The rules for federal health care programs are immensely complicated, and it is understandable that many home health providers and business owners become overwhelmed attempting to deal with the government’s constantly-changing regulations. Unfortunately, despite their best efforts, with increasing frequency these companies and individuals are finding themselves the subjects of federal investigations involving accusations of fraudulent conduct. Some of the common reasons for these investigations include:
- Overly-complicated rules and regulations
- Untrained or unmotivated staff
- Unreliable billing personnel
- Fast-growing practice
- Lack of an effective compliance program
Equally unfortunate, the government and the federal health care statutes have made clear that these are not excuses for violating the law. As a result, if you are under investigation for home health fraud in New Mexico, you need to speak with an attorney right away.
What Is Medicare Fraud?
Most home health care investigations allege that a home health provider has committed Medicare fraud. Specifically, what home health care providers are typically accused of are things like:
- Billing fraud – Charging for services that were in fact never provided, or billing Medicare for the same service more than once.
- Preparing improper cost reports – Billing Medicare for durable medical equipment (DME) and other medical devices that are never actually provided to patients.
- Coding fraud – One of the most common forms of coding fraud is called, “up-coding.” This involves billing a service under an incorrect code that provides a higher reimbursement rate.
- Billing for services that are not medically necessary – Home health providers can only seek Medicare reimbursement for services that are medically necessary. Billing for unnecessary services is a common form of health care fraud.
When Is an Investigation Civil? When Is an Investigation Criminal?
Medicare and Medicaid fraud are serious federal offenses that can either be charged as civil violations or criminal misconduct.
The question of whether an investigation is civil or criminal is among the most important questions you need to ask when you first meet with your attorney. While there are certain factors that may indicate that an investigation is criminal, it is often not possible to accurately assess the nature of an investigation until your defense attorney contacts the investigating agency (or agencies). For example, the fact that an agent with the federal bureau of investigation (FBI) or another federal enforcement agency shows up at your office does not necessarily mean that the case is criminal. This is a critical moment when proper decisions need to be made with your counsel.
If you become aware of a health care investigation against you, you need to take action and call a federal defense attorney immediately. In numerous cases, our experienced attorneys have been able to keep the government from bringing criminal charges against our clients. But, in order to do this, we need to get involved in the investigation as early as possible.
What Happens in a Home Health Care Case?
The Three Stages of a Federal Health Care Fraud Case
All home health care investigations have three stages. In the first stage, the government investigates alleged wrongdoing and, if it finds reason to believe that the subject of the investigation has committed health care fraud , it will either issue a subpoena or ask the court to execute a search warrant. If you have received a subpoena or a search warrant has been executed, it is critical that you call experienced defense counsel immediately.
With the appearance of your counsel, the case enters its second stage. The second stage primarily involves your attorney negotiating with government officials to obtain an efficient and favorable resolution to your case. The third stage is the resolution of your case, and how this goes will depend greatly on whether your attorney was able to keep the case civil, or if you are facing criminal charges that will need to be adjudicated in court.
At What Point Should You Hire an Attorney?
The importance of hiring experienced defense counsel at the earliest time possible cannot be overstated. When facing a federal investigation, you need experienced lawyers that (i) can protect your business and your good name, and (ii) can keep you from facing criminal charges.
At Oberheiden & McMurrey, LLP, our former federal health care prosecutors and experienced defense counsel have handled numerous health care investigations in New Mexico and Nationwide. We are prepared to take immediate action to enforce your legal rights. The sooner you call us, the greater the chances that we can protect you, your business, and your family.
What is the “Emergency Defense Package”?
Our attorneys have developed an “Emergency Defense Package” to provide clients that are under investigation with an immediate action plan. The “Emergency Defense Package” has been featured on news stations and in the media, and includes protocols, instructions, and defense strategies for individuals and businesses facing charges of health care fraud.
The “Emergency Defense Package” Contains:
- General Protocols: What to Do
- Instructions for Management: How to Deal with Agents
- Instructions for Management: How to Deal with Employees
- Instructions for Employees
- Document Retention Forms
- Compliance Examination Instructions
- Important Contact Information
You can call (800) 701-7249 at any time to request more information about Oberheiden & McMurrey, LLP’s “Emergency Defense Package.”
The Four Goals of Our Defense at Oberheiden & McMurrey, LLP
In each health care fraud case, we have four goals to protect our clients:
- Avoiding a Criminal Investigation
- Avoiding Media Coverage
- Protecting Our Client’s Good Name Keeping the Entire Case Confidential
- Protecting Our Client’s Financial Future
Schedule a Free Consultation with an Experienced Attorney at Oberheiden & McMurrey, LLP Today
As a result of our experience-based and results-oriented approach, at Oberheiden & McMurrey, LLP we have a long, successful history of defending clients in health care fraud investigations in New Mexico and nationwide. If you would like to speak with Dr. Nick Oberheiden or any of the other experienced defense attorneys at Oberheiden & McMurrey, LLP about your case, contact us to request a free consultation today.
Oberheiden & McMurrey, LLP represents clients in governmental investigations in New Mexico and across the country. Our attorneys have been able to avoid civil and criminal responsibility for the firm’s clients in health care fraud investigations involving the following government agencies, among many others:
- Successful defense of a health care services company against an investigation by the Office of Inspector General for Medicare Fraud
- Successful defense of health care company against investigations by the Department of Justice for alleged Health Care Fraud
- Successful defense of health care company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations
- Successful defense of a health care company against an investigation by the Office of Inspector General and Department of Health and Human Services
- Successful defense of a health care company against an investigation by the Office of Inspector General and the Department of Justice for alleged Medicare Fraud
- Successful defense of a physician owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations
- Successful defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud