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Oberheiden Attorneys

How To Prevail in Medicare Fraud Cases

Categories: Health Care Law

medicare fraud

Dedicated Defense Attorneys Fighting Medicare Fraud Charges in the Federal Courts

Oberheiden & McMurrey, LLP
Former U.S. Prosecutors & Experienced Counsel
“How can your lawyer effectively negotiate with the government if that lawyer is not 100% familiar with all Medicare rules and regulations— and their relevant exceptions?” 
Dr. Nick Oberheiden
Medicare Attorney
“If your lawyer does not understand Medicare, how can that lawyer convincingly explain your situation to the jury?”
Bill C. McMurrey
Former Chief Coordinator, Health Care Fraud (DOJ)
“Just like you see a heart specialist (and not a dentist) when you suffer a heart attack, you should not hire just any lawyer when you are accused of Medicare fraud. I know from my tenure at the Department of Justice how complex Medicare really is. The best rape defense lawyer and the city’s best DUI lawyer may not be aware of every relevant health care law detail; but, in health care fraud cases, details often decide who wins. With so much on the line, you simply cannot afford to experiment when choosing the lawyer that is tasked to defend your business, your livelihood, your license, and your freedom.”
Lynette S. Byrd
Former AUSA, Health Care Fraud (DOJ)

Why Do Clients Trust Oberheiden & McMurrey in Medicare Investigations?

Oberheiden & McMurrey differs from other law firms because of our focus on federal health care law audits and investigations. Oberheiden & McMurrey is one of the country’s most distinguished health care fraud defense firms. What characterizes our attorneys is our depth of Medicare law experience and our track record of successful case outcomes. Clients trust us because our attorneys are able to competently advise them on the right course of action in Medicare audits and appeals or active civil and criminal government investigations. We have represented physicians, nurses, nurse practitioners, home health care agencies, hospice care agencies, hospitals, toxicology laboratories, pharmacies, business owners, health care marketing groups, and many other members of the health care industry in Medicare related False Claims Act, Stark Law, Anti-Kickback, and health care fraud investigations in cases across the United States.

Who Will Handle My Medicare Fraud Case At Oberheiden & McMurrey?

When you hire Oberheiden & McMurrey, you will be represented by senior lawyers with significant experience in Medicare audits and proceedings. The attorneys at Oberheiden & McMurrey represent clients who are facing federal criminal charges or believe they are under investigation by the government. Our attorneys operate as “One Team.” No associates. No paralegals. No delegation to junior lawyers.

Nick Oberheiden (Attorney)

“Hundreds of health care fraud investigations have taught me: every single case is different. No lawyer will ever be able to help you without understanding who you are; your story matters. I am eager to develop an effective defense strategy together with you. You provide the real facts and I work on the law and identify our defenses. I routinely represent physicians, health care businesses of all sizes, business owners, and Medicare providers seeking reliable advice to oppose and defend a government audit or investigation. I would be delighted to add you to our long list of success stories.”

Bill McMurrey (Attorney)

“I can say with confidence that after two decades as a federal prosecutor and after close to 25 years on the forefront of federal investigations, I know how the government works. I left the federal government as a distinguished prosecutor. I served as the chief coordinator for criminal health care fraud, leader of the Medicare Fraud Strike Force, and highly decorated Department of Justice Trial Attorney. If you are under investigation for Medicare fraud, you should take the time to call me directly. I may not solve all your problems in one phone call, but I am committed to give you my assessment of your situation in a 100% free and confidential consultation.

Glenn Harrison (Attorney)

“I have spent my entire career in federal courtrooms, first as a Department of Justice Trial Attorney, then as a Special Assistant United States Attorney (SAUSA) in health care fraud cases, and finally on behalf of my health care law clients in private practice. I would be delighted to sit down with you and answer your questions. Medicare audits and investigations are not for just any lawyer. The rules are complex and mistakes can be life altering. I am here to share my professional experience and my insights to advise you on the best option tailored to your situation.”

What Exactly is Medicare Fraud?

Medicare Fraud is a generic term that refers to the submission of false or fictitious claims to the Medicare governmental health care program. Specifically, Medicare Fraud cases allege fraudulent billing practices and reimbursement requests for false, non-existing, excessive, or unauthorized services and may involve one of the following acts.

