Pennsylvania Medicaid Fraud
Pennsylvania Medicaid Fraud Defense Lawyers With Substantial Experience
Medicaid providers and health care businesses in Pennsylvania are currently experiencing the highest and most aggressive levels of enforcement in Pennsylvania’s history. Targeted by both the Pennsylvania DA’s office and the Department of Justice, Pennsylvania dentists, physicians, and mental health providers must emphasize compliance in order to escape the government’s radar.
Pennsylvania medicaid fraud attorney Dr. Nick Oberheiden has represented medical providers and businesses in hundreds of civil and criminal investigations involving allegations of kickbacks, Medicare fraud, and Medicaid fraud.
Nick’s commitment to defending health care providers has allowed him to establish a substantial track record of turning criminal cases into civil matters, and avoiding criminal charges and jail time in dozens and dozens of health care fraud cases.
Frequently featured by Pennsylvania and national media, Nick understands that the successful resolution of a health care fraud investigation requires both profound familiarity with all underlying industry regulations as well as the ability to make compelling presentations in the presence of prosecutors and judges.
How to Effectively Defend Against Pennsylvania Medicaid Fraud Investigations: (214)469-9009
The golden rule in health care fraud cases is to consult with an experienced attorney as early as you find out (or have reason to believe) that you are under Medicaid investigation.
In Pennsylvania, Medicaid investigations typically begin with an audit of Medicaid patient records or with written correspondence from the Pennsylvania Medicaid Fraud Control Unit (MFCU), the Pennsylvania Attorney General’s office, or the Human Resources Administration (HRA), Bureau of Fraud Investigation.
They are two main categories of Medicaid fraud investigations to distinguish. In the vast majority of cases, Pennsylvania Medicaid will attempt to recoup reimbursements Medicaid had audited and now considers overpayments. The second category, which is dramatically rising in popularity in Pennsylvania Medicaid cases, is to criminally charge Medicaid providers. However, criminal Medicaid investigations almost never come without prior announcement. In almost all instances will the government build its case based on patient charts previously requested or based on interviews Medicaid investigators conducted— even if those events occurred years ago and were almost forgotten about by the provider.
Medicaid allegations are best to defend at an early stage in the investigation, when lawyers familiar with the pertinent regulations and the skillset to communicate with prosecutors can stop the case by introducing clarifications, explanations, and logical defenses.
In cases were such early opposition is not possible, Nick Oberheiden frequently sees how misconceptions and simply untrue facts on the government’s side can lead to absurd criminal charges. Again, it is critical for an attorney to proactively take control of the case by discussing and convincing decision-makers that fraud either did not occur or did not occur deliberately and willfully. In fact, there are number of ways to do that.
- Your lawyer may show but you had no pecuniary interest in any alleged wrongdoing (“No Motive”);
- Your lawyer may show that you had no knowledge of the alleged fraudulent scheme (“No Intent”);
- Your lawyer may introduce affirmative defenses such as mistake of fact (“Affirmative Defenses”);
- Your lawyer will simply hold the government to its burden of proof to show that you allegedly did all of this beyond a reasonable
Nick Oberheiden has used these and other defenses successfully in a great variety of cases. Nick has also utilized the expertise of consultants when, for example, he had to demonstrate to the government that his client’s acted within the accepted standards of medicine, followed medical guidelines, or was simply incorrectly advised by the billing or coding or legal department.
However, Nick uses these defenses carefully (and perhaps different) than most other lawyers. While any traditional criminal defense lawyer may raise the “No Intent” objection like a reflex, Nick recognizes that the government will not take an X-ray of his client’s brain to find out what the true intent-level was at the time of the alleged offense. Instead, Nick will substantiate lack of intent first and identify information that will make the PROSECUTOR say that there was no intent. How so? Give Nick a call on his cell phone at (214)469-9009 today.
10 Things You Should Know about Medicaid Fraud Charges in PA
Who Is Investigating Physicians for Medicaid Fraud in Pennsylvania?
A number of state and federal agencies are investigating Medicaid fraud in Pennsylvania. Because Medicaid is a hybrid program, partially funded by state and federal monies, alleged fraud and abuse can be investigated as a state or as a federal offense. In many instances, the Pennsylvania Attorney General‘s office, the Human Resources Administration (HRA), Bureau of Fraud Investigation, and the Pennsylvania Medicaid Fraud Control Unit (MFCU) will work hand-in-hand with the Department of Justice (DOJ), the Office of Inspector General (OIG), and the Federal Bureau of Investigation (FBI).
What Are the Penalties for Medicaid Fraud in PA?
