The Criminal Defense Firm has significant experience in representing clients accused of hospice or home healthcare fraud.
Detroit Medicare Fraud Investigations
Detroit is one of only nine U.S. cities in which the federal government has established special task forces to monitor, investigate, and prosecute Medicare Fraud. Healthcare practitioners and businesses in Detroit must know that government prosecutions in Detroit are more aggressive and significantly more frequent than in other communities and spearheaded by the elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and others.
Put our highly experienced team on your side
Brian J. Kuester
Former U.S. Attorney
Former DA
Amanda Marshall
Former U.S. Attorney
Local Counsel
Joe Brown
Former U.S. Attorney
& Former District Attorney
Local Counsel
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Linda Julin McNamara
Former Chief, DOJ Appeals
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
Hospice & Home Healthcare Fraud
The Criminal Defense Firm represents Detroit hospice and home health agencies, business owners, and medical professionals in connection with corporate compliance, internal investigations, Medicare audits, reimbursement and recoupment questions, as well as against civil and criminal government investigations.
- OIG & Grand Jury Subpoenas
- Medicare & Medicaid Fraud
- Anti-Kickback Statute
- False Claims Act & Qui Tam Defense
- Stark Law (Self-Referrals)
- HIPAA Compliance
- DEA and Prescription Issues
- Certifications of Medical Necessity
- Billing Errors and Overbilling
- Overutilization of Services and Equipment
- RAC & ZPIC Audits
- IRS Investigations
The Criminal Defense Firm works with the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO), the National Center for Assisted Living (NCAL) and similar programs and our attorneys are profoundly familiar with certification requirements, hospice re-certifications, clinical status determinations, respite care, homebound evaluations, medical necessity, conditions of coverage, and plan of care requirements.
What Are the Penalties?
Targets investigated for home health and hospice allegations are exposed to recoupment requests, nonpayment of future claims, civil fines of up to $11,000 per false claim, exclusion from federal healthcare programs, treble damages, attorney fees, criminal fines, criminal indictment, or imprisonment.
- Up to 10 Years in Prison for Each Count of Medicare Fraud
- Up to 20 Years in Prison If the Fraud Resulted in Serious Bodily Injury
- Life in Prison If the Fraudulent Medicare Practice Resulted in the Patient’s Death.
- Civil & Criminal Fines
Incorrectly prescribing, supervising, or certifying professionals may be excluded from all federal healthcare programs, prohibited from receiving reimbursement from any federal healthcare program and may face a suspension or revocation of their license.
Choosing the Right Defense Lawyer
The drastic penalties described above call for the hiring of a competent and successful attorney. Healthcare investigations jeopardize your business, your reputation, and your family livelihood. You need attorneys that vigorously defend you and that have the skills to convince the government, the media, and the public that you did nothing wrong.
When picking the right attorney, home health and hospice care business owners and medical professionals should look for three criteria.
- First, your attorney must be utmost familiar with all rules and regulations relating to home health and hospice care. When you defend against the government, you simply don’t have time to explain billing, coding, or certification rules to uninformed lawyers.
- Second, you must pick a lawyer who has successfully resolved healthcare audit and fraud investigations. Most lawyers say that they are “aggressive” and “excellent,” but what does it help you hire the best DWI or assault defense lawyer in town when that lawyer has no record negotiating complex healthcare fraud cases with OIG and HHS agents?
- Third, on top of profound healthcare knowledge and prior success, your attorney must have superior litigation and trial expertise. Prosecutors know exactly how good and experienced a defense lawyer is in court. Ask your lawyer how many actual healthcare fraud trials he or she have handled in their careers.
When interviewing with lawyers, smart clients ask smart questions. Test your lawyer candidate and insist on a concrete answer to the following question:
How many Medicare Fraud cases have you handled so far that resulted in no civil and no criminal liability for your client?
Our Proven Defense Strategies
What shapes the healthcare fraud defense reputation of The Criminal Defense Firm are our experience and our record. Throughout our careers, we have handled over 1,000 healthcare investigations and tried more than 200 criminal cases in court. Many of our attorneys were previously in charge of healthcare audits and fraud investigations at the Department of Justice and they now offer their valuable insights and contacts with our clients.
- Pressure on the Government. Targets of government investigations need to act quickly. The longer the government scrutinizes and searches without firm opposition by experienced defense counsel, the easier it will be for a prosecutor to build a case. Don’t give the government that advantage. Hire the experienced attorneys of The Criminal Defense Firm from the moment you learn of an audit or an investigation. Let us use our contacts to provide you immediate answers to these pressing questions: What is this investigation about? Is the case civil or criminal? Does the government threaten jail time? What can my lawyers do to get the issue resolved?
- No Intent. In our experience, we have found that many incidents that prompt healthcare investigations originate from organizational and human errors, not from criminal spite. Mistakes happen due to unqualified or overwhelmed staff, negligence, supervision errors, and unfamiliarity with constantly changing rules. Many of our home health and hospice care clients have seen fast growth in recent times and their corporate infrastructure could sometimes not catch up with their expansion. The U.S. justice system acknowledges the possibility of human errors, and the U.S. Constitution puts a high burden of proof on the government to show criminal intent. In each and every case, our attorneys vigorously, aggressively, and relentlessly force the government to accept its constitutional burden.
- Appropriate Certifications. Several home health and hospice care fraud cases claim that the business owners and responsible providers incorrectly and thus unlawfully certified or re-certified medical necessity. The attorneys of The Criminal Defense Firm know that while this is easy to say, it is hard to prove. Not just do we routinely work with high caliber experts to contradict the government; we also have the practical experience to direct judges and juries to the many certification exceptions and delegation rules that the government likes to omit in their complaints.
- Media Intervention. Our commitment to defend our clients against unfounded allegations of fraud and wrongdoings goes far beyond establishing legal strategies and defense plans against government investigations. Many of our clients are equally concerned about their reputation and their perception in the public. The media has the power to ruin someone’s reputation or to ignite rumors about wrongdoings by offer biased and prejudicial news reports to its audience. Our attorneys routinely intervene into slandering reporting and obtain news spots and opportunities to correct, rectify, and educate the story on behalf of our clients.
Our Record
Our clients range from individual providers to entire healthcare systems. We represent clients in Detroit who are under investigation by the Department of Justice (DOJ), the Department of Defense (DOD), the Federal Bureau of Investigation (FBI), Drug Enforcement Administration (DEA), the Office of Inspector General (OIG), the Medicaid Fraud Control Unit (MFCU), Detroit and Michigan law enforcement, or the Internal Revenue Service (IRS).
- Defense of Healthcare Service Business Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Department of Justice and the FBI for Medicare Fraud.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Department of Justice and the FBI for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Department of Defense and the FBI for Tricare Fraud.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Department of Defense and the OIG for Tricare Fraud.
Result: No civil or criminal liability. - Defense of Physician Syndication Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and Stark Law.
Result: No civil or criminal liability. - Defense of Physician Investigated by the Department of Health and Human Services and the Office of Inspector General for Medicare Fraud and Stark Law Violations.
Result: No civil or criminal liability. - Defense of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Office of Inspector General for Medicare Fraud and Stark Law Violations.
Result: No civil or criminal liability. - Defense of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability. - Defense of Healthcare Marketing Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability. - Defense of Healthcare Service Business Investigated by the Department of Health and Human Services and the Office of Inspector General for Medicare and Tricare Fraud.
Result: No civil or criminal liability. - Defense of Healthcare Conglomerate Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability.