Former federal prosecutors
offering unparalleled knowledge and a proven track record


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Oberheiden Attorneys

Experienced Attorneys Providing Health Care Fraud Defense for Philadelphia, Pennsylvania

The Oberheiden & McMurrey, LLP has 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 Health Care Fraud Defense Team includes such talent as a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office, several former health care fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force.  We offer our services to clients in Philadelphia as well as the rest of Pennsylvania.

Health care fraud allegations in Philadelphia, Pennsylvania and in the surrounding areas can ruin your career. Call Oberheiden & McMurrey, LLP now if you’re being investigated for health care fraud. Don’t wait. Call now and ask to speak with a member of our Health Care Fraud Defense Team. The call is confidential and it’s free.

Philadelphia Is Directly Monitored by the Federal Government

In the United States, there are nine locations that are directly monitored by the federal government for health care fraud. The monitoring is done by the Medicare Fraud Strike Force. This is a team of federal prosecutors and investigators of several federal agencies, such as the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. Other federal agencies often have members who are part of this team.

Philadelphia and the surrounding areas are constantly monitored because of the number of people who rely on a federal health care program. This causes more claims to be filed for reimbursement with these federal health care programs. The federal government believes that in areas with higher numbers of claims, there is also more health care fraud.

In 2016, the Department of Justice released a statement that revealed that they had investigated around 300 cases of health care fraud. Individual health care providers were the center of 80 of those investigations. The rest of the cases centered on a health care entity or business. The agency stated that they recovered more than $900 million in fraudulently paid out claims.

What Is the Definition of Health Care Fraud?

Health care fraud happens when one or more fraudulent claims are filed with a federal health care program such as Medicaid, Medicare, Tricare, or federal workers’ compensation for reimbursement. These claims are filed with the federal government for medical services or equipment. It includes a violation of at least one of the following laws:

  • 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 special 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 up-coding of claims. Up-coding 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 strives to protect clients from facing criminal charges. If you’re in Philadelphia or the surrounding areas and you’re being investigated for health care fraud, call us now. Your initial call is free and confidential.

Health Care Fraud Has Civil and Criminal Penalties

Health care fraud can have civil and criminal penalties in Philadelphia. In a civil court setting, you could be forced to repay the federal claims in question, lose the ability to be reimbursed for future claims, and you could be barred from participating in federal health care programs.

If you are charged criminally, you could end up with a criminal record, expensive fines, or even a federal prison sentence:

  • 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 that we receive from those in the Philadelphia area is what the worst case scenario is for health care fraud. The answer is facing criminal charges and receiving a federal criminal sentence. Whether you will be charged criminally or be sentenced to prison will depend on several factors, such as the severity of any injury to the patient, if the prosecutor wants to pursue criminal charges, and why the investigation started.

Oberheiden & McMurrey, LLP serves Philadelphia and the surrounding area with health care fraud defense strategies. Our experience as former health care prosecutors for the federal government, in addition to our experience as defense attorneys, gives us a unique understanding of how these cases should be handled.

Is It a Criminal Matter?

Health care fraud allegations in Philadelphia and the surrounding areas are almost always started as civil matters. Yet, they can quickly become criminal. To protect yourself and your business, contact Oberheiden & McMurrey, LLP as soon as you know that you’re being investigated.

Contact by a prosecutor is not an indicator to determine if the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor as an indicator. Rather, signs of a criminal investigation may include search warrants, seizure warrants, arrest warrants, target letters, contact from a federal criminal prosecutor, involvement from the IRS, or the receipt of a grand jury subpoena.

Key Legal Defenses to Health Care Fraud

Oberheiden & McMurrey, LLP is a health care fraud defense firm serving Philadelphia and the surrounding areas. We examine the facts in each case to choose the most efficient defenses for our clients. We’ve helped hundreds of clients. Many of our attorneys have former experience as health care prosecutors and auditors for the federal government. We’ve utilized our experiences to develop fundamental legal defenses for our clients facing health care fraud allegations.

Immediate legal advocacy with the federal government. Our main objective is to protect our clients against criminal clients. Once we are retained, we immediately contact the federal government to start our legal advocacy on your behalf. This immediate contact reduces the amount of time that the federal government has to investigate you without interruption. This is extremely important to your case. If the federal government has too much time to investigate you, you could face criminal charges. Our goal is to get answers to the most important questions within hours:

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

Proving a lack of criminal intent. The federal government must meet a high burden of proof to show that you committed a crime and acted with criminal intent. We evaluate the evidence given by the federal government to determine if they are able to meet that burden of proof. Often, the federal government will point to billing inaccuracies to say that you committed a crime. Yet, we’ve found that these inaccuracies occur not because of fraud, but because of a mistake. While these mistakes should certainly be addressed and corrected, they shouldn’t cause you to face criminal penalties. Mistakes often occur when health care practices or businesses grow quickly or because someone makes a mistake. The most common mistakes that cause these allegations include 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.

Using applicable defenses. Oberheiden & McMurrey, LLP analyzes the facts in each case to determine applicable defenses. This may include the use of statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entire resolve a health care fraud case.

Defending your professional reputation with the media. One of the most common concerns of our clients is how their professional reputation will be affected by this allegation. Oberheiden & McMurrey, LLP works to preserve your professional reputation. Our lawyers will watch for opportunities to correct misinformation and we also address slanderous commentary from the media.

If you’re under investigation for health care fraud in Philadelphia, Pennsylvania or the surrounding areas, contact Oberheiden & McMurrey, LLP. The call is free and confidential.

Our Track Record

  • Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense 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.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.

health care Fraud Defense Lawyers Serving Philadelphia, Pennsylvania

Nick OberheidenNick Oberheidenis a health care fraud defense attorney. Dr. 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. He is most known for stopping federal investigations before criminal charges can be filed. 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 by emailing us directly.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving in Philadelphia, Pennsylvania 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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