Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Medicare Fraud Legal Defense for the Philadelphia Areas

The Oberheiden & McMurrey, LLP is a Medicare fraud defense law firm serving Philadelphia and the surrounding areas. We are legal advocates for individuals, facilities, and businesses under investigation by the federal government, involved in a qui tam lawsuit, named in a jury trial, or those involved in a federal audit. Our skilled defense team also provides planning for federal compliance programs to help clients avoid potential issues. Oberheiden & McMurrey, LLP is a team of attorneys that includes former health care fraud prosecutors. Initial consultations are free and confidential.

Defining Medicare Fraud

Medicare fraud is a federal violation. It involves claims that are filed with federal health care programs such as Medicare, Medicaid, Tricare, or federal workers’ compensation. These claims have an error on them. If the federal government accuses you of Medicare fraud, you’re being accused of violating at least one of the following statutes or laws:

There are nine locations in the United States that undergo constant surveillance by the federal government for Medicare fraud. Philadelphia is one of those areas. Philadelphia has a large population that relies on a federal health care program. That means more claims are filed in the area. The increase in claims leads the federal government to believe that there are also more instances of Medicare fraud.

The federal government uses a hybrid team of investigators and prosecutors known as the Medicare Fraud Task Force. This team is made up of representatives from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. That list is not all-inclusive. Other federal agencies can be involved. If you’re under investigation by the Medicare Fraud Strike Force or if you’ve been contacted by a federal agency, call Oberheiden & McMurrey, LLP. Initial consultations are free and confidential.

Medicare Fraud Investigations in Philadelphia

Philadelphia Medicare fraud investigations often begin because of a mistake made on a federal health care claim. The mistake most often occurs during the coding or the billing. Common billing mistakes include an unauthorized charge, an incorrect charge, or an excessive charge. Common mistakes on claims from Philadelphia are:

  • Phantom billing – billing for services that were never performed;
  • Double billing for medical equipment or services;
  • Submitting a claim for medically unnecessary medical services or equipment;
  • Submitting a claim for medically unnecessary medical supplies;
  • Submitting a claim for a medically unnecessary certification (including a claim for hospice or home health care);
  • Inflating charges;
  • Up-coding;
  • The overuse of medical equipment of services;
  • Providing or accepting kickbacks.

In Philadelphia, the most commonly investigated targets are doctors, nurses, pharmacists, pharmacies, and nursing homes. Keep in mind that any person, business, or facility that files a claim with a federal health care program can be investigated.

Medicare Fraud: Civil and Criminal Penalties

Medicare fraud includes civil and criminal charges. These lawsuits, regardless of whether they are civil or criminal, are filed in federal court. Federal civil penalties may include:

  • Repayment of claims in questions;
  • Future claims aren’t paid;
  • A fine of up to $11,000 per false claim;
  • Exclusion from federal health care programs;
  • Assignment of treble damages;
  • Attorney fees

You could also lose your hospital privileges and your professional license.

Federal criminal penalties include:

  • Fines that cost you hundreds of thousands of dollars, even for a misdemeanor;
  • A criminal record;
  • A federal prison sentence of up to 10 years for each count of Medicare fraud for which you are convicted;
  • Federal prison sentence of up to 20 years for each count of Medicare fraud that resulted in serious bodily harm to the patient or patients;
  • A life sentence in federal prison for Medicare fraud that results in the death of a patient.

Finding a Medicare Fraud Defense Lawyer Serving Philadelphia

In Philadelphia, a Medicare fraud investigation can include criminal charges. You need a health care fraud defense attorney in order to navigate both the health care law aspect and the potential criminal charges that may be associated with it. Choose a health care fraud defense attorney who has:

  1. A successful record when handling Medicare fraud cases;
  2. Knowledge of the Medicare fraud and health care fraud laws and regulations;
  3. Knowledge of statutory exceptions;
  4. Both litigation and jury trial practices.

You should then ask the health care fraud defense attorney the following questions:

  1. How many Medicare fraud cases have you handled throughout your career?
  2. How many of those resulted in no civil or criminal charges or in dismissals for your clients?
  3. How many of those cases were tried in court?

Medicare Fraud Strategies for Philadelphia Clients

Oberheiden & McMurrey, LLP is a Medicare fraud defense firm. We’ve helped hundreds of clients settle their case or go to trial. We have used our skills to develop Medicare fraud strategies that we implement for our Philadelphia clients.

Contacting the federal government. Our lawyers immediately contact the federal government to begin the process of resolving the allegations. To start, we ask the important questions:

  • What is the investigation about?
  • What prompted the investigation?
  • Is the investigation civil or criminal?
  • Which federal agencies are involved?
  • What is the ultimate goal of the government?
  • How can this matter be resolved?

Getting answers to these questions can help us to plan your defense, and it can mean the difference between a civil settlement and criminal charges. Often, we get answers to those questions in just a few hours.

Reviewing the evidence provided by the federal government. We analyze and question the federal evidence that is used by the federal government. This one strategy often results in:

  • Dismissal of charges;
  • No criminal charges;
  • Client retains professional license;
  • Civil fine with no criminal plea;
  • Reducing a felony to a misdemeanor;
  • No federal prison sentence.

Lack of criminal intent. Additionally, the federal government must prove that you acted with criminal intent. This is hard for them to prove since most Medicare fraud cases start because of a mistake. The most common mistakes in Philadelphia are:

  • Using unqualified staff;
  • Inadequate supervision;
  • Inappropriate delegation and outsourcing;
  • Structural errors;
  • Human errors;
  • Oversight;
  • Employees who are overwhelmed;
  • No Medicare compliance program in place;
  • The changing health care laws and rules.

Our objective is to show that you admit to making a mistake and you are willing to correct it.

Using the right defense strategies. Our defense team takes the time to analyze the facts involved in each case. This enables us to use custom Medicare fraud defense strategies. One of our recent clients was accused of providing a fraudulent certification for home health care services. We were able to prove that our client was protected by a recognized delegation exception and that the certification was compliant within the law. In another recent case, we refused to admit liability on behalf of our client. Instead, we proved to the federal prosecutor that our client acted within a safe harbor exception.

Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP serves Philadelphia and the surrounding areas. We provide legal defense and advocacy for individuals, business owners, entire entities, attorneys, executives, hospitals, pharmacists, and pharmacies that are being investigated for fraudulent billing, illegal kickbacks, allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. We can help you in many areas, including:

  • Health care fraud defense
  • Compliance program creation and implementation
  • Internal investigations
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

If you’re being contacted by the DOJ, Department of Defense, the FBI, the DEA, the Office of Inspector General, Medicare Fraud Control Unit, the IRS, Philadelphia or Pennsylvania law enforcement, contact Oberheiden & McMurrey, LLP right away. The initial 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.

Medicare Fraud Defense Lawyers Serving Philadelphia

Nick OberheidenNick Oberheiden is a Harvard-trained and internationally educated 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 knowledge 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 skills 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.

IF YOUR FREEDOM IS AT STAKE

YOU SHOULD CONTACT US TODAY

Contact the Experienced Attorneys of Oberheiden & McMurrey, LLP Now for a Confidential Consultation

Contact Us Now
×