where fraudulent Medicare practices result in a patient’s death)
- Exclusion from Medicare participation and other program-related penalties
If prosecutors pursue additional charges, such as mail fraud, wire fraud, money laundering, and tax evasion, the potential fines and aggregate term of imprisonment can increase substantially. Additionally, conspiracy and attempt charges can result in fines and imprisonment even if no improper billings have actually been submitted. Finally, for licensed health care providers, a Medicare fraud investigation can lead to state licensing board action even if federal prosecutors ultimately decide not to pursue civil or criminal charges.
5 Reasons to Choose Oberheiden, P.C. for Your Nebraska Medicare Fraud Investigation
With the potential for severe consequences, Nebraska health care providers targeted in Medicare fraud investigations need to make an informed decision about their legal representation. Here are five reasons why health care providers nationwide trust the federal defense team at Oberheiden, P.C.:
- We have built a practice that is focused on federal defense, with particular emphasis on defending health care providers in Medicare fraud investigations.
- Our attorneys have centuries of combined experience on both sides of federal health care fraud cases.
- With our team approach, all clients benefit from our senior attorneys’ collective experience and have direct access 24/7.
- We aggressively pursue pre-charge and pre-trial resolutions that are designed to protect our clients as discretely and cost-effectively as possible.
- When necessary, we utilize our vast trial experience to fight for our clients’ freedom and right to practice in court.
Contact Us Today for a Free Case Assessment
To discuss your Nebraska Medicare fraud investigation in confidence, contact us now for a free case assessment. Our attorneys are available by phone 24/7 at 888-519-4897, and if you contact us online we will respond as soon as possible.