Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Health Care Fraud Defense Team Serving the State of Ohio

Oberheiden & McMurrey, LLP is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our attorneys are the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and education from the country’s best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in the state of Ohio as well as surrounding areas.

If you’re a health care provider, entity, or business in Ohio and you’re facing an allegation of health care fraud, you should call the Oberheiden & McMurrey, LLP right away. We are a health care fraud defense law firm providing services in Ohio. We have extensive experience in health care fraud defense, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG and grand jury subpoenas, criminal defense, and internal investigations. Our elite Health Care Fraud Defense Team includes a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s office, multiple former health care fraud prosecutors, former lead prosecutors from the Medicare Fraud Strike Force, and attorneys with leading law school education.

If you’re being investigated for health care fraud, call right now and ask to speak with a member of our Health Care Fraud Defense Team. Initial consultations are free and confidential.

Ohio Is Directly Monitored by the Medicare Fraud Strike Force

Ohio is directly monitored by the Medicare Fraud Strike Force because it is one of nine areas in the nation that has a large population that depends on a federal health care program for benefits. The Medicare Fraud Strike Force is an exclusive team of prosecutors and investigators from multiple federal agencies, including the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. This list isn’t all-inclusive. Other federal agencies often have representatives that are part of this team.

Since Ohio has a large number of citizens who depend on a federal health care program, more claims are filed for reimbursement. The government pays close attention to claims filed in the area to ensure that they are not paying out on false claims. The Medicare Fraud Strike Force monitors, investigates, and ultimately prosecutes confirmed health care fraud. The Department of Justice investigated more than 300 allegations of health care fraud during 2016. They released a statement breaking down the investigations to include around 80 individual providers and more than 200 entities and businesses. The agency recovered more than $900 million in claims.

Defining Health Care Fraud

Federal health care fraud is an attempt at reimbursement for medical equipment or services provided through a federal health care program like Medicaid, Medicare, Tricare, or federal workers’ compensation with one or more false claims. It includes a violation of at least one of the following:

  • The Anti-Kickback Statute. Federal health care law outright prohibits kickbacks in exchange for referrals. Any individual (including doctors, marketing representatives, and business owners) is subject to prosecution for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
  • Stark Law. Stark Law, also known as the Self-Referral Law, prohibits doctors from referring patients to specific health care service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest, or if there is a compensation arrangement. Note, however, that there are statutory exceptions to this law.
  • False Claims Act. If you submit a claim to Medicare or any other federal health care program, you are required by law to abide by the False Claims Act. If the claim submitted to the federal government is discovered to be inaccurate, the federal government will likely launch an investigation into your billing practices under the criminal provisions of the False Claims Act.
  • Prescription Fraud. The federal government pays attention to health care practices that have an unusually high number of narcotic prescriptions. If you are suspected of running a “pill mill,” you are at a high risk of being investigated for insurance fraud and for violating DEA dispensing rules.
  • Billing Fraud. The federal government is persistent about investigating the upcoding of claims. Upcoding means that the next higher code is used for a service when the billing is done. The federal government is also prone to investigating phantom billing (billing for services that were not provided), billing for patients who do not exist (referred to as ghost patients), and billing for equipment or services that are deemed not medically necessary.
  • Certification Errors. The home health care and hospice industry is frequently a practice that the federal government chooses to maintain a close eye on. The most common accusations include fraudulent certification for home health care and hospice care.

Oberheiden & McMurrey, LLP is proud of its record of success in helping our clients avoid criminal charges. If you or your health care practice, clinic, entity, or business are being investigated for health care fraud in Ohio, pick up the phone and call Oberheiden & McMurrey, LLP now. The call is free and confidential.

Health Care Fraud Has Civil and Criminal Penalties

Health care fraud is extremely serious in nature. It can lead to civil or criminal charges that result in serious penalties. Civil penalties include repayment of claims, non-payment of future claims, and you may be excluded from federal health care programs. Additionally, you could be called before the Ohio disciplinary board, lose your license, or lose your hospital privileges. Criminal penalties are also extremely serious. They include criminal charges, fines in the hundreds of thousands of dollars, and a federal prison sentence of:

  • Up to 10 years for each count of health care fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
  • Life sentence if the health care fraud resulted in the death of a patient

One of the most common questions we are asked during initial consultations with Ohio clients is what the worst-case scenario may be. The possibility of facing criminal charges or a prison sentence are the worst-case scenarios, but these depend on several factors, including the severity of any injury suffered by a patient, the interest the prosecutor has in pursuing criminal charges, and the reason why the investigation was launched.

