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Seattle Healthcare Fraud

Healthcare Fraud Defense in Seattle

Healthcare fraud investigations involving the U.S. Department of Justice (DOJ), Centers for Medicare and Medicaid Services (CMS), and other agencies can lead to financial penalties, program exclusion, and even federal imprisonment. Our firm brings over 100 years of experience to defending Seattle healthcare providers against the government. Contact our Seattle healthcare fraud defense lawyers to discuss your situation.

For healthcare providers in Seattle, Washington, the dangers of federal healthcare fraud allegations are very real. Allegations of overbilling Medicare, Medicaid, Tricare, and other government benefit programs can lead to civil or criminal prosecution; and if convicted, providers can face insurmountable financial penalties and the potential for years, if not decades, behind bars. Investigators and prosecutors assigned to task forces such as the Medicare Fraud Strike Force have a mandate to aggressively pursue charges against providers suspected of fraud, waste, and abuse. Providers targeted in federal investigations must act swiftly to protect themselves against charges, conviction, and sentencing.

Just how big are the risks? In a civil case only involving charges under the False Claims Act (most cases will involve multiple charges under a variety of federal statutes), providers can face recoupments, treble (triple) damages, fines of approximately $21,000 per false claim, and loss of federal healthcare benefit program eligibility. In a criminal case, the fines can reach $250,000 for individuals (or $500,000 for businesses), and prosecutors can seek up to five years of federal imprisonment for each individual offense.

