What Are the Penalties for Medicare Fraud in Ohio?
Find Out (For Free) Why Ohio Health Care Providers Hire Oberheiden, P.C.: (214) 692-2171
Health care providers and business owners in Ohio are experiencing an unprecedented rise of federal Medicare or Medical Billing Fraud and Medicaid Fraud investigations. Federal prosecutors in Ohio, now the state with the 5th largest Medicare population in the United States, have begun to systematically paint respected doctors, community servants, and established business owners as violators of federal laws. In this climate of aggressive enforcement, Ohio physicians and business owners need lawyers that have proven in hundreds of cases how to convince the government, judges, or juries that the medical billing fraud allegations are not true.
Lawyers Dedicated to Defending Ohio Health Care Providers
When you face troublesome audits or find yourself in the middle of a federal investigation, Oberheiden, P.C. is on your team. Unlike most other firms, our firm is a federal defense firm with a substantial track record of protecting physicians in Ohio and elsewhere against unjust fraud charges or license revocations. In hundreds of health care fraud defense cases across the nation, our attorneys have demonstrated their ability to resolve complex, hopeless, career-threatening Medicare Fraud, Medicaid Fraud, referral kickback cases, opioid prescription investigations, and any other form of health care fraud allegation. If your freedom is on the line, don’t experiment. Call (214) 692-2171. Do what so many clients before you have done, trust the Oberheiden PC lawyers and let us accomplish your goals. We have 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
- Dialysis Centers
- Family Medicine Doctors
- Internal Medicine Specialists
- Pain Management Doctors
- Medicare Clinic Owners
What Are the Penalties for Civil Medicare Fraud in Ohio?
Medicare fraud can be civil and criminal. In civil cases, the Office of Inspector General, which is a federal agency that investigates health care fraud with the U.S. Department of Health and Human Services and the U.S. Department of Justice, has jurisdiction and authority to impose civil liability on individuals and companies that fraudulently received Medicare funds.
Civil violations include submitting false and fraudulent claims, physician self-referrals, kickbacks, drug price reporting, and other violations committed without criminal intent.
Most civil investigations begin with serving a subpoena from the Department of Health and Human Services, Office of Inspector General. Many of these investigations are prompted by whistleblower cases filed by former employees who report fraud in an effort to collect a civil reward under the False Claims Act.
Recent changes in legislation have doubled the already draconian fines attached to civil health care fraud. For example, certain Civil Monetary Penalty Law (CMPL) violations increased from previously $ 10,000 to now $ 20,000 per false claim.
What Does the Government Have to Prove in Ohio Medicare Fraud Cases?
Medicare Fraud as a federal crime is regulated in 18 U.S.C. 1347. Pursuant to this statute, a person is guilty of health care fraud in Ohio federal court if the government prosecutors can prove beyond a reasonable doubt that the following mandatory elements 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.
Because health care fraud and Medicare fraud are federal offenses, violations are typically investigated by Ohio-based federal law enforcement agencies such as the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG), the Ohio Medicaid Fraud Control Unit (MFCU), and prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office in Cleveland, Columbus, Akron, or Cincinnati.
What Are the Penalties for Criminal Medicare Fraud or Medical Billing Fraud in Ohio?
Federal prosecutors in Ohio are aggressively targeting health care business owners and physicians licensed to practice in Ohio in a variety of federal criminal health care fraud cases involving Medicare Fraud, Medicaid Fraud, illegal kickbacks, and opioid prescriptions. The following real-life examples demonstrate the dimension health care fraud enforcement has reached in Columbus, Cincinnati, and Cleveland, and Akron.
- An Ohio CEO and four doctors were indicted for their alleged roles in a Medicare fraud scheme that involved a network of Ohio clinics prescribing illegal medications. The indictment alleges that the CEO owned and operated pain clinics throughout Ohio and conspired with doctors working at these clinics to prescribe and sell opioids for cash. The CEO and doctors would prescribe medically unnecessary drugs, such as Oxycodone and Hydrocodone to Medicare beneficiaries and would split the proceeds after Medicare reimbursed the fraudulent prescriptions. The doctors would also sell these opioids on the street for cash payments. The CEO and four doctors have been charged with conspiracy to commit health care fraud, money laundering, and wire fraud. All defendants have pleaded not guilty.
- An Ohio man who owns substance abuse recovery centers throughout Ohio is under investigation by the Ohio Medicaid Fraud Control Unit for his involvement in a multi-million-dollar Medicaid fraud scheme. According to the complaint filed against the owner of these recovery centers, the owner allegedly had his employees bill Medicaid for services that were not properly documented and for services that were inflated to be more expensive that they actually were. The complaint also alleges unethical treatment of patients who were admitted to the recovery centers. Patients were given unauthorized drugs to help deal with their withdrawal symptoms and often had to wait days before they were allowed to see a doctor. This investigation is ongoing.