Oberheiden & McMurrey, LLP is prepared to defend our Ohio clients against health care fraud. Our former experience as former health care prosecutors, coupled with our experience as defense attorneys, provides a unique insight that we use to the benefit of our clients. If you’re being investigated for health care fraud in Ohio, call us now. Initial consultations are free and confidential.

Is It a Criminal Matter?

health care fraud investigations can be civil or criminal. Oberheiden & McMurrey, LLP has a reputation for helping clients avoid criminal charges. We do this by early contact with the federal government. Call us as soon as you’re contacted about a health care fraud investigation so that we can begin to advocate on your behalf.

Contact from a federal prosecutor isn’t a sign that you’re facing criminal charges. All federal agencies with prosecutors have a civil and a criminal division. That’s why you can’t determine the nature of the charges you may face based solely on the fact that you’ve been contacted by a prosecutor. Determining whether the investigation is criminal in nature can depend on the legal interpretation of many different elements, such as OIG subpoenas, the manner in which the inquiry is made or in the way in which the allegations are made, and other indicators of criminal prosecution. Criminal prosecution may be signaled by the use of search warrants, seizure warrants, arrest warrants, target letters, involvement of federal criminal prosecutors, IRS involvement, or grand jury subpoenas.

If you have questions about whether you’re facing a civil or criminal health care fraud investigation, call Oberheiden & McMurrey, LLP. We are experienced in representing individual providers, entire health care systems, and other related health care businesses. We provide our health care defense services to individuals, businesses, and entities in and around Ohio that are being investigated by the Department of Justice, the Department of Defense, Office of Inspector General, Drug Enforcement Administration, the Federal Bureau of Investigation, Medicare Fraud Control unit, Ohio state Law Enforcement, or the IRS.

Strategic Health Care Fraud Defense Strategies for Ohio Clients

Oberheiden & McMurrey, LLP provides legal representation in Ohio to those facing allegations of health care fraud. We’ve handled hundreds of trials and cases. Several of our attorneys have previous experience as health care auditors and as prosecutors working with the Department of Defense. This experience is an asset to our firm and our Ohio clients.

Immediate contact with federal investigators. Our objective in each case is to help our clients avoid criminal charges. Our experience and track record prove that the best way to do this is to immediately contact federal investigators on behalf of our clients. We can usually get answers to the most important questions within just a few hours after being retained:

  • What is the investigation about?
  • What is the purpose of it?
  • How long will the investigation take?
  • What is the most likely outcome?

Testing evidentiary standards. Federal prosecutors must meet high Constitutional standards in order to bring charges against you. They must prove beyond a reasonable doubt that you committed a crime and that you performed your actions with criminal intent. In each case, we test the standard. Often, federal prosecutors will try to use your billing inaccuracies against you as an example of criminal intent. However, we’ve learned from experience that mistakes happen. Mistakes do not and should not be held as a crime. Oberheiden & McMurrey, LLP continues to provide successful legal defenses for clients by showing that billing inaccuracies are a result of human or organization errors, and did not occur because of an intention to defraud the government. The use of unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care are the most frequent errors that cause these investigations. While these mistakes should certainly be addressed and corrected, they should not lead to criminal charges.

Strategic health care fraud defenses. Oberheiden & McMurrey, LLP reviews each case on its own merits to develop strategic legal defenses. This often includes locating applicable defenses and statutory loopholes. Many of our cases have been successful based on these legal exceptions. As an example, Stark Law involves medical necessity certifications, and we’ve been able to point to exceptions that either mitigate or entirely resolve a health care fraud matter.

Representation both in and out of the courtroom. Oberheiden & McMurrey, LLP is committed to clients both in and out of the courtroom. Accusations of this nature can ruin your career. Our clients are always concerned about how these charges may affect them. The media holds a lot of power. They use inaccurate and biased reporting that don’t tell the entire story. Our lawyers address slander and will also seek opportunities to correct misinformation about our clients.

If you’re being investigated for health care fraud, contact us at Oberheiden & McMurrey, LLP now to learn how we can help. The call is free and confidential.

Our Track Record

The commitment of Oberheiden & McMurrey, LLP 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 the State of Ohio

Nick OberheidenNick Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. In addition to his health care defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Clients greatly benefit from Ms. Byrd’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she regularly argues federal matters for her clients.

We are available every day of the year. You can call us directly or complete our contact form or email us directly.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving the State of Ohio and Surrounding Areas
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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