Litigation. Compliance. Defense. Health Care Fraud & Criminal Defense Trial Lawyers
Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-462-7972
Nationwide 214-469-9009

Miami Medicare Fraud Defense Lawyers

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Experienced Health Care Fraud Defense Attorneys Serving the State of Florida

The Dallas-based health care law defense firm Oberheiden, P.C. works on cases in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. From the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office and former senior Department of Justice trial attorneys to former lead prosecutors of the elite Medicare Fraud Strike Force and other talented attorneys, our attorneys have years of relevant experience and come from the best law programs in the country. We serve clients throughout the state of Florida and surrounding areas.

Doctors, nurses, physician assistants, other health care providers, hospitals, clinics, and health care companies investigated for Medicare fraud need an experienced law firm. Oberheiden, P.C. provides Medicare fraud defenses for individuals, facilities, or businesses. Harvard-trained Dr. Nick Oberheiden is the managing principal partner.

Medicare Fraud Basics

Medicare fraud is defined by federal statute. It is an extremely serious allegation that can lead to both civil and criminal penalties. It is the submission of one or more false claims to a federal government health care program. It often includes an illegal payment for the false claims. It also includes Medicaid, Tricare, and federal workers’ compensation. If you’re accused of Medicare fraud, you’re being accused of violating at least one of the following:

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

Health care providers, organizations, and facilities in Florida have a higher likelihood of being investigated than most other areas in the United States. Although the federal government monitors the entire country, Florida is one of nine areas that is watched over by the Medicare Fraud Strike Force. This is because Florida has a large number of federal health care program beneficiaries. More claims are filed in Florida, and this leads the federal government to watch for more instances of Medicare fraud.

The Medicare Fraud Strike Force is a hybrid team of investigators and prosecutors from multiple federal agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and more. This team watches for, investigates, and prosecutes Medicare fraud in Florida. If you’re being investigated, you may come into contact with federal agents, investigators, and prosecutors from one or more federal agencies.

Billing Errors Trigger Florida Medicare Fraud Investigations

One of the most common triggers for Medicare fraud investigations in Florida is that of billing errors. These errors are noticed by the government, and then labeled as fraudulent billing practices and reimbursement requests. They may include excessive charges, unauthorized charges, and false charges. In Florida, the most common billing mistakes that cause an investigation include:

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

Doctors, nurses, other health care providers, health care services, nursing homes, registered care facilities, hospitals, clinics, pharmacies, labs, DME companies, DNA centers, and cancer care centers are all common targets for Medicare fraud investigations in Florida.

Facing Serious Civil and Criminal Penalties

Medicare fraud allegations are extremely serious. It can include both civil and criminal penalties. During the beginning of a Medicare fraud investigation, you may not know whether the matter is civil or criminal. Regardless, both are extremely serious matters. Civil penalties may include one or more of the following:

  • Civil fines up to $11,000 per false claim
  • Recoupment requests
  • Non-payment of future claims
  • Future exclusions from federal health care programs
  • Treble damages
  • Paying attorney fees on behalf of the government

Criminal penalties may include one or more of the following:

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

You could also lose your professional license, face state disciplinary action, and even lose your hospital privileges.

Finding the Right Medicare Fraud Defense Lawyers

Now that you understand the seriousness of the allegations and potential penalties, it is time for you to do your research to find the right Miami medicare fraud defense attorney. You should find an attorney who has a combination of negotiation skills and experience in Medicare fraud.

A large number of Florida health care providers and businesses default to hiring a health care attorney. Although a health care attorney is certainly well-versed in health care law, he or she may not be prepared to take on federal criminal matters. Tax evasion, money laundering, and mail fraud are often charged in addition to Medicare fraud. A health care attorney may not have the negotiation experience that you need. He or she also may not have extensive trial experience or the necessary preparation to face federal prosecutors.

Health care providers and businesses who are under the impression that they are going to face criminal charges often hire a Florida criminal defense attorney. However, most criminal defense attorneys aren’t trained or experienced in federal criminal law. They also won’t have the experience and understanding of medical utilization, billing, and coding regulations.