I would recommend Nick Oberheiden and his team in a heartbeat. I was facing a legal issue that was promptly resolved by the firm. Highly recommend the expertise of the staff. Thank you.
Kirtan 2.
Kirtan 2.
Nick has been there since the beginning. Throughout this experience he has had made me feel like my case is his most important. He excels in his area of law and I would not hesitate to recommend him to anyone that needs assistance. I am honored to have had him help me through this period.
j A.
j A.
Quick response, very knowledgeable, passionate, with a caring team with real experiencewith the same federal agencies that I was corresponding with (Roger Bach!) thus making all the legal concerns understandable. I would recommend to any other health care professional or would use Nick Oberheiden again if ever needed.... Thank you!read more
Shaunna R.
Shaunna R.
I am compelled to recommend Nick Oberheiden after dealing with many blood thirsty attorneys. Nick was extremely responsive, knowledgeable, and trustworthy. His expertise and relationships in the realm of federal healthcare is great. I wish I would have called him sooner. If you are facing a federal investigation... or suit, make Nick the first call you make. He really cares and is looking out for his clients best interest. His expertise has allowed my situation that seemed so daunting to be very more
Lisa K.
Lisa K.
I found myself in an unfortunate situation with the federal government. I hired Nick Oberheiden as my attorney and it has been a life saving decision. His expertise and knowledge along with his commitment is superior and of utmost importance in federal cases. Nick has kept his word throughout this stressful process... and helped me receive the best possible outcome. You will not regret hiring Nick and his law firm to defend you!!!read more
Amir K.
Amir K.
Over the past decade I have plenty of experience with health care and federal attorneys. The one that has stood by far above and beyond the most intelligent, thoughtful, straight-forward, and strategic in defense and actions has been Nick Oberheiden. Nick has achieved results that others claim they could not. He has... taken on circumstances that felt as if not winnable, and worked to create a positive outcome. Nick has become a rock and support person through my troubling time and a beacon of hope and action that things will come out in the best possible manner. There is no attorney that I could support more then Dr. more
Matt H.
Matt H.
Dr Nick Oberheiden is a truly excellent attorney in every way! He’s knowledgeable and responds to all phone calls and emails swiftly. He is concise, and puts information in understandable terms. He is happy to explain and clarify any confusing matters or material. He will put your mind at ease immediately. For me,... it was like a superhero was protecting and helping me through what was one of the most stressful situations of my professional life! Nick is worth every single bit of the five star rating from me, and from other clients who have given him five star reviews as well!read more
Katherine R.
Katherine R.
We needed legal service and advise, Nick Oberheiden made a bad situation better. Prompt service, responded to email , and phone calls, addressed the problem professionally and on time. Would highly recomend them.
John P.
John P.
I have conferred and worked with Nick on several healthcare fraud defense cases, representing doctors, laboratory/pharmacy owners, durable medical equipment providers and marketing companies all investigated by the U.S. Department of Justice. Nick's level of expertise when it comes to the intricacies of medicare... billing, operational regulations and corporate structure is unmatched. His experience and knowledge, combined with his high-level contacts within the Department of Justice, nationwide, make him an invaluable resource to anyone who finds themselves being investigated or audited by the Government. Nick is easy to communicate with, and goes above and beyond to make himself available to his clients and colleagues in their time of more
Joseph N.
Joseph N.
From the moment we walked into Nick’s office, he made us feel safe and secure. Nick exemplifies kindness and compassion for his clients, qualities that I have found rare with attorneys. Nicks passion and expertise in Healthcare and Law are unrivaled.I strongly encourage and recommend others to use Nick.... Professionally, Nick is a Genius!read more
Shawn C.
Shawn C.
As a former supervising investigator with a large New York State agency investigating health care fraud, I have conferred with many defense attorneys over my thirty-year career. I can honestly say that I was not impressed with many of them, that is, until I met Dr. Nick Oberheiden. Not only is he an exceptional... attorney, who provides his clients with expert strategic legal guidance, he is highly regarded for his extraordinary character and integrity. Nick is extremely ethical and always has his clients' best interests at heart. Today, I am proud, honored and privileged to work with Nick in assisting him with his clients' needs, whether it is to determine if they have any criminal liability or to proactively establish a compliance program to prevent them from falling victim to any government audit/investigation. Nick works very efficiently - saving his clients time and money. So, if you are looking for an attorney to represent you or to offer you expert guidance, don't hesitate and contact Dr. Nick Oberheiden. You'll be glad you did!read more
Greg M.
Greg M.
I was a federal agent for over 30 years and have worked with many of the most successful DOJ and DoD attorneys. Dr. Oberheiden leads a team made up of the best former Federal, State, local attorneys and investigators that can quickly assess any type of federal legal matter. The collective knowledge and experience of... Dr. Oberheiden and his "Dream Team" have yielded successful outcomes in a significant number of federal legal matters which have benefited his clients time and time again! He and his team are determined to work each case to anticipate a prosecutor's case strategy and identity weaknesses in that strategy. Dr. Oberheiden is a relentless legal strategist that has earned him his favorable reputation among the legal community nationwide! If you want a reliable and results-oriented lawyer working for you, Oberheiden P.C. has my highest recommendation and confidence!read more
