St. Louis, Missouri Medicare Fraud Defense Lawyers

Defending Medical Professionals against health care Fraud Charges in Missouri

The Criminal Defense Firm is a health care law defense firm the specifically deals in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. With attorneys like the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force, our firm is represented by years of relevant experience and some of the nation’s best law schools, such as Harvard and Yale. We serve clients in St. Louis as well as throughout Missouri State.

If you run a health care facility or business or are a health care provider in the St. Louis area, you are at a higher risk of being placed under investigation for violating health care fraud. If you discover that you are being investigated, you require the aid of legal professionals skilled in the practice of health care fraud defense. The Criminal Defense Firm is currently serving clients in the city of St. Louis.

Defining Medicare Fraud

Medicare fraud is deemed a federal offense and brings with it serious criminal and civil penalties. It would be pertinent to understand, however, that the term “Medicare fraud” is a broad one because it doesn’t solely involve Medicare. Rather, it pertains to any federal health care program, including (but not limited to) Medicaid, Tricare, and federal worker’s compensation. In order for your actions to be considered health care fraud, you must have submitted a false claim to any federal health care program, resulting in at least one violation of at least one of any of the following laws:

• Physician Self-Referral Law (also known as Stark Law)
• False Claims Act
• Anti-Kickback Statute
• U.S. Criminal code
• Social Security Act

Medicare fraud results in an illegal payment being made by the federal government to a provider, entity, or business after a false or fraudulent claim are filed.

There is a higher risk of Medicare fraud investigation in St. Louis than in a large majority of other areas in the United States. The area is one of nine locations that are under the meticulous watch of the Medicare Fraud Strike Force. This is because of the fact that there are a large number of beneficiaries for federal health care programs. Put simply, more claims are filed in St. Louis, and thus, the federal government maintains a close vigil on the area. The task of the Medicare Fraud Strike Force is to monitor, investigate, and prosecute Medicare fraud.

The Medicare Fraud Strike Force Team is a combination of investigators and prosecutors that come from an array of federal agencies, including, but not limited to, the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. During the course of an investigation, it is a strong possibility that you could come into contact with one or more representatives from each of any of the agencies involved with the Medicare Fraud Strike Force. Furthermore, you are also at risk of losing your professional license and your hospital privileges; you may also be subject to disciplinary proceedings.

Billing Errors Often Result in Medicare Fraud Investigations

The majority of Medicare fraud investigations in the city of St. Louis come as the result of billing errors. These billing errors are declared bogus billing practices and reimbursement requests. They can encompass fraudulent charges, unauthorized charges, and excessive charges. Usual billing errors include, but are not limited to:

• Phantom billing (billing for services that weren’t performed)
• Billing for medically unnecessary services or equipment
• Billing for equipment or services that weren’t ordered
• Certifications for medically unnecessary supplies or services (such as medical devices or hospice care)
• Charge inflation
• Double billing for equipment, services, or treatment
• Upcoding for equipment, services, disorders, or treatment
• Overuse of services
• Overuse of equipment
• Providing or accepting kickbacks

In St. Louis, the most commonly investigated individuals, entities, and organizations include doctors, nurses, health care services, nursing homes, registered care facilities, hospitals, clinics, pharmacies, DME providers, labs, DNA centers, and cancer treatment centers.

A Look at Civil and Criminal Penalties

Medicare fraud investigations are issues of the most serious and severe variety, and can result in criminal and civil penalties. Civil penalties may include:

• Assessment of treble damages
• Civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future claims
• Exclusion from federal health care programs
• Assessment of attorney fees

Criminal penalties may include:

• A criminal record
• Fines that cost you hundreds of thousands of dollars
• 10 years in federal prison for each count of Medicare fraud for which you are convicted
• 20 years for each count of Medicare fraud if it resulted in serious bodily injury to the patient
• A life sentence if the Medicare fraud resulted in the death of the patient

Choosing the Right Defense Lawyer Is Critical

If you find yourself under investigation for Medicare fraud, it is extremely important that you endeavor to select the right St. Louis defense attorney. Your attorney should have the skills and experience necessary for you to succeed during the investigation, negotiation, and even in the trial.

An observably large number of practitioners in the St. Louis area believe that they should choose a health care attorney. When it comes to fruition that Medicare fraud is alleged, you are confronted with a very likely risk of being charged with extremely serious federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. Though it is true that a health care attorney could be accustomed to health care law, he or she may not possess the experience and understanding of federal criminal defense that you require. Furthermore, he or she may not have the negotiation skills necessary to confront the federal government or to face federal prosecutors in a court of law.