Medical providers and business owners accused of Medicaid fraud in Pennsylvania need to be worried about two types of penalties. If they are unsuccessful in defending the Medicaid fraud allegations, the case can result in a guilty plea or a conviction at trial. Because Medicaid fraud is a felony in Pennsylvania, jail is a real possibility. Similarly, entering a guilty plea or a conviction would be reported to the provider’s respective professional disciplinary board such as the Pennsylvania Medical Board and may result in a license revocation. To avoid these consequences, it is of paramount importance to engage qualified counsel as early as possible to systematically and effectively confront and defeat the allegations and to obtain an outcome that will allow you to continue your career.
Our Attorney Does Not Seem to Have Much Experience: Can We Switch to a Medicaid Fraud Defense Attorney?
Being represented against accusations as serious as Medicaid fraud (grand larceny, welfare fraud) necessitates absolute trust in your lawyer. If you, at any point, believe or realize that the attorney you had originally hired is not familiar with the pertinent health care rules or does not offer convincing strategies to oppose the allegations, it may be time to consider a second opinion. Just like you would not want just any surgeon to operate on your child, the selection of the right Medicaid fraud defense attorney must be based on personal trust and objective experience. Anyone accused of Medicaid fraud or under investigation can contact Nick at anytime, including on weekends, to discuss the case and to obtain his opinion free of charge. All you need to do is call Nick on his cell phone (214-469-9009) with your specific questions about your case.
What Should I Do When a Pennsylvania MFCU Investigator Comes to My House?
If investigators from the Medicaid Fraud Control Unit come by your house or your place of business, you need to be on high alert. The Pennsylvania Medicaid Fraud Control Unit is aggressively investigating any form of Medicaid fraud and abuse on behalf of the Pennsylvania Attorney General and the Department of Justice. You should resist the temptation to discuss any questions they may have for you because you will not be able to undo your statement; the trained investigators and agents may even try to misconstrue your answers to fit the purpose of the investigation. The right approach is to insist on your lawyer’s presence so that your lawyer can first find out from the agents directly why they want to talk to you and whether or not you may be a target of the investigation.
Can My Business Be Charged With Medicaid Fraud in PA?
Yes, the Pennsylvania District Attorney’s Office and the Attorney General have the authority to charge both individuals and companies with criminal Medicaid fraud. While the consequences of a conviction for an individual can result in jail time, companies convicted of Medicaid fraud are typically charged with hefty criminal fines.
When Should I Plead Guilty to Medicaid Fraud in PA?
You should not plead guilty if your case is defendable, that is if an experienced and qualified lawyer is of the opinion that the government will not meet its burden of proof to show beyond a reasonable doubt that you committed Medicaid fraud.
Is Medicaid Fraud a State or a Federal Offense?
In Medicaid fraud cases, prosecutors have a choice to bring charges either on the state or on the federal level. If charged as a federal felony, Medicaid fraud will fall under 18 U.S.C. 1347, which imposes a sentence of up to 10 years per account. If charged as a state felony, Pennsylvania state prosecutors will typically claim grand larceny and welfare fraud when they bring their case.
Is There a Chance to Have a Medicaid Fraud Charge Be Reduced to a Misdemeanor?
One of the big differences between state and federal Medicaid fraud charges is the ability of a lawyer to negotiate the charging instrument. While it is rare to convert Medicaid fraud into a misdemeanor when the Department of Justice is involved, a negotiated plea bargain with the Pennsylvania District Attorney’s office may allow a client to plead to just a misdemeanor charge. The difference is of critical importance— in particular for Pennsylvania medical providers. A felony conviction will automatically lead to a license revocation, while a misdemeanor may trigger some disciplinary harm, but will typically not end the physician’s ability to continue practicing medicine.
How Much Would It Cost to Defend a Medicaid Case?
The amount of legal fees in a Medicaid fraud defense case depends on a number of factors, among them are: whether you have already been charged or whether the case is in the early stage of an investigation; whether the case focuses just on you or involves a number of potential co-defendants; whether you are planning to plead guilty or whether you are determined to defend your rights at trial. No matter what your preference and what your situation is, Nick will work with you in an effort to offer a fee schedule that is both fair and predictable so that you know exactly how much the defense case will cost you before Nick begins his work.
How Can I Engage Nick’s Services?
The easiest part of your case is to contact Nick. If you call Nick at (214)469-9009, your call will go straight to Nick. He will take the time to listen to you and provide you with a free assessment. If you want to move forward with the representation, Nick will send you an email with all next steps. Super easy!