Portland, Oregon Medicare Fraud Defense Lawyers

Experienced Health Care Fraud Attorneys Serving the Portland Area

The Criminal Defense Firm is a Dallas-based health care law defense firm with a diverse and tested group of attorneys, including 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 deals with the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. The asset protection lawyers at our firm have years of relevant experience and studied at some of the nation’s top law programs, such as Harvard Law School and Yale Law School. We serve clients in Portland as well as throughout the state of Oregon.

If you’re a health care provider or business owner in Portland, Oregon, and you’re being investigated for Medicare fraud, you need the assistance of a lawyer in health care fraud defense. The Criminal Defense Firm provides Medicare fraud defense for Portland, Oregon practitioners, hospitals, clinics, and health care businesses.

What Is Medicare Fraud?

Medicare fraud is a federal offense that has both civil and criminal penalties. It’s actually a broad term that relates to the submission of false claims to any federal government health care program. Although it’s called Medicare fraud, it includes false claims to Medicaid, Tricare, or federal workers compensation. It usually includes a violation of one or more 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 occurs when an illegal payment is made by the federal government to a provider or business after a false or fictitious claim is filed.

In Portland, Oregon, there is a higher instance of investigation of Medicare fraud than in most of the United States. It is one of nine locations in the country that is closely monitored by the Medicare Fraud Strike Force. Since there are a large number of Medicare recipients living in Portland, more claims are filed through CMS. This larger number of claims is the key reason why the government watches the area closely. The Medicare Fraud Strike Force monitors investigate and prosecute Medicare fraud.

The Medicare Fraud Strike Force Team is a hybrid team of investigators and prosecutors from numerous federal agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. Other agencies are also included. You could come into contact with one or more representatives from each agency. In addition to possibly facing civil and criminal penalties, you could also lose your professional license and your hospital privileges.

Billing Mistakes Cause Medicare Fraud Investigations

Most Medicare fraud investigations that take place in Portland begin because the government believes that an individual or business is using fraudulent billing practices and reimbursement requests. This can include false charges, charges that weren’t authorized by the federal health care program, and excessive charges. In Portland, the most common issues that result in allegations of Medicare fraud include:

• 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

Portland area doctors, nurses, health care services, nursing homes, registered care facilities, hospitals, clinics, pharmacies, DME providers, labs, DNA centers, and cancer treatment centers are some of the most commonly investigated for Medicare fraud.

Civil and Criminal Penalties

Medicare fraud investigations in Portland, Oregon have serious civil and criminal penalties. You may face civil, criminal, or both. 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

Planning Your Defense

Medicare fraud can affect your life. You may lose your license. You may face criminal charges. You may have to pay huge fines. If you’re being investigated, you’re likely thinking about choosing the right defense attorney. When planning to hire a defense attorney, you should look for a Portland defense attorney who has the skills and the experience that you need to help you during the investigation, and who can help you if you’re prosecuted in either civil or criminal court.

Some Portland, Oregon health care providers and businesses may initially consider hiring a health care attorney because of their knowledge of health care law. However, when Medicare fraud is alleged, you are likely to be charged with serious federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. A health care attorney may know health care law, but he or she may not have the experience and knowledge of the federal criminal defense. He or she may not have the negotiation skills to take on the federal government or to face federal prosecutors in a court of law.

Others immediately look for a criminal defense attorney because of the potential of being charged with a crime. However, most Portland criminal defense attorneys don’t have federal experience. They’re experienced in drug charges, DUIs, assaults, and theft. They may not have the necessary knowledge of the intricacies of billing, coding, and medical utilization rules that are involved. Medicare fraud is a very serious allegation. You do not have time to explain health care law to an attorney who doesn’t have adequate experience in the field.

The right choice is a health care fraud defense attorney serving Portland, Oregon. As you do your research, look for these four traits:

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

Once you’ve found a firm that displays those traits, your research isn’t over. You should ask the following three questions to get a good 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 in Portland, Oregon

The Criminal Defense Firm serves Portland, Oregon health care practitioners and entities with proven and strategic Medicare fraud defenses. Many of our attorneys have previous experience from senior positions within the Department of Justice. Portland clients get a custom defense for their case based off of incredible insight provided by our team members. Our goal is to resolve the investigation while reducing the possibility of criminal charges.

Early intervention with the investigating bodies. Throughout our experience, we’ve learned that one of the very best strategies we can use in a Medicare fraud case is to get involved early with the investigating bodies. If the government has too much uninterrupted time to investigate you, you are more likely to face criminal charges. We get into contact with the investigating agencies and get answers for you within hours of our engagement. 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?

Questioning the government?s evidence. The federal government must use evidence to prove that you?ve committed a crime. Their evidence must meet a standard known as ‘beyond a reasonable doubt.’ When we question the validity of their evidence, we?ve routinely seen 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

No criminal intent. The government must also prove that you acted with criminal intent. This is hard for the government to prove because most Medicare fraud investigations in Portland are a result of an honest mistake and not because someone set out to defraud the government. The most common 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

Portland has very few legitimate cases of Medicare fraud. However, many businesses and providers who are accused of Medicare fraud because of an honest mistake just assume that they must have committed a crime, and they accept whatever penalties the government levies against them; this includes criminal penalties. Because of this, many people are no longer able to work in the medical field.

The Criminal Defense Firm addresses the lack of criminal intent. Our goal is to prove to the federal government that while you may have made a mistake that should be addressed, you did not do so with criminal intent.

Applicable defenses for each case. Each Medicare fraud case is different. The Criminal Defense Firm takes the time to thoroughly review each case that we take on to determine applicable defenses that can be used. We recently handled a Medicare fraud case where the government alleged that our client fraudulently certified home health care services. We proved to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant with the law. In 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 provides aggressive Medicare fraud defense for Portland, Oregon 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 can help 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 provides legal representation of providers, businesses, and facilities in Portland, Oregon. If you’re under investigation by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, Portland, or Oregon law enforcement, call us immediately. Our initial consultations are free of charge and are confidential.

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.

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