Penalties in Home Health Medicare Fraud
Medicare Fraud Defense Attorneys Available Now
Everyone knows how dangerous it is to mess with Medicare billing. Few, however, are aware what actual penalties and consequences Medicare fraud allegations can trigger. Of all industries, owners of home healthcare centers are disproportionately high exposed to audits, investigations, and even criminal charges. Whether it is Form 485, lack of necessity, patients not being homebound, illegal referral kickbacks, or fraudulent billing—the FBI continues to scrutinize home health centers and medical providers nationwide.
Remember: The Government Must Prove Criminal Intent
You Found the Right Law Firm! Oberheiden P.C. has protected home healthcare owners, medical providers, and nurses accused of healthcare fraud, Medicare fraud, lack of medical necessity, errors in connection with Medicare Form 485 in audits and investigations across the United States. We have convinced federal agents, prosecutors, and UPIC auditors over and over that not every mistake is intentional. Our guided approach to healthcare audits and fraud accusations has kept doctors and company owners in business!
- Nick Oberheiden, Founder
- Lynette S. Byrd, Former Assistant United States Attorney (DOJ Healthcare)
- Aaron Wiley, Former Assistant United States Attorney (DOJ Healthcare)
- Amanda Marshall, Former U.S. Attorney (DOJ)
- We Have Local Counsel Across the U.S.
We Don’t Let Bad Things Happen to You. Our attorneys have advised home healthcare agencies in all stages. Because most of our home health agency clients call us early, when they just find out that they are under audit or investigation, we are able to turn things around quickly. From hundreds of healthcare cases as both Medicare prosecutors and defense attorneys we understand how critically important an early intervention is. Call us as early as you can to learn how we have fixed compliance problems and avoided criminal charges for so many people before you. We are committed to do the same for you.
- ZPIC, UPIC Audits
- CMS Patient File Requests
- OIG Interviewing Patients
- FBI Agents Seeking Interview
- Search Warrants
- Arrests and Criminal Charges
- Federal Trials
When you are worried about your license and your reputation, you should leave those worries to the trusted and proven attorneys at Oberheiden P.C. We routinely handle the following case types.
- Healthcare Fraud (18 U.S.C. 1347)
- Conspiracy to Make False Statements Relating to Healthcare Matters (18 U.S.C. 1035; 18 U.S.C. 371)
- Conspiracy to Commit Healthcare Fraud (18 U.S.C. 1347; 18 U.S.C. 371)
- Conspiracy to Commit Theft or Embezzlement in Connection with Healthcare (18 U.S.C. 669; 18 U.S.C. 371)
- Attempt or Conspiracy to Commit Healthcare Fraud (18 U.S.C. 1347; 18 U.S.C. 371)
- Conspiracy to Commit Medicare Fraud (18 U.S.C. 1347; 18 U.S.C. 371)
- Conspiracy to Accept or Receive Illegal Kickbacks (42 U.S.C. 1320a-7(b)(b); 18 U.S.C. 371)
- Conspiracy to Commit Medicaid Fraud (18 U.S.C. 1347; 18 U.S.C. 371)
- Conspiracy to Unlawfully Use Health Information (42 U.S.C. 1320d-6; 18 U.S.C. 371)
The Government Has the Burden of Proof in Medicare Fraud Cases
Medicare fraud is a form of healthcare fraud that is often investigated by the FBI and the Office of Inspector General in combination with other state and federal agencies. The general healthcare law statute is 18 U.S.C. 1347. Pursuant to this statute, a person is guilty of healthcare fraud if:
- The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare 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 healthcare benefit program; and
- The defendant acted with the intent to defraud the healthcare benefit program.
Because Medicare fraud and illegal kickbacks are federal crimes, these offense types are investigated by the Federal Bureau of Investigation and prosecuted by Assistant United States Attorneys either from the Department of Justice or one of the 95 local U.S. Attorney’s Offices spread across the 50 U.S. states.
What Are the Penalties for Home Health Medicare Fraud?
A defendant convicted of Medicare fraud at trial or a defendant who decided to plead guilty to 18 U.S.C. 1347 must expect severe penalties. Pursuant to Title 18 of the United States Code, a defendant guilty of home healthcare fraud will be sentenced to up to 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment. The concrete penalty depends on many factors including the alleged damage that was created to the Medicare program.
- A woman from Miami pleaded guilty to her role in a home healthcare fraud scheme. According to the plea agreement, the woman worked as a patient recruiter for several home health agencies in the Miami area. The woman referred Medicare eligible individuals to home health agencies, even though these individuals did not qualify for home health services. For referring the patients, the woman was paid illegal kickbacks by the home health agencies. As a result of the scheme, Medicare paid out approximately $750,000. The woman was sentenced to spend thirty months in prison as a result of her involvement in the scheme.