During the past year, i had the privilege to work alongside Dr. Nick Oberheiden as a team-member defending the owners of a specialty pharmacy being investigated by the HHS-OIG and the USDOJ. Thanks to Nick's leadership, knowledge and expertise, "Team Oberheiden" earned the pharmacy and its owners exoneration from... criminal and civil penalties. Case closed!read more
bill T.
bill T.
Excellent lawyer! I have been very happy with his legal services and highly recommend Dr. Nick Oberheiden.
Jakob S.
Jakob S.
Nick was extremely professional, polite, helpful, and friendly. He put my friend at ease and made us feel welcome to be with her. He answered our questions even though we were just there for support. Would definitely recommend him to anyone and would use myself if ever needed.
Jamie G
Jamie G
Nick is not smart, he is BRILLIANT! He knows the proceedings of the court extremely well and is a genius when working with prosecutors and judges!He is extremely hard working, and although I knew he was working on multiple cases, every time we dealt with mine, he made me feel that my case is the most important to... him. I will most certainly not be where I am, had it not been for Nick. I had worked with a couple of lawyers before Nick came so highly recommended to me, and I can tell you that he simply light years above them. Nick bats for the big leagues!!read more
Lorraine Emma De B.
Lorraine Emma De B.
I am a retired FBI Special Agent, who worked extensively with many attorneys. I find Dr. Oberheiden ti be very knowledgeable of the healthcare issues. He has a vast knowledge of all federal violations. He is very conscientious about the benefits of his clients. I saw him working around the continent of North America... to assist his clients. One of the great traits of the Oberheiden Law Firm, is that he tackles the allegations long before they reach the court stage. His capable staff is also very qualified and assist all clients as if they are the only client in their firm. I strongly recommend the Oberheiden Law Firm to anyone who has a federal more
Gamal A.
Gamal A.
Nick is extremely professional and knows what he is doing. He is also very kind as a person (unless he is in court!) I would recommend him to just about anyone if they need an amazing lawyer that is top notch and would frankly be scary to face in the court room. He will always do a great job representing his clients.... Thank you very more
Anna P.
Anna P.
Nick is the absolute top expert in any federal case
Jeff C.
Jeff C.
Smart. Smarter. Nick.As a healthcare executive, I once ran into a litigation issue. I hired Nick and, literally, before I knew it the case was resolved in my favor. Nick has an incredible presence and every lawyer in the room knows that Nick will do exactly what he says. It was a mesmerizing experience to see Nick in... action! Very calm and determined, Nick is the absolute top more
Whitney Bryant M.
Whitney Bryant M.
Nick has been a friend and trusted advisor for almost 10 years. As anyone just looking at his bio can tell, Nick is an outstanding attorney in highest demand across the country. All healthcare providers should hire attorney Nick Oberheiden!! You will not be disappointed.
Pamela M.
Pamela M.
Dr. Oberheiden has served as council and represented our company on several occasions, even during depositions, contract reviews and providing invaluable advice on multiple occasions that transpired into multilevel success in our business. He and his teams knowledge of both local, state and federal statues,... accompanied by their areas of expertise law regarding best asset protection, estate planning and wealth management solutions have provided both professional and personal growth for my companies, safeguarding them and protection my family’s name and legacy. I would recommend this firm and Dr. Nick Oberheiden without hesitation. I have no doubt that you will experience success with his more
Corban M.
Corban M.
I have worked with Nick Oberheiden for over ten years on various litigation matters in and around New York City. Nick is an accomplished and seasoned lawyer and litigator---efficient, reliable, practical and, at the same time, highly academic. Nick will take the time necessary to understand a client's short- and... long-term goals, and tailor his representation and advice to work toward and achieve those ends. Nick is a zealous advocate for his client, and will never sacrifice his client's interests for a quick or easy resolution to a case. At the end of the day, Nick is a great person to know if you or your business is in need of a top litigator or defense more
Brendan C.
Brendan C.
When I was faced with one of the most terrifying and unexpected situations in my life, I called Dr. Oberheiden. I had vetted other attorneys and came right back to him. His knowledge, expertise, and reassuring presence made the decision easy. Throughout my case, his level of communication was what I needed and... expected. He constantly updated me on the status and progress of my case and was able to “talk me off the ledge” when the stress of it all would set in. He is simply the best of the best...there’s not a question about more
Scarlett L.
Scarlett L.
Nick is a superb lawyer with exceptional skills and a formidable personality. Nick works harder, he thinks smarter, and he delivers faster than any lawyer you will ever find. Good, better, Nick!
Jacqueline S.
Jacqueline S.
1st class service. Atty. Iberheiden and Atty. Lynette Byrd were always available for us during the whole process of our Home Health Audit. Thank you so much!
Ed O.
Ed O.
I am a healthcare compliance consultant with almost 25 years of experience. The one advice I have for anyone seeking a lawyer with unbeatable healthcare law experience is to hire attorney Nick Oberheiden. For the past 8 years, I have worked with Nick on a variety of healthcare matters—from DEA compliance to DOL... supervisory rules to setting up PT and pain management clinics. I have never once seen a client not being 100% intrigued by Nick’s proven expertise in the field of healthcare structuring and compliance.Dr. more
Nick Oberheiden is a spectacular lawyer, a true life saver. Nick is simply the very best!
Michael P
Michael P
Nick Oberheiden is the absolute best federal litigation attorney. Nick gives you the immediate comfort of feeling 100% protected. He is polite, respectful— and extremely compelling. His legal strategy turned out to be brilliant.
Marshall M
Marshall M
Great firm, with a great firm record of experienced healthcare and litigation attorneys.
Chris A.
Chris A.