  • Billing for Services Never Performed (Phantom Billing)
  • Billing for Services that Were Medically Unnecessary
  • Billing for Supplies and Equipment that Were Never Ordered
  • Billing for Supplies and Equipment that Were Medically Unnecessary
  • Certification for Services that Were Medically Unnecessary (g. Home Health or Hospice Fraud)
  • Certification for Supplies that Were Medically Unnecessary (g. DME)
  • Double Billing, Up-Coding, Inflating Bills
  • Overutilization of Services or Equipment

Although not exactly a correct use of the term, more broadly, Medicare fraud refers to health care fraud in general. Because Medicare fraud is by far the most common form of health care fraud, many people use Medicare fraud and health care fraud synonymously to include the following:

  • Anti-Kickback Violations
  • Violations of Federal Bribery Statutes
  • Prescription Fraud
  • Stark Law Violations
  • False Claims Act Violations

Who are the targets of Medicare Fraud investigations? Physicians, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, DME companies, and other health care service providers are among the most common targets of Medicare Fraud investigations. Health care fraud is a serious offense. Penalties range from civil recoupment requests, non-payment of claims and program exclusion to criminal prosecution, fines, and even incarceration. Specifically, the general criminal health care fraud statute at 18 U.S.C. § 1347 provides:

  • Up to 10 Years in Prison for Each Count of Health Care Fraud
  • Up to 20 Years in Prison If the Fraud Resulted in Serious Bodily Injury
  • Life in Prison If the Fraudulent Scheme Resulted in a Patient’s Death.

What Should I Do When I am Under Medicare Investigation?

Clients are always surprised to find out from us how much can be done to mitigate, avoid, or end a government investigation. While every client’s situation is different, there simply is no such thing as a hopeless case. Something can always be done to improve or remedy the situation. However, time is of the essence if you or your business are under pending or expected investigation. The longer you wait — the more time you grant the government to build its case against you without sophisticated opposition from defense counsel — the easier it is for the government to confront you with something within your practice in support of a fraud case.

Oberheiden & McMurrey has successfully represented corporate and individual clients against Medicare fraud allegations. Clients contact our experienced former U.S. prosecutors and defense counsel from across the United States to obtain reliable and effective legal advice so that they can move on with their business and life. Our recognized health care fraud defense attorneys have handled hundreds of health care investigations, both on behalf of the United States and in private practice, and it is that unique combined experience that allows us to be proud of our track record of successful Medicare fraud case outcomes for our clients.

  • Immediate Defense. Our priority in Medicare cases is to protect our clients against criminal charges. The chances to do so are significantly higher for those clients that contact us early on, when there is still time to be creative and proactive by negotiating case resolutions with the government. The extraordinary experience of our attorneys in health care fraud cases allows us to quickly assess the case and your situation. Because we understand that there will be many questions on your mind, we attempt to provide you answers to your most pressing questions as soon as possible, often the same day you engage us. For example, we will work relentlessly to tell you what exposure we see for your business and for yourself. Is the case civil or criminal? Where in the process is the investigation right now? What are the specific Medicare fraud allegations? Do the allegations have any merit? What defenses exist that may impact the investigation? What are the chances to end the investigation without recourse to court? What is the likely outcome of my case?
  • Specific Medicare Experience. Answering a client’s questions and engaging in sophisticated negotiations with the government in Medicare cases assumes a nuanced and profound understanding of the relevant Medicare laws and exceptions. After all, it is difficult to persuade experienced federal government attorneys and highly trained federal agents in charge of Medicare law enforcement that their assumptions are mistaken without demonstrating full familiarity with the laws that govern the investigation and the laws that will ultimately decide whether a client is subject to federal civil or criminal exposure. The former Medicare fraud prosecutors at Oberheiden & McMurrey will ensure that your rights are protected from day one.
  • No Intent. Few clients approach us to tell us that two years ago they sat at the kitchen table and searched for ways to defraud the federal government. In fact, the vast majority of companies and individuals that are subject to a Medicare fraud investigation are shocked and concerned and reach out to us for help in this time of crisis. Not every mistake justifies repercussions. Our defense job is to remind the government prosecutors of the high burden that the U.S. Constitution requires — to prove criminal intent beyond a reasonable doubt. Our attorneys have successfully defended clients across the country by demonstrating that potential mistakes, billing errors, and other inaccuracies were the result of organizational or human error and not an expression of willful and intentional misconduct.
  • Trial Expertise. From an effective case management and strategy perspective, the government must always understand that you and your lawyers have the capacity to challenge the fraud allegations in front of a neutral judge or jury. The specific trial background of your attorneys gives your representation credibility and signals that you will not just surrender but are prepared to present your case in court. With those trial skills come negotiation skills. Effective negotiations must signal that you are willing to find a compromise and a resolution, but if the outcome of that negotiation is not satisfactory you are willing to go to battle.

The attorneys of Oberheiden & McMurrey have appeared on behalf of clients from all sectors of the Medicare industry to defend fraud allegations at U.S. Attorney’s Offices and in courts across the United States. If you want to find out what we can do in your case, you should call us today and request a free and confidential consultation with a partner level attorney at Oberheiden & McMurrey.

