Oberheiden, P.C. is a team of highly-experienced federal defense lawyers who have a proven track record of success in Medicare fraud investigations. Our attorneys have successfully defended physicians, pharmacists, hospice and clinic owners, testing laboratories, company executives, and other clients in Virginia and nationwide.
From Northern Virginia to the Appalachian region, health care providers in all parts of Virginia are facing federal investigations targeting their Medicare billing practices. With Medicare fraud costing the federal government billions of dollars every year, fighting fraud is a top federal law enforcement priority, and authorities currently have their sights set on health care providers.
If your business or practice is under investigation, it is important that you engage experienced legal representation. At Oberheiden, P.C., we represent physicians, pharmacists, hospice and clinic owners, testing laboratories, durable medical equipment (DME) company executives, hospital administrators, board members, and other clients throughout Virginia and nationwide. Once you engage our firm, our team of senior health care fraud defense attorneys will promptly intervene in the government’s investigation and take all steps necessary to mitigate or eliminate your risk of prosecution as quickly, discretely, and cost-effectively as possible.
During a Medicare fraud investigation, it is critical to execute a strategic defense that is focused on the specific facts and allegations at hand. From the allegations against you to the federal agency (or agencies) involved, we will custom-tailor our representation to the circumstances of your investigation and aggressively defend you at all stages of the process. As your defense counsel, our sole focus is on protecting you, and we will use our extensive experience in Medicare fraud investigations to effectively challenge or disprove the allegations against you.
Experienced Legal Representation for Medicare Fraud Investigations Involving All Federal Agencies
Our experience includes representing clients in Medicare fraud investigations conducted by all relevant federal agencies. Most investigations involve one or more of the following:
1. Centers for Medicare and Medicaid Services (CMS)
The Centers for Medicare and Medicaid Services (CMS) conduct investigations based upon audit reports from Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), and other contractors under its “fee-for-service” audit program, as well as automated review of providers’ program billing data and information from other sources.
2. Department of Justice (DOJ)
The Department of Justice (DOJ) also relies heavily on data analytics to identify targets for Medicare fraud investigations. It conducts investigations that are both civil and criminal in nature, and its prosecutors routinely pursue charges under the False Claims Act, Anti-Kickback Statute, Stark Law, federal health care fraud statute (18 U.S.C. § 1347), and other applicable federal laws.
3. Department of Health and Human Services (HHS) Office of Inspector General (OIG)
The Office of Inspector General (OIG) is, “at the forefront of the Nation’s efforts to fight waste, fraud and abuse in Medicare, Medicaid and more than 100 other HHS programs.” It aggressively targets health care providers suspected of Medicare fraud, often in conjunction with CMS, the DOJ, and other state and federal agencies.
4. Federal Bureau of Investigation (FBI)
With field offices in Chesapeake, Richmond, and Washington D.C., the Federal Bureau of Investigation (FBI) participates in Medicare fraud investigations throughout Virginia.
5. Internal Revenue Service (IRS)
The Internal Revenue Service (IRS) investigations tax-related civil and criminal allegations triggered by Medicare fraud investigations. The scope of its involvement can range from a remote audit to gathering evidence to pursue criminal tax evasion charges through its Criminal Investigations Division.
6. Drug Enforcement Administration (DEA)
The Drug Enforcement Administration (DEA) handles investigations related to Medicare-participating providers’ prescription drug practices. This includes prescription, distribution, and administration of controlled-substance medications, with particular emphasis on opioid drugs.
Q&A with Oberheiden, P.C.’s Federal Health Care Fraud Defense Team
Q: What are federal authorities looking for during Medicare fraud investigations?
If your business or practice is under investigation for Medicare fraud, this means that federal authorities already have at least some evidence to suggest that improper billings have been submitted. This could be as a result of an audit, a whistleblower claim, a patient complaint, or an apparent “anomaly” in your business’s or practice’s program billing data. Whatever the case may be, the goal of the government’s investigation is to find proof that you have overbilled Medicare so that it can recoup any improper payments and pursue charges for a civil or criminal Medicare fraud violation.