Instead of choosing to enlist the services of a health care fraud defense attorney, many others opt to seek out a St. Louis criminal defense attorney. However, a large amount of criminal defense attorneys who are working in St. Louis lack the experience that is necessary to handle federal criminal charges. They may not have the knowledge that is required to comprehend the complicated details of the billing, coding, and medical utilization rules that are involved. Medicare fraud is a drastic and extremely serious allegation. Thus, you should not hand over the fate of your practice to someone who doesn’t have the right experience. The risks are far too great.

Seek out a health care fraud defense attorney serving the St. Louis area. As you weigh and research your options, look for these four key aspects:

1. A proven track record of success in Medicare fraud cases
2. Industry knowledge
3. Deep familiarity with health care laws and their exceptions
4. Litigation and trial experience

Even once you’ve come across a firm that carries those traits, your search has not yet concluded. You should continue on to ask the following three questions if you want to obtain a sufficient understanding of just how much experience they have with Medicare fraud cases:

1. How many Medicare fraud cases have you handled during your career in law?
2. How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
3. How many Medicare fraud cases did you try in court?

Proven Medicare Fraud Defense Strategies

The Criminal Defense Firm serves St. Louis area health care providers, entities, organizations, and business by implementing our three core principles and by providing strategic defenses. Many of the attorneys in our organization exhibit previous experience as federal health care prosecutors with the Department of Justice. Such experience has played a large part in assisting us to craft our core principles. Our primary goal is to resolve the investigation while minimizing the risk of criminal charges.

Early contact with the government. Throughout our history of serving clients, we have learned that one of the most effectual strategies we can carry out in Medicare fraud cases is to get involved early with the investigating agencies. If the government has a profuse amount of continuous-time to investigate you, you are far more likely to face criminal charges as a result. In general terms, it takes us only hours to get answers on your behalf during our engagement with investigating agencies. We’ll find out:

• What is the investigation about?
• What prompted the investigation?
• Is this civil or criminal?
• Which federal agencies are involved in the investigation?
• Who all is being investigated?
• How can the matter be resolved?

Lack of evidence. The federal government is required to use evidence to prove that you’ve committed a crime. It is necessary for their evidence to meet a standard known as (beyond a reasonable doubt.) When we put the validity of their evidence into question, we have routinely produced the following results:

• Case dismissal
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reducing a felony to a misdemeanor
• No prison time

Lack of criminal intent. Moreover, the government is obligated to prove that your actions were performed with criminal intent. This is frequently difficult for the government to prove because most Medicare fraud investigations in the St. Louis area are the result of honest mistakes rather than the fault of any intent to defraud the government. The most common of mistakes include:

• Unqualified or untrained staff
• Inadequate supervision of staff
• Delegation and outsourcing of work to unqualified entities
• Business errors
• Human error
• Oversight
• Employees who are overwhelmed
• Lack of a Medicare compliance program
• Failure to keep up with the quickly changing health care laws and rules

Despite the fact that the St. Louis area sees very few actually legitimate cases of Medicare fraud, many businesses and providers who find themselves accused of Medicare fraud due to an honest mistake may simply assume they must have in some way committed a crime. The business or provider will then accept whatever penalties the government may levy against them, including criminal penalties. Thanks to this, many practitioners are no longer able to work in the medical field.

Developing applicable defenses for each case. Although all Medicare fraud cases share many common characteristics and similarities, each individual case is unique. At The Criminal Defense Firm, we take the time needed to review and examine each case and develop strategic and applicable defenses. Recently, we oversaw a Medicare fraud case wherein the government contended that our client was protected by a recognized delegation exception that rendered the certification fully compliant with the law. Take, for example, another case: We refused to admit liability. We proved to federal prosecutors that our client acted within a safe harbor exception.

The Criminal Defense Firm

The Criminal Defense Firm offers robust and calculated Medicare fraud defense strategies for St. Louis area health care businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation for illegal kickbacks, fraudulent billing practices, and allegations of medically unnecessary services, services not rendered, and unlawful joint ventures. We are able to assist you with:

• Health care fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

The Criminal Defense Firm offers legal advocacy of providers, businesses, and facilities in St Louis. If you are under investigation by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, or St. Louis law enforcement, make it your top priority to call us as soon as possible. Our initial consultations are confidential and utterly free of charge.

Our Track Record

• Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of a health care services company against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act and Stark Law violations.
  Result: No civil or criminal liability.

• Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Health Care Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
  Result: No civil or criminal liability.

• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

Medicare Fraud Defense Attorneys Serving St. Louis

We are available every day of the year. You can call us directly or complete our contact form or email us directly.

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 this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. The Criminal Defense Firm is a Texas firm with headquarters in Dallas.