What Are the Penalties for Medicare Fraud in North Carolina?

Find Out (For Free) Why North Carolina Health Care Providers Want Oberheiden, P.C. on Their Defense Team: 214-692-2171

It is not easy to be a Medicare provider in North Carolina. You want to help patients, you want to work with the system, you respect CMS and the Medicare regulations—and nonetheless you may find yourself in the middle of a ZPIC audit, Medicare audit, or even under Medicare fraud investigation.

We know how this feels. Oberheiden PC attorneys have represented hundreds and hundreds of Medicare business owners accused of fraud or wrongdoing across the United States. Trusted and respected for our health care law knowledge and our criminal defense experience, among many others, we have successfully represented the following individuals and companies.

  • 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

Oberheiden, P.C. Is a Medicare Fraud Defense Law Firm Serving North Carolina

When you are worried about your license, your career, and perhaps even your freedom, you should not experiment. Just like you would likely choose a spine surgeon and not a dentist if you needed back surgery, you should also think twice before you hire a lawyer for the most important legal case of your life. Unlike most other firms, Oberheiden PC focuses its practices on defending doctors and business owners against health care fraud and Medicare fraud allegations. Don’t call us for drunk driving but do consider our demonstrated experience for your Medicare situation.

What Are the Penalties for Civil Medicare Fraud in North Carolina?

Federal prosecutors in North Carolina often pursue Medicare fraud as a civil case. Rather than trying to prove criminal intent, the U.S. Attorney’s Office in North Carolina simply claim that a medical provider or business submitted false claims to CMS/Medicare and thus, without need for intent, is liable under the Civil Monetary Penalty Law and the False Claims Act. With penalties beginning at more than $ 10,000 per claim per violation, the only main advantage of a civil fraud case is that no jail time is sought. Other than that, penalties in civil Medicare fraud cases can quickly turn a healthy business into an almost bankrupt practice.

If you received a subpoena from the U.S. Attorney’s Office or the Department of Health and Human Services informing you about possible violations of Medicare laws, Stark Law, the Anti-Kickback or other federal health care regulations, call Oberheiden PC right away. Oberheiden PC lawyers have successfully defended clients against civil fraud allegations in almost the entire United States, an experience hard to find elsewhere. Call us at 214-692-2171 and see how we would protect your business and your monies.

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

  • 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 North Carolina?

Sentencing in North Carolina Medicare cases is based on the Federal Sentencing Guidelines. Pursuant to Title 18 of the United States Code, a defendant guilty of Medicare fraud is exposed to up to 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment.

Penalty calculation in North Carolina Medicare Fraud cases are complex and depend on many factors. If you have questions or need guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Call 214-692-2171.

  • A hospital in North Carolina has agreed to a monetary settlement with the United States for its alleged role in scheme to defraud Medicare. According to the settlement, the hospital allegedly submitted claims to Medicare for various procedures performed at a higher rate of reimbursement than what was allowed. The procedures billed were classified as “inpatient” when the patients who received these procedures lacked the medical necessity to receive inpatient status. Based on the medical condition of the patients, these procedures should have been performed on an outpatient status. As a result of the allegations, the hospital will pay $1.9 million back to Medicare. Since this case was resolved by a settlement, there has been no finding of liability against the hospital.
  • An owner of a mental health facility in North Carolina pleaded guilty to his role in a scheme to defraud Medicare. According to the plea agreement, the owner paid kickbacks to patient recruiters to find him individuals who were Medicare eligible and who suffered from age related mental illness, such as Alzheimer’s and dementia. Once the patients were referred to the mental health facility, the owner would write false patient records and fabricate medical symptoms in order to qualify the patients for partial-hospitalization. The partial-hospitalization services were then billed to Medicare as if they were medically necessary. As a result of the scheme, Medicare paid out $63 million. The owner of the mental health facility was sentenced to 168 months in prison for his role in the offense.
  • A health care system based in North Carolina has agreed to a monetary settlement with the United States to resolve allegations that it defrauded Medicare. According to the settlement, the health care system is alleged to paid illegal kickbacks to physicians working at its hospitals. Executives at the health care system devised a plan to pay physicians bonus payments based on how many patients the physicians could refer to hospitals managed by the health care system. Physicians would also receive a bonus if they ordered lab tests for patients they referred. The services provided to the patients who were illegally referred were then submitted to Medicare for reimbursement. To settle these allegations, the hospital will pay $115 million back to Medicare. Since this case was resolved with a settlement, there has been no finding of liability against the health care system.
  • The parent company of two North Carolina hospitals has agreed to a settlement with the United States for allegations that its hospitals defrauded Medicare. According to the settlement, the North Carolina hospitals pressured physicians, under threat of termination to admit Medicare beneficiaries to the emergency room who did meet medical necessity requirements to receive emergency room services. The hospitals would then submit the ER bills to Medicare for reimbursement. Asa result of the settlement, the hospitals’ parent company will enter in to a corporate integrity agreement and will pay $62 million back to Medicare.

What Is the Statute of Limitations for Medicare Fraud in North Carolina?

In North Carolina 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.

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