- Five people in Ohio were indicted for their roles in defrauding Medicaid and Medicare stemming from a home health care fraud conspiracy. The five individuals owned and operated several home health agencies throughout Ohio and allegedly billed Medicare and Medicaid for services that were not performed. The indictment alleges the individuals forged medical records to indicate that they had provided services to patients, when in fact they had not. The five individuals charged in this offense allegedly caused $7 million in losses to Medicare and Medicaid based on their fraudulent billings.
- Two owners of an Ohio based home health agency were found guilty following a seven-day trial for Medicaid fraud. According to evidence presented at trial, the owners of the home health agencies ordered their employees to falsify patient records in order to qualify the patients for home health services that they otherwise were not entitled to. The forged medical records resulted in over $100,000 fraudulent home health services that were billed to Medicaid for reimbursement. The two owners were found guilty of a felony count of Medicaid fraud and a felony count of tampering with evidence.
- A cardiologist in Ohio was convicted by a federal jury for his involvement in a scheme to over-bill Medicare. According to evidence presented at trial, the cardiologist performed numerous procedures that were not medically necessary and subjected patients to potentially dangerous medical tests in order to submit more bills for reimbursement to Medicare. The cardiologist would write false symptoms on patient charts and then lie to patients telling them they had cardiac issues they really did not have. Using the fraudulent symptoms, the cardiologist would perform unnecessary nuclear stress tests, cardiac catherization, and insert non-needed cardiac stints. The cardiologist would then bill all the medically unnecessary procedures to Medicare and use his falsified patient records as justification for reimbursement. As a result of this scheme, Medicare paid out $5.7 million. The cardiologist was sentenced to 20 years in prison for his role in the offense.
- An Ohio man who pretended he was a doctor pleaded guilty to defrauding Medicare. According to the plea agreement, the man worked for a home health agency and acted as the agency’s licensed physician, when he was not a medical professional. The man would see patients and represent himself as a doctor and then subsequently certify patients for home health services. The fraudulent patient services provided because of the certifications were then billed to Medicare for reimbursement. As a result of the scheme, Medicare paid out more than $6 million.
- An Ohio based hospital has agreed to a monetary settlement with the United States for its alleged role in defrauding Medicare. According to the settlement agreement, the hospital knowingly approved medically unnecessary spinal surgeries being performed by ones of its surgeons. The cost of the fraudulent spinal surgeries was billed to Medicare for reimbursement. The surgeon who performed the surgeries was federally indicted for his role in the scheme, but fled the United States following his arraignment and currently remains a fugitive. To settle the allegations, the hospital has agreed to pay $4.1 million back to Medicare. Since this case ended with a settlement, there has been no finding of liability against the hospital.
- An Ohio hospital and an Ohio Heart Center have agreed to a monetary settlement with the United States for their alleged roles in submitting fraudulent bills to Medicare. According to the settlement, the hospital and the heart center were alleged to have been performing medically unnecessary heart procedures on Medicare beneficiaries. The hospital and heart center were performing angioplasties and stent placements on patients who did not have the medical symptoms demand the performance of these procedures. The medically unnecessary cardiac procedures were then billed to Medicare for reimbursement. To settle these allegations, the hospital will pay $3.8 million back to Medicare and the heart center will pay approximately $500,000 back to Medicare. Since these allegations ended with a settlement, there has been no finding of liability against the hospital or heart center.
The sentencing in Ohio Medicare Fraud cases depends on the calculated recommendations under the Federal Sentencing Guidelines. Generally speaking, the higher the damage amount to Medicare/CMS, the higher the sentence.
If you have any questions or concerns or need to better understand the penalty calculation for Medicare Fraud in Ohio or need to get 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.
Don’t Let the Government Take Your License or End Your Career
If you are concerned about a health care investigation in Ohio, you should not hesitate and give the government more time to investigate you— but team up with qualified lawyers who can give you advice on how to build a defense based on hundreds of cases like yours handled and completed. Because your life, your reputation, and your time with your family is at stake, you should carefully interview attorneys to identify those with a true experience in defending physicians, business owners, or other members of the health care industry. As a suggestion, ask the following three questions:
- Which Lawyer Will Handle My Case?
- How Many Cases Has that Lawyer Handled that Are Like My Situation?
- Do You Have Flexible Payment Terms?
Call Oberheiden, P.C. Today and Speak to Senior Counsel rather than secretaries, paralegals, or lawyers that will delegate your important case to someone else once you signed the retainer contract. Call (214) 692-2171 and get the answers you deserve.