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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

Bill McMurrey
Former DOJ-Trial 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

Hospice Care Fraud Defense in New Mexico

The U.S. government began intensifying its fraud investigations of hospice services in 2015. As a result, hospice providers in New Mexico and across the country are increasingly facing accusations of criminal conduct and the potential for huge civil liabilities. In short, the government believes that many hospice providers are committing health care fraud by billing their dying patients for unnecessary services. Since hospice fraud is prosecuted as a federal felony, if you have received a subpoena or are under investigation, you could be facing years in federal prison.

Clearly, the last thing you want is for the government to brand you as a criminal or impose fines and penalties that cost you your business. Our former federal prosecutors and experienced defense lawyers are here to help you protect your legal rights. Call Oberheiden, P.C. today at (888) 727-5159 to speak with a former federal prosecutor at no cost to you.

You Have Been Accused of Hospice Fraud. What Now?

The federal health care fraud statutes cover any individual or business that directly or indirectly contracts with the United States government. As a result, hospices and their owners, executives and employees can all potentially face criminal penalties and civil liability for hospice fraud. At some point during its existence, almost every for-profit hospice company in New Mexico will be accused of fraud.

Booming Business

The government has been executing criminal search warrants against hospices with increasing frequency over the past few years. Recent statistics have shown that more than half of all Medicare patients die while under in-patient or at-home hospice care. As a result, hospice care is a booming business, and this means that it has the government’s attention. Unfortunately, this also means that more and more hospices are being charged with fraud.

Example: In 2015, a federal appeals court affirmed a 15-year prison sentence and $16.2 million restitution order for a home hospice owner who was found guilty of paying for referrals and paying doctors and nurses to falsify patient records.

Certification Errors and Unnecessary Services Lead Hospice Fraud Accusations

Falsification of records and payment or receipt of kickbacks are common accusations in indictments for all types of health care fraud. However, the most common fraud charges against hospices actually center on the Medicare rule which states that hospice care should only be provided if a physician has certified that the patient has six months or fewer to live.  Lack of certification, falsified certifications, and failure to discharge patients when their life expectancy improves are all common accusations in fraud cases involving hospices.

The federal government also regularly files fraud charges against hospices and their owners for ordering medications not for pain or symptom relief, but for treating a patient’s underlying condition (in the hospice setting, patients must agree to cease medical treatment and accept only palliative care).  Similarly, the government frequently accuses hospices of ordering unnecessary or redundant medical equipment, such as wheelchairs or walkers.  Often, these cases are investigated based on nothing more than data analytics which suggest that certain hospices are “outliers” in terms of cap repayments, live discharges, elevated levels of care, length of stay, or use of particular diagnostic codes.

What Are the Penalties for Hospice Fraud?

Critically, you do not need to intend to commit hospice fraud in order to violate the law. In fact, the government does not even need to prove that you had actual knowledge of the wrongfulness of the transaction in order to obtain a conviction.

If found guilty, you could be exposed to recoupment requests, civil fines of $11,000 per false claim, criminal fines, non-payment of reimbursement future claims, exclusion from federal health care programs, treble damages, attorneys’ fees, and incarceration in a federal prison.

The possibility of facing charges for Medicare, Medicaid, Tricare, and other types of health care fraud should caution you to invest your time and resources in working with an experienced attorney to develop a strategic and thoughtful defense plan.

Government Investigation: Civil or Criminal?

Hospice fraud is investigated by the Office of Inspector General (OIG), the Department for Health and Human Services (HHS), the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), Medicaid Fraud Control Units (MFCUs), and State Medicaid Agencies in cooperation with the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the General Services Administration (GSA), and the Centers for Medicare and Medicaid Services (CMS).

One of the first questions you need answered is whether the investigation is civil or criminal. Health care fraud statutes offer both options, and the type of investigation you are facing will determine how your attorney defends your case. At Oberheiden, P.C., we can figure out whether you are facing civil allegations or criminal charges and respond accordingly.

How do we do this? By relying on years of experience combined with the insight and knowledge of our former government officials to spot key details and nuances of the investigation. These may include:

  • The way you were notified about the investigation
  • Which agent and which federal agency contacted you
  • The government official in charge of the investigation

Importantly, the involvement of a prosecutor or a federal agency does not necessarily suggest that your case is a criminal investigation.

How We Defend Against Accusations of Hospice Fraud

When you hire the attorneys and former government officials at Oberheiden, P.C., one of the first things you will notice is that we know your industry and exactly how the government is building its case against you.

When you work with an attorney at Oberheiden, P.C., you get:

  • Industry Knowledge. Since hospice fraud charges often stem from billing and coding errors, it is critical for your attorneys to have a thorough understanding of CMS protocols. Do not let misinterpretations of coding policies or missed updates to billing changes expose your business. Our attorneys have analyzed, reviewed, and defended close to 500,000 billed claims. Similarly, if you are being accused of certification errors, you need lawyers who understand the legal requirements of hospice certifications to get your case dismissed.
  • Government Experience. The difference between culpability and simple human error is often a fine line that requires convincing negotiation skills and a fine attention to detail. The lawyers and former government officials of Oberheiden, P.C. have proven health care and law enforcement competence. Our attorneys have extensive experience handling all types of fraud allegations in the health care industry. Take a look at our track record to see for yourself.
  • An Aim to Avoid Criminal Charges.. We want to keep investigations civil, not criminal. In many instances, our attorneys are able to persuade the government that any errors were not intentional or willful, but rather the result of honest mistakes and human error. Keeping the government focused on a civil investigation is critical, because in each fraud investigation prosecutors have two choices: to conduct a civil investigation and seek recoupments, or to prosecute criminally and seek imprisonment. The law provides for both.

Our “Emergency Defense Package”

If you are being investigated for hospice fraud, you do not have time to waste. Our “Emergency Defense Package” has been featured in news and media across the country as a tool to provide immediate help to clients under federal investigation. The “Emergency Defense Package” is a proven protocol that has been developed over years of federal criminal practice and will address your most pressing questions, including:

  • Is the investigation civil or criminal?
  • Should I talk to the government?
  • Do I have a duty to talk to federal agents?
  • What should I tell my employees?
  • Can I continue my business?
  • What happens next in my case?

The “Emergency Defense Package” was developed by our experienced defense lawyers and former government officials, and is designed to provide instant assistance for hospice owners facing federal investigations. The “Emergency Defense Package” discusses several proven steps to help you take control and not fall victim to the government’s tactics during investigations. Call us today to find out how our “Emergency Defense Package” will make a difference in your case.

A Team You Can Trust

The attorneys at Oberheiden, P.C. have successfully defended clients against Medicare fraud, Medicaid fraud, Tricare fraud, Anti-Kickback, and False Claims Act accusations across the country. We have concluded a large number of health care fraud cases with no civil or criminal liability for our clients. We regularly represent clients in civil and criminal investigations throughout New Mexico.

Call us today to discuss your case with one of our attorneys. All initial consultations are free and confidential. Let us show you how we can fight to help you avoid federal charges or have your charges dismissed.

Our Track Record

  • Investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation 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, case dismissed.
  • Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General for alleged health care fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability, case dismissed.
  • 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, case dismissed.

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.

Bill C. McMurrey

Bill C.
McMURREY

Dr. Nick Oberheiden

Dr. Nick
OBERHEIDEN

Lynette S. Byrd

Lynette S.
BYRD

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