If your healthcare business or medical practice is being targeted in a federal fraud investigation in Seattle, you absolutely must present a strategic defense. If the investigative process continues unchecked, prosecutors will keep working until they find sufficient evidence to file charges, and they will prosecute you to the fullest extent of the law. While few healthcare providers expect to garner the federal government’s attention, and fewer still actually believe they have done something wrong – the reality is that the breadth of our nation’s healthcare laws creates significant exposure even for providers who accidentally commit billing violations. Do you need a law firm that can provide a strategic defense? Call Oberheiden, P.C and speak to a proven Seattle healthcare fraud lawyer for free.

Strategic Defense for Seattle Healthcare Providers Accused of Fraud

Seattle Healthcare Fraud

At Oberheiden, P.C., we focus our practice on representing clients in healthcare fraud investigations and prosecutions. We have a legal team that includes former senior DOJ prosecutors, that have decades of experience in the “other side” thinks – this is so because they have worked for the other side. We have a client list that includes licensed practitioners, healthcare business owners and executives, physician-owned entities, hospitals and other medical facilities, pharmacies, hospices, and home health agencies, and durable medical equipment (DME) companies, among others. We offer seasoned experience and significant insights into successfully defending our clients against healthcare fraud allegations. From audits and investigations to criminal trials and appeals, we do it all – and we have a notable record of success at each stage of the process.

During your case, you will work closely with the attorneys on our healthcare fraud defense team. With our team approach, each of our attorneys plays a role in every case we handle, ensuring that each client receives the very best legal representation that we have to offer. The attorneys on our healthcare fraud defense team includes Dr. Nick Oberheiden. Dr. Oberheiden is our firm’s founder and Managing Partner. He represents healthcare practitioners across the nation utilizing his extensive and in-depth knowledge of the Medicare billing regulations and healthcare fraud defense strategies.

Meet the rest of your attorneys at Oberheiden, P.C.

“Our companies have worked with firms all over the country within various specialties and now use [Oberheiden, P.C.] almost exclusively. Nick represented our companies in some federal law investigations. His guidance and expertise allowed us to continue to concentrate on our core business as he dealt with the complex legal issues.” – Healthcare Provider, Firm Client

“Dr. Oberheiden has successfully represented our company in various federal health matters involving the OIG, the Department of Labor, and the Department of Health and Human Services. Dr. Oberheiden quickly understands all issues and is able to convincingly present the client’s side of the story. From my experience with other lawyers, should we ever need legal help, the first thing our company will do is to call Dr. Oberheiden.” – Healthcare Provider, Firm Client

Skilled Seattle Healthcare Fraud Defense Lawyers for All Healthcare Fraud Matters

We rely upon our extensive experience to effectively represent individuals and corporate clients in all healthcare fraud matters. Our attorneys have extensive experience in matters including, but not limited to:

  • Whistleblower Claims (qui tam defense)
  • Letters from the U.S. Attorney’s Office
  • Civil Investigative Demands (CIDs)
  • Grand Jury Subpoenas
  • Department of Health and Human Services Office of Inspector General (OIG) Subpoenas
  • Requests for Depositions and Subpoenas to Testify in Court
  • Medicare and Medicaid Audits
  • Centers for Medicare and Medicaid Services (CMS) and State Licensing Board Matters
  • DEA and Prescription Investigations

We handle healthcare fraud investigations and prosecutions involving all substantive legal issues, such as those listed below.

Billing and Coding Fraud

All providers that bill Medicare, Medicaid, Tricare, and other federal healthcare benefit programs are required to strictly comply with these programs’ billing and coding requirements. Coding errors, even those that are unintentional, constitute “fraud” under federal law – and they can subject providers to severe financial penalties and other consequences. Some of the most-common allegations against providers accused of billing and coding fraud include:

  • Double-billing a single benefit program, billing multiple programs for the same service, or billing a benefit program and a private insurer
  • Billing for “non-allowable” costs such as operational expenses, or billing for services provided by unlicensed or excluded practitioners
  • Billing for services, supplies, and equipment at their stand-alone reimbursement rates instead of the “bundled” rates provided for under the applicable program regulations (referred to as “unbundling”)
  • Billing for services, supplies, and equipment at a higher rate than specified under the applicable program regulations (referred to as “up-coding”)
  • Billing for services, supplies, and equipment that have not actually been purchased or provided to patients (referred to as “phantom billing”)

Providers facing allegations of billing and coding fraud must be cautious not to simply assume that the government’s allegations are correct. While some federal agents and prosecutors are experts in the Medicare, Medicaid, and Tricare billing regulations, they also make mistakes, and the regulations change over time. Maybe a bill that your office submitted complied with then-current regulations even though it would be considered non-compliant today. Maybe a reimbursement request which appears fraudulent based on data analysis is actually fully legitimate given the unique aspects of your business or practice. There are numerous potential defenses to allegations of billing and coding fraud, and in order to build an effective defense, you need to get out in front of the government’s investigation.

Illegal Kickbacks, Referral Fees, and Physician “Self-Referrals”

As a general rule, it is unlawful to use program-reimbursed funds to pay referral fees, kickbacks, and other forms of remuneration in connection with the provision of healthcare services or the purchase or lease of equipment, facilities, or supplies. The Anti-Kickback Statute and Stark Law contain broad prohibitions against these types of transactions and financial relationships, and allegations of offering, soliciting, paying, and accepting illegal forms of remuneration are common in comprehensive healthcare fraud investigations.

The Anti-Kickback Statute applies to all healthcare providers, and it prohibits any and all forms of compensation. This includes:

  • Cash payments
  • Discounts for services, supplies, or equipment
  • Free or below fair market value use of clinical space, equipment, or staff
  • In-kind gifts
  • Marketing commissions
  • Payments to family members

Unlike the Anti-Kickback Statute, the Stark Law is specific to physicians and entities with which they have a direct or indirect compensation or investment relationship. It also only applies to referrals for “designated health services,” which include:

  • Clinical laboratory services
  • DME and medical supplies
  • Home health services
  • Imaging
  • Inpatient and outpatient hospital services
  • Outpatient pathology
  • Outpatient prescriptions
  • Parenteral and enteral nutrients, equipment, and supplies
  • Physical therapy
  • Prosthetics, orthotics, and related supplies
  • Radiology and radiological therapy

However, while the Anti-Kickback Statute and Stark Law contain broad prohibitions on compensation arrangements involving payment of program-reimbursed funds, they are subject to numerous safe harbors and exceptions which protect a variety of different types of transactions. In Anti-Kickback Statute and Stark Law investigations, our Seattle healthcare fraud defense lawyers’ focus is often on demonstrating that one (or more) of these safe harbors or exceptions applies. Some of the safe harbors and exceptions most commonly used by physicians, clinics, and other providers include those that protect:

  • Arrangements with hospitals
  • Cooperative health service organizations
  • Discounts and price reductions
  • Group purchasing organizations
  • In-office ancillary services
  • Indirect compensation arrangements
  • Isolated transactions
  • Non-monetary compensation
  • Personal service arrangements
  • Rentals for office space and equipment

“False and Fraudulent” Claims

Billing and coding violations, kickbacks, and physician self-referrals can all be prosecuted as “false and fraudulent” claims under the False Claims Act (FCA). The False Claims Act prohibits any and all improper requests for payment from the government, and it imposes both civil and criminal penalties. Other common allegations against healthcare providers under the False Claims Act include:

  • Billing for medically-unnecessary services, supplies, and equipment. In order to be eligible for reimbursement, a service, supply, or piece of equipment must meet the relevant program’s definition of medical necessity. If a service or item is deemed medically-unnecessary under the applicable program guidelines (even if it may have been reasonably necessary within the course of patient care), billing for the service or item can trigger FCA liability.
  • Submitting reimbursement requests based upon falsified patient records. Prosecutors often take aggressive action against providers who they believe to have falsified patient data in connection with a request for Medicare, Medicaid, or Tricare reimbursement. If you (or someone within your business or practice, such as a billing administrator) has been accused of falsifying records, you will need to tailor your defense strategy to combatting these dangerous allegations.

