500 Griswold St #2450
Detroit, MI 48226
(Meeting location by appointment only)
Serving the Detroit Area with Experienced Health Care and Medicare Fraud Legal Defense
The Oberheiden, P.C. has significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our health care law defense firm is comprised of the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and a slew of talented lawyers with years of relevant experience, many with law degrees from institutions like Harvard and Yale. Our attorneys serve clients in Detroit and the state of Michigan.
What Is Medicare Fraud?
Medicare fraud is an extremely broad term because it encompasses more than just the Medicare program. It actually involves any federal government health care program, including Tricare. By definition, Medicare fraud involves the submission of false or fictitious claims to the government for payment involving a government health care program. It can involve violations of many things including:
- Violations of the False Claims Act
- Violations of the Anti-Kickback Statute
- Violations of the Stark Law (the Physician Self-referral law)
- Violations of Social Security Act
- Violations of the U.S. Criminal Code
The common thread between all of these various potential Medicare fraud charges is that they revolve around a health care provider or business that receives money illegally from the federal health care program.
Detroit is highly scrutinized by the federal government in regard to Medicare fraud. Detroit, Michigan is one of nine areas in the United States that has a specialized task force in place to investigate and prosecute Medicare fraud. Detroit is the home to a large number of Medicare recipients. This means more claims. When an area files a large amount of claims, such as in Detroit, the health care practitioners and businesses face a higher risk of Medicare fraud.
Claims are filed through the Centers for Medicare and Medicaid Services (known as CMS).
In 2016, the Department of Justice announced that there was more than $900 million in false claims. In Detroit, the elite Health Care Fraud and Enforcement Action Team (HEAT) investigates allegations of Medicare fraud. HEAT is composed of prosecutors and investigators from several federal agencies, including the Department of Justice, Department of Health and Human Services, the Office of Inspector General, the Federal Bureau of Investigation, and other federal agencies.
Types of Medicare Fraud
There are many different types of Medicare fraud. This type of fraud generally refers to fraudulent billing practices and reimbursement requests involving false, excessive, or unauthorized services. The typical claims include:
- Phantom billing – services that were never performed, but that were billed
- Billing for medically unnecessary services
- Billing for supplies or equipment that were never ordered
- Billing for medically unnecessary supplies or services
- Certification for medically unnecessary services (commonly seen in both health and hospice fraud)
- Certification of medically unnecessary supplies (such as DME)
- Double billing
- Inflating bills
- Overuse of equipment or services
- Offering or accepting kickbacks
Regardless of what you do in the Detroit medical industry, you may be at risk of being investigated for Medicare fraud. Doctors, nurses, health care businesses, hospice care facilities, nursing homes, registered care centers, physician syndications, DNA centers, cancer treatment facilities, DME companies, and any other Detroit area health care provider or business is at risk.
Facing Penalties in Detroit, Michigan
If you’re investigated for Medicare fraud, you face some very serious civil and criminal liabilities. From the civil arena, you could face repayment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, exclusion from federal health care programs, payment of future damages, being ordered to pay treble damages, and attorney fees.
The criminal court can also find you criminally liable. You could be forced to pay large fines, have a criminal record, and face time in a federal prison. For each count of Medicare fraud, you could face 10 years in prison. If the Medicare fraud results in seriously bodily injury (as commonly seen in counterfeit or excessive medication), you may receive 20 years per count. If the Medicare fraud results in the death of a patient, you could face a life insurance.
In addition to those severe penalties from both the civil and criminal courts, you could also face the loss of your professional license and the loss of your hospital privileges.
Making the Right Choice to Defend Your Medicare Fraud Charges
Now you’ve learned just how serious the repercussions of Medicare fraud can be for Detroit health care providers, facilities, and businesses, it’s time to discuss how you can minimize the risk of dealing with the possible punishments. It is extremely important to choose a lawyer who has the skills and the experience to defend you against the federal government. It’s important to choose a lawyer with experience because the intricacies of a health care fraud defense case can be far too much to handle for lawyers who don’t have experience in this area of law. Often, people facing Medicare fraud defense cases decide to choose either a health care lawyer or a criminal lawyer. Generally, these lawyers aren’t the best choice.