Medicare fraud cases are complex and can take a lot of time to resolve. You need someone who has the right combination of experience in both health care law and federal criminal defense. You need a Florida health care fraud defense attorney. As you do your research, look for these key features:

  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 narrowed down your options, you should ask three specific questions to ascertain the true nature of the attorney’s experience in Medicare fraud:

  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?

Using Powerful Medicare Fraud Defense Strategies

The Oberheiden, P.C. provides legal services in Florida to health care providers, businesses, and entities by using powerful Medicare fraud defense strategies. Several of our team members have previous experience as former prosecutors with the Department of Justice. We’ve taken that experience, along with our experience as defense attorneys, and developed powerful Medicare fraud defense principles to help us determine the best strategic moves for each client.

Early intervention. One of the most effective defense principles for Medicare fraud is early intervention with the federal government. The longer that the federal government has to investigate you, the more likely it is that they will bring criminal charges. We get into contact with the investigating agencies to get answers to important questions like:

  • What is the case about?
  • What prompted the investigation?
  • Is this a criminal or a civil matter?
  • Which federal agencies are involved?
  • Who all is under investigation?
  • What is the ultimate goal of the government?
  • How can the investigation be resolved?

In many cases, we are able to get this information for our clients within the first few hours after our engagement.

Analyzing the evidence. The federal government must present evidence to show that you’ve committed Medicare fraud. This evidence must meet the Constitutional standard of ‘beyond a reasonable doubt.’ We analyze the evidence in each case and put it to the test to determine if it meets the legal standard. By doing this, we’ve seen the following results on a regular basis:

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

Lack of criminal intent. The federal government must also prove that you acted with criminal intent. There are very few instances of criminal Medicare fraud in Florida. Most people just do not go to work with the idea in their head to do something to defraud the government. Rather, most instances occur in Florida because of an honest mistake. The most common mistakes include:

  • The use of unqualified or untrained staff
  • Lack of adequate supervision
  • Delegation and outsourcing of work
  • Structural or organizational mistakes
  • Human errors
  • Oversight
  • Overwhelmed employees
  • No Medicare compliance program
  • Quickly changing health care laws and rules

While it may be evident that the errors you committed should be corrected, making a mistake simply isn’t a criminal matter. People who make honest mistakes shouldn’t be subject to criminal penalties. Yet, when most Florida health care providers and businesses find out that they’re accused of Medicare fraud, they simply accept that they’re guilty of a crime and face the consequences. Oberheiden, P.C. works to show the federal investigating bodies that you made an honest mistake.

Using strategic defenses in each case. Medicare fraud cases have the same basic allegation: A false claim was filed that resulted in an illegal payment. There are likely other charges along with it. However, despite the similarities seen in Medicare fraud cases in Florida and around the nation, each case is different because of its individual set of facts. This is why Oberheiden, P.C. takes the time to analyze each case to determine strategic defenses for each case. Recently, we handled a Medicare fraud case where the government alleged fraudulent certification for home health care services by our client. We were able to prove to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant within the law. In another Medicare fraud case, we refused to admit liability. We were able to prove to prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. serves health care businesses, owners, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other entities in the Florida area who are accused of fraudulent billing, illegal kickbacks, and allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. We can help you in many areas, including:

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

We pride ourselves in our service to both individuals and entire businesses and hospital systems in Florida. If you’re being investigated by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, DEA, the Office of Inspector General, Medicare Fraud Control Unit, the IRS, or Florida law enforcement, call us immediately. Initial consultations are confidential and totally free.

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.

Miami Medicare Fraud Attorneys On Your Side

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. He is most known for stopping federal investigations before criminal charges can be filed. 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 ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Clients greatly benefit from Ms. Byrd’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she regularly argues federal matters for her clients.

We’re available every day of the year to discuss your case with you. Simply call us, email us, or complete our contact form.

1 (888) 727-5159
Including Weekends
Oberheiden, P.C.
Serving Florida and Surrounding Areas
www.criminaldefense.com

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.

Miami Medicare Fraud Attorney – Health Care Fraud Defense – CriminalDefense.com

Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503