Prescription Drug Fraud

Prescription drug fraud investigations targeting physicians, pharmacists, clinics, and other providers and facilities often involve multiple federal agencies and the potential for severe charges under a variety of federal statutes. Recently, the DOJ formed an Opioid Fraud and Abuse Detection Unit comprised of agents and prosecutors who are specifically tasked with targeting providers suspected of contributing to the wave of opioid abuse and dependence. Compound pharmacy fraud has been a major focus of the federal government’s anti-fraud enforcement efforts as well. Our defense attorneys and former federal prosecutors have extensive experience in prescription drug fraud cases involving allegations such as:

  • Dispensing more medication than was prescribed
  • Drug shorting and refill schemes
  • Falsifying and forging prescriptions
  • Illegally importing prescription medications
  • Prescribing drugs that are medically-unnecessary
  • Prescribing medications without an in-person exam
  • Prescription drug diversion
  • Selling fraudulent prescriptions

Home Health and Hospice Fraud

The home health and hospice care sectors have seen enhanced scrutiny from federal authorities in recent years as well. While these investigations can involve all of the substantive issues discussed above, they often involve two issues that are unique to home health and hospice care:

  • Physician Certification Fraud – Prior to commencing treatment home health agencies and hospices must obtain physician certifications. They must also obtain recertifications for their patients every 60 days. Common allegations in physician certification fraud investigations include falsifying and forging certifications, offering kickbacks and referral fees to certifying physicians, and seeking certifications from physicians other than patients’ primary care providers.
  • Election Statement Fraud – In addition to obtaining physician certifications, hospices must also obtain election statements from their patients. Failing to notify patients of their rights (and the fact that electing for hospice care can waive certain of these rights) can lead to allegations of election statement fraud. Other activities such as forging patients’ signatures, backdating election statements, failing to keep adequate records, and refusing to accept patients’ election revocations can lead to these allegations as well..

Seattle Healthcare Fraud Defense: Answers to Frequently-Asked Questions (FAQs)

Q: What should I do if I have been contacted by federal authorities regarding my business’s Medicare billings?

If you have received an inquiry regarding your Medicare, Medicaid, or Tricare billings (or any other aspect of your healthcare business or medical practice), it is important that you speak with a Seattle healthcare fraud defense lawyer immediately. You need to respond appropriately; but in order to do so, you also need to know the answers to questions such as:

  • Why is the government looking into your business or practice?
  • What type of inquiry have you received (i.e., was it a letter or civil investigative demand (CID))?
  • Is the government’s inquiry civil or criminal in nature?
  • How long has your business or practice been under investigation?
  • What is the scope of the allegations against you, and what are the potential ramifications?

When we represent clients in healthcare fraud investigations, one of our first steps is to intervene in the investigation in order to obtain answers to the questions we just listed. Armed with this information, we can then begin to help our clients make informed decisions about protecting their legal rights.

Q: What do I need to know about facing an investigation under the False Claims Act?

If your business or practice is being targeted for alleged healthcare fraud, any charges will most likely include civil or criminal charges under the False Claims Act. To learn more about the risks of being prosecuted under the FCA, you can read:

Q: What factors should you consider when choosing a healthcare fraud defense attorney in Seattle?

When choosing an attorney (or team of attorneys) to represent you, the two most important factors are experience and prior results. While prior results do not guarantee future outcomes, a significant record is still highly relevant to choosing the attorney (or attorneys) you want defending you against the government. For more considerations, we encourage you to read: Defending Healthcare Fraud: Choosing the Right Lawyer. Choose wisely. Hire one of our skilled and winning Seattle health care fraud defense lawyers.

Contact our Seattle Healthcare Fraud Defense Lawyers at Oberheiden, P.C.

If your Seattle healthcare business or medical practice is under investigation by the DOJ, OIG, DEA or another federal agency or task force, we encourage you to contact us promptly for a free initial consultation. To speak with the Seattle healthcare fraud defense attorneys on our fraud defense team in confidence, please call 888-680-1745 or request a case assessment online now.

Additional Pages for Seattle, Washington

This information has been prepared for informational purposes only and does not constitute legal advice. While this information may constitute attorney advertising in some jurisdictions, merely reading this information does not create an attorney-client relationship. Every case is different, any prior result described or referred to herein cannot guarantee similar outcomes in the future. Oberheiden, P.C. is a Texas limited liability partnership with its headquarters in Dallas, Texas. Mr. Oberheiden limits his practice to federal law.

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