In addition to the more reactive recommendations above, we strongly recommend the establishment of compliance tools and structures to reduce the risk of a Medicare investigation in the first place. The focus of these structural implementations is to demonstrate to law enforcement your intent to comply with all state and federal regulations.

  • Regulatory Compliance Program (establish, monitor, enforce OIG-approved compliance policies; appoint and train compliance officer, compliance training re HIPAA, fraud and abuse laws, specific home health rules to include certification and re-certification procedures)
  • Sound Corporate Structures (employment manual, executed and valid employment and contractor agreements, and operating agreements are consistent with state and federal regulations)
  • Voluntary Audit (vet all corporate documents and policies, take sample files and review billing codes and procedures, review all company policies, extensive compliance training)

What makes Oberheiden & McMurrey different is our experience and our track record. Throughout our careers, our attorneys have handled hundreds of civil and criminal health care investigations. Many of our attorneys come from senior positions within the Department of Justice and share their experience, insights, and contacts as former federal prosecutors in charge of health care matters.

What Results Have the Attorneys at Oberheiden & McMurrey Obtained for Their Clients in Medicare Investigations?

Attorneys in our Health Care Practice Group offer decades of government and private practice experience. Our attorneys pride themselves on being health care fraud defense attorneys who understand the important nuances of the Medicare industry. Helping clients resolve their health care law issues is what we do and how we made a name for ourselves. We understand how complex the Medicare rules are and how easy it is to deviate from permanently evolving and changing regulations. Clients typically contact us because they find themselves in the middle of a government audit, government investigation, or a situation in which they need criminal defense attorneys clearing their name and reputation. Our job is to protect your license, livelihood, and your freedom. See for yourself how we have done in cases that may be similar to yours. Here is a small selection of recent case outcomes.

Federal Health Care Fraud Cases (Criminal & Civil):

  • Medicare Fraud Investigation by the U.S. Attorney’s Office and the Federal Bureau of Investigation (FBI) Against Our Client. We Were Able to Convince the Government to End the Case Investigation After Providing Convincing Evidence that Our Client Complied With All Relevant Medicare Laws and Regulations. Our Detailed Medicare Law Understanding Allowed Us to Successfully Defend Our Client and the Case Resulted in No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the Department of Justice and the Federal Bureau of Investigation (FBI) Against Our Client. We Took the Case With the Goal to Preserve Our Client’s License and His Freedom. After Several Meetings with the Government Prosecutors, We Were Able to Convince the Government to End the Investigation. Our Detailed Understanding of All Relevant Medicare Laws Permitted Us to Successfully Defend Our Client and the Investigation Resulted in No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the Department of Justice and the Office of Inspector General (OIG) Against Our Client. We Were Able to Convince the Government to End the Case Investigation After Providing Convincing Reasons that Our Client Complied With All Relevant Medicare Laws and Regulations. Our Medicare Law Familiarity Allowed Us to Successfully Defend Our Client and the Case Resulted in No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the FBI in Connection with the Office of Inspector General Against Our Client. We Were Able to Show the Federal Prosecutors that Our Client Did Not Violate Federal Health Care Laws. Our Experience With Medicare Fraud Investigations Allowed Us to Persuade the Government to Conclude the Fraud Investigation with No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the Department of Health and Human Services in Connection with the Department of Justice Against Our Client. We Provided the U.S. Attorney’s Office Specific Medicare Law Exceptions and We Were Able to Convince the Government to End the Investigation. We Were Able to Successfully Defend Our Client and the Case Resulted in No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the U.S. Attorney’s Office and a Number of Federal Law Enforcement Agencies Against Our Client. Initially, Our Client Received a Subpoena from the Department of Health and Human Services and the Office of Inspector General for Alleged Medicare Fraud. We Were Able to Stop the Investigation and We Were Able to Successfully Defend Our Client and the Case Resulted in No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the Office of Inspector General (OIG) out of the Washington D.C. Headquarters Against Our Client. Throughout a Number of Meetings with the Federal Prosecutors We Were Able to Convince the Government that Our Client Did Not Violate Medicare Laws. We Were Able to End the Investigation and We Were Able to Successfully Defend Our Client and the Case Resulted in No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the FBI in Connection with the Office of Inspector General Against Our Client. We Were Able to Show the Federal Prosecutors that Our Client Did Not Violate Federal Health Care Laws. Our Experience With Medicare Fraud Investigations Allowed Us to Persuade the Government to Conclude the Fraud Investigation with No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the FBI in Connection with the Office of Inspector General Against Our Client. We Were Able to Show the Federal Prosecutors that Our Client Did Not Violate Federal Health Care Laws. Our Experience With Medicare Fraud Investigations Allowed Us to Persuade the Government to Conclude the Fraud Investigation with No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by the FBI in Connection with the Office of Inspector General Against Our Client. We Were Able to Show the Federal Prosecutors that Our Client Did Not Violate Federal Health Care Laws. Our Experience With Medicare Fraud Investigations Allowed Us to Persuade the Government to Conclude the Fraud Investigation with No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.
  • Medicare Fraud Investigation by Various Federal Law Enforcement Agencies Against Our Client. The Case Began With a Subpoena Issued by the Department of Health and Human Services. The Request in the Subpoena Led Us (Rightly) to Conclude that the Investigation Was Criminal in Nature. We Provided Substantial Information and Addressed the Medicare Fraud Allegations in a Number of Meetings and Ultimately Negotiated an End of the Investigation Leaving No Civil and No Criminal Liability for Our Client and Any of Its Principals, Directors, Employees, and Otherwise Affiliated Individuals.

We are proud of our track record. Our attorneys have helped many clients from across the United States to a result of no civil and no criminal exposure. In fact, we have accomplished great results in what initially appeared to be almost hopeless situations. We have turned targets of federal health care fraud investigations into witnesses, we have negotiated civil penalties from millions to nominal fines, we have convinced prosecutors to move on to other matters, we have ensured our physician clients maintained their licenses, we have successfully argued that health care law defenses and exceptions apply to our clients’ situations, and we have saved our clients decades and decades of jail time by choosing the right defense strategy.

The former federal prosecutors and attorneys of Oberheiden & McMurrey are available to discuss your case. Don’t let the situation get out of control and don’t let the government build a criminal case against you. Call us today and let us identify your options.

What Is Oberheiden & McMurrey’s Federal Trial Experience?

Our trial philosophy is simple: we will go to trial when we firmly believe that we can win. Sometimes going to trial is not just the best but also the only option. Professionals can’t afford to lose their license and nobody should plead guilty just to hasten the end of the case. At Oberheiden & McMurrey, the decision to go to trial is made after careful analysis of all existing evidence, identification of all available helpful and adverse witnesses, testimony prediction, and a determination of any conceivable and plausible alternative to trial. Oberheiden & McMurrey clients don’t go to court unprepared. Our clients are zealously represented by highly qualified federal trial attorneys with specific health care law backgrounds.

If you are looking for a true federal trial law firm, then look no further. Oberheiden & McMurrey is one of the country’s most prominent and most distinguished federal trial law firms. Our attorneys have led trial teams in federal courts across the United States. Combined, our lawyers have served as responsible supervisors or as lead counsel in approximately 300-500 federal criminal trials, many of them involving health care law. The attorneys at Oberheiden & McMurrey are skilled, trained, and highly respected criminal litigators. At any given time, our attorneys are presently involved in federal litigation allowing us to constantly hone our skillset and spread our reputation of excellence throughout the country.

Whom at Oberheiden & McMurrey Should You Contact to Get a Free Consultation?

Clients contact Oberheiden & McMurrey from across the United States to seek reliable and effective advice regarding potential or pending government investigations. Our attorneys offer decades of relevant government experience— and they include the former chief for health care fraud at the U.S. Attorney’s Office, former Assistant United States Attorneys (AUSA), former Special Assistant United States Attorneys (SAUSA), and other nationally respected health care fraud defense lawyers. No matter what the situation, our attorneys have the experience and skillset to appropriately assess the best options. Medicare rules are complicated, and violations can trigger severe penalties. Experience matters, so do not waste your time with junior lawyers or attorneys that first need to research your legal questions.

  • Nick Oberheiden is the managing principal of Oberheiden & McMurrey. Nick has successfully represented health care executives, business owners, public officials, physicians, and lawyers in civil and criminal health care fraud investigations.
  • Bill McMurrey is a former Department of Justice trial lawyer, former Assistant United States Attorney (AUSA), former federal prosecutor, and the former long-time chief coordinator for health care fraud at the Department of Justice for the Northern District of Texas.
  • Glenn Harrison is a former Department of Justice Trial Attorney, former Special Assistant United States Attorney (SAUSA), and former federal prosecutor. Glenn is particularly experienced with civil and criminal health care fraud investigations and he offers his decades of experience to clients in need of reliable advice.
  • Lynette 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 on behalf of her clients.

We recognize the importance of each matter and we dedicate our fullest attention to each client. We are available to discuss your concerns in a free and confidential consultation, including on weekends. Call us today.

Oberheiden & McMurrey, LLP
Compliance – Litigation – Defense
(800) 810-0259
(214) 469-9009
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