- A California doctor was convicted of healthcare fraud by a federal jury for his role in a scheme involving home health agencies. According to evidence presented at trial, the doctor would refer Medicare eligible patients of his to a Los Angeles based home health agency. The referred patients were not in need of home health services. In exchange for referring his patients to the home health agency, the doctor was paid kickbacks from the agency. During the course of the scheme, the doctor received over $500,000 in illegal kickbacks. As a result of his role in the offense, the doctor was sentenced to 42 months in prison.
- The operator of a medical clinic in Texas was found guilty by a federal jury for his role in a healthcare fraud scheme. According to evidence presented at trial, the medical clinic operator conspired with a Texas doctor to sell fraudulent home heath certifications to Houston area home home agencies. The home health agencies would then use the fraudulent certifications to bill Medicare for services that were never provided. The home health agencies would pay the medical clinic operator from the proceeds they received from submitting the fraudulent documents. As a result of the scheme, Medicare paid out over $11 million.
- An owner of a Michigan home health agency pleaded guilty to her role in a home healthcare fraud scheme. According to the plea agreement, the home home agency owner paid patient recruiters to refer her Medicare eligible patients and then subsequently billed Medicare for services rendered to these patients that were medically unnecessary. During the entirety of the scheme, Medicare paid more than $8 million. Based on her role in the offense, the home health agency owner was sentenced to 84 months in prison.
- The owner of a home health agency in Chicago was convicted by a federal jury for his role in defrauding Medicare. According to evidence presented at trial, the home health agency owner paid patient recruiters to refer his agency Medicare eligible patients. Most of the referred patients did not qualify for home health services, so the owner would fabricate patient records to make it seem as if they did qualify. The owner would then submit bills to Medicare for these medically unnecessary services. As a result of the scheme, Medicare paid out over $3 million. Employees of the home health agency were also found guilty for their roles in the scheme as well.
- A woman who worked at a home health agency in Miami pleaded guilty to her role in a scheme to defraud Medicare. According to the plea agreement, the woman performed physical therapy services at the Miami home health agency even though she was unlicensed to do so. The owner of the home health agency would then bill the physical therapy services to Medicare as if they had been performed by a licensed professional. The owner of the home health agency was indicted in the scheme as well. As a result of the scheme, Medicare paid $8.6 million based on the fraudulent physical therapy services.
- A Texas man was convicted by a federal jury for defrauding Medicare. According to evidence presented a trial, the man owned a Dallas area home agency and had been excluded from participating in Medicare. After being excluded from Medicare, the man was not to have any involvement with his home health agency. Evidence showed the man still kept his ownership of the home health agency by using another individual as a front and still received profits from the home health agency. The man was also found guilty of submitting bills to Medicare for services rendered at the home health agency for services that were not medically necessary. As a result of his role in the offense, the man was sentenced to 60 months in prison.
- A Louisiana doctor pleaded guilty for his role in a scheme to defraud Medicare. According to the plea agreement, the doctor conspired with an owner of a New Orleans based home health agency and was paid kickbacks from the agency for patient referrals. The doctor also would certify patients for Medicare covered home health services when in fact these patients were not eligible for such services. The home health agency would then submit bills to Medicare for reimbursement based on the fraudulent certifications. In an attempt to cover up the scheme, the doctor was listed as the home health agency’s medical director and was paid monthly. However, these monthly payments were based on the number of patients the doctor referred to the agency and not based on medical services performed.
- A woman from Texas was convicted by a federal jury for her role in a home health fraud scheme. According to evidence presented at trial, the woman worked as a patient recruiter for several Texas based home health agencies. The woman would find Medicare eligible individuals and pay them a nominal fee to have services performed by the various home health agencies. The home health agencies would then bill these services to Medicare as medically necessary and then pay the patient recruiter from the reimbursement received from Medicare. During the entirety of the fraud, Medicare paid $3.6 million as a result of the fraudulent claims.
- A Detroit area woman was found guilty by a federal jury for her role in a scheme to defraud Medicare. According to evidence presented at trial, the woman acted as a licensed physician at a home health agency and would perform services on patients as if she was a doctor. The woman would then sign patient records using the name of a licensed physician to make the records appear legitimate. The home health agency would then submit the bills for services the woman performed for reimbursement from Medicare. Medicare paid $8.9 million for the submitted bills, believing the services were being permed by a licensed medical professional.
What Is the Statute of Limitations for Healthcare Fraud?
In criminal healthcare 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 healthcare fraud conspiracy.
How Can Oberheiden P.C. Avoid Charges in Home Health Cases?
Depending on the stage your investigation is in, we apply different tools to convince regulators, auditors, or prosecutors that you did not do something wrong. Importantly, we have created compliance structures for many of our home healthcare clients that are designed to prevent occurrences of fraud. Specifically, we have trained management, staff members, directors of nursing, and even medical providers to pay particular attention to some hidden dangers on Form 485. By the same token, if you are charged with Medicare Fraud, we have a long track record of dismissing indictments and obtaining probation.
The key to our success is you. The earlier you call us, the better we can help you. We are available now and on weekends to hear from you about your concerns and your case. Experienced attorneys will make you notice immediately: Oberheiden P.C. is all about protecting businesses and people!