In most cases, federal agents will be looking for evidence of billing improprieties and other illegal practices such as:
- Billing for services not actually rendered
- Billing for services that were not “medical necessity”
- Billing for services at a higher rate than the one allowed
- Billing for related services and supplies at individual rates rather than a reduced “bundled” rate
- Double-billing Medicare and another government benefit program (such as Medicaid or Tricare) or a private insurer
- Improperly prescribing, distributing, and billing for prescription medications
- Making unnecessary and gratuitous use of durable medical equipment (DME)
- Falsifying patient records and misrepresenting test results
- Offering or accepting illegal referral fees, rebates, kickbacks, or other forms of “remuneration”
Q: What are the penalties for overbilling Medicare?
The penalties that are on the table in a Medicare fraud investigation will depend upon the specific allegations involved and whether the investigation is civil or criminal in nature. When you engage our firm to represent you, we will work quickly to determine your potential exposure, as this will inform many aspects of our defense. In broad terms, the penalties for Medicare fraud include:
Civil Medicare Fraud Penalties
- Recoupment of overbilled amounts
- Denial of pending claims
- Pre-payment review of future claims
- Civil fines
- Treble (triple) damages
- Attorneys’ fees
- Exclusion from Medicare participation
Criminal Medicare Fraud Penalties
- Criminal fines
- Federal imprisonment (including the potential for life imprisonment in cases where fraudulent Medicare practices result in a patient’s death)
- Exclusion from Medicare participation and other program-related penalties
Beyond these lists, there are some other important facts for Virginia health care providers to know as well. For example, in both civil and criminal cases, the aggregate penalties are determined by the volume of the alleged improper conduct. For example, in a civil case under the False Claims Act, fines will be imposed on a “per-claim” basis, with each individual billing request constituting a separate “claim.” Health care providers can also face enhanced penalties if prosecutors allege that Medicare billing violations or other improper practices resulted in patient injury or death (i.e. as a result of improperly prescribing opioid medications); and, in criminal cases, federal prosecutors will often pursue additional charges for mail fraud, wire fraud, money laundering, and other crimes.
Q: Am I safe if I did not intentionally overbill Medicare?
Unfortunately, no. While lack of intent is a defense to criminal Medicare fraud charges, unintentional billing violations can still trigger civil prosecution and the laundry list of penalties outlined above. Additionally, even if you did not actually overbill Medicare, federal prosecutors may still try to pursue charges for conspiracy or attempt. Due to the government’s intensive focus on combatting Medicare fraud, once resources have been devoted to an investigation, prosecutors will be looking for any justifiable grounds to pursue charge.
Q: In Medicare fraud investigations, is it possible to avoid charges or negotiate a deal if charges get filed?
Yes. Our firm has an extensive track record of resolving clients’ Medicare fraud investigations without civil or criminal charges. We have also had clients’ charges dismissed following indictments; and, when it has been in our clients’ best interests to do so, we have negotiated deals that have avoided criminal pleas and allowed our clients to continue running their businesses and practices. The key to mitigating the consequences of a Medicare fraud investigation is to begin defending yourself as soon as possible, and this means engaging experienced defense counsel right away.
Q: Why should I choose Oberheiden, P.C. in Virginia?
Health care providers in Virginia and nationwide trust Oberheiden, P.C.’s federal health care fraud defense team to protect them during Medicare fraud investigations. With our attorneys’ centuries of combined legal experience and in-depth knowledge of the legal and medical principles involved in Medicare fraud investigations, we have become go-to legal counsel for Medicare-participating providers across the country.
Here is what you can expect when you choose Oberheiden, P.C. for your Medicare fraud investigation in Virginia:
- Strategic and proactive defense based upon extensive experience defending against Medicare fraud allegations and prosecuting health care fraud cases on behalf of the DOJ.
- Insight into the reasoning and strategy behind the investigation derived from our attorneys’ experience as former federal health care fraud prosecutors.
- Aggressive challenging of the government’s tactics and assumptions at all stages of the process, with the goal of securing a favorable pre-charge or pre-trial resolution.
- Direct access to your defense team 24/7 by phone, text, and email.
- Relentless pursuit of a favorable outcome that avoids federal charges and protects your right to do business or practice medicine in Virginia.
Meet the federal health care fraud defense team at Oberheiden, P.C.
Schedule Your Confidential Initial Case Assessment
To discuss your Medicare fraud investigation with a member of our defense team, please call 888-519-4897 or tell us how to reach you online. We will schedule your confidential initial case assessment as soon as possible.