Hiring a Health Care Fraud Defense Lawyer
The ideal attorney for your Medicare fraud defense cases is a health care fraud defense lawyer. Look for four specific points in a Detroit health care fraud defense lawyer:
- A track record of success
- Health care industry and criminal knowledge
- Intimate knowledge of health care laws
- Experience in litigation
In addition to those four specific points, you should ask your potential Detroit Medicare fraud the following three questions:
- How many Medicare fraud cases have you handled during your legal career?
- Of those cases, how many resulted in no civil charges, no criminal charges, or dismissals?
- How many of the health care fraud cases that you’ve handled did you try in court?
The Use of Proven Defense Strategies in Detroit Medicare Fraud Cases
Oberheiden, P.C. has learned something over the decades. What we’ve learned isn’t just from the cases we’ve handled as a health care fraud defense team. It’s also from our past experience. Some of our health care fraud defense attorneys formerly held senior positions within the Department of Justice. We’ve taken these experiences, insights, and contacts and are putting them to work for our clients in Detroit and around the nation. Each case is different, but there are some defense strategies that tend to work very well to minimize the risk of criminal charges.
- Early intervention with investigating bodies. Our experienced attorneys get involved early with the investigating bodies. It’s like pulling a small weed out by the roots before it has the chance to ruin an entire garden. The longer you allow a weed to grow, the worse it can damage your garden. In this instance, the longer you allow the government to investigate the charges without having an attorney, the more you risk the investigation turning into a criminal matter.
- Assert a lack of evidence. Our justice system has a requirement that places a heavy burden on the federal government to show that you committed a crime. They must prove beyond a reasonable doubt that you committed an illegal act and that you did so with criminal intent. We test this Constitutional standard to the test in each case. Doing so has resulted in dismissals, avoidance of criminal charges and civil fines, reducing a felony to a misdemeanor, and no prison time.
The government must also have evidence that you had criminal intent. Oberheiden, P.C. has realized that the majority of actions that cause these investigations aren’t because someone wants to commit intentional Medicare fraud. You’re busy working with your patients. That dedication can often cause negligence that results in Medicare fraud investigations. The most common causes include:
- Unqualified staff;
- Lack of supervision;
- Delegation and outsourcing;
- Structural or organizational mistakes;
- Human errors;
- Lack of oversight;
- Overwhelmed employees;
- No compliance program; and
- Medicare rules and laws that change.
These errors aren’t criminal. However, the government may try to make them out to be.
- Lack of Criminal Intent. Even with the amount of Medicare claims that are filed in Detroit, intentional health care fraud is incredibly rare. Yet, health care professionals, businesses, and facilities who are accused of it often just accept the charges and the associated penalties for criminal allegations. Don’t just accept it. Retaining Oberheiden, P.C. can improve your chances of proving that there was a lack of criminal intent that led to the allegations.
- Using applicable Medicare fraud defenses. Next, it’s time to look for applicable legal defenses. To give you an idea of this, one of our recent Medicare fraud cases involved the government alleging that our client fraudulently certified the need for health care services. We used a delegation exception to show the government that the certification was fully compliant with the law. In another case, we did not admit liability. Instead, we were able to show that our client acted within a safe harbor exception.
Oberheiden, P.C. represents Detroit-area business owners, health care executives, attorneys, doctors, nurses, hospital systems, pharmacies, labs, and other health care businesses and entities. We can help you with:
- Health care fraud defense
- Implementing a corporate compliance program
- Internal investigations
- Qui tam defense
- Protecting your assets
- Licensure proceedings
- Disciplinary proceedings
- Jury trials
If you’re in Detroit and under the investigation by the Department of Justice, Department of Defense, the FBI, the DEA, the Office of Inspector General, HEAT, the Medicaid Fraud Control Unit, Detroit or Michigan law enforcement, or the IRS, give us a call. These serious allegations need to be dealt with right away. We can help.
Medicare Fraud Defense Attorneys Serving Detroit
Dr. Nick Oberheiden has used his Harvard training and international education to successfully represent health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, in political corruption scandals, government investigations, and assisted in media campaigns, including 60 Minutes. He is best known for stopping federal investigations before criminal charges are levied. 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 S. Byrd is a former Assistant United States Attorney (AUSA). Detroit clients greatly benefit from Ms. Byrd’s former experience with the Department of Justice where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations. Ms. Byrd 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.
Serving Detroit, Michigan and Surrounding Areas
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, P.C. is a Texas firm with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.