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

Missouri Medicare Fraud Defense Lawyers

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Health Care Fraud Defense Attorneys Serving the State of Missouri

The Oberheiden, P.C., a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense, has a diverse and tested group of attorneys. Among those at our firm are 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 other talented lawyers that have years of relevant experience and graduated from some of the premier law schools in the country. We serve clients all over Missouri as well as the surrounding areas.

Do you run a health care facility or business, or are you a health care provider in the State of Missouri? If so, you are more likely to be placed under investigation for violating health care fraud laws. If you find out that you are currently being investigated, you need the assistance and proficiency of legal professionals skilled in the practice of health care fraud defense. Oberheiden, P.C. is currently serving clients in the State of Missouri. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and managing partner of Oberheiden, P.C.

Defining Medicare Fraud

Medicare fraud is a federal offense and can result in serious criminal and civil penalties. It is important to understand, however, that the term “Medicare fraud” is rather broad because it doesn’t wholly involve Medicare alone. Instead, it encompasses any federal health care program including (but not limited to), Medicaid, Tricare, and federal worker’s compensation. 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 has the outcome of an illegal payment being made by the federal government to a provider, entity, or business after a false or fraudulent claim is filed.

In the State of Missouri, there is a much higher risk of Medicare fraud investigation than there is in a large majority of other areas in the United States. The state is one of nine locations that is under punctilious observation by the Medicare Fraud Strike Force. This is due to the fact that there are a large number of beneficiaries for federal health care programs. In summation, more claims are filed in Missouri, and as a result, the federal government sustains close surveillance over the state. The intent of the Medicare Fraud Strike Force is to monitor, investigate, and prosecute Medicare fraud.

The Medicare Fraud Strike Force Team is a coalition of investigators and prosecutors that come from an assortment 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 progression of an investigation, it is immensely likely that you will come into contact with one or more representatives from each of any of the agencies involved with the Medicare Fraud Strike Force. In addition, you also stand the 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

Most Medicare fraud investigations in the State of Missouri develop as the result of billing errors. These billing errors are declared spurious billing practices and reimbursement requests. They can comprise 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 Missouri, 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 affairs of the most serious and severe kind, and can have an outcome of 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 come under investigation for Medicare fraud, it is extremely important that you make a concerted effort to select the right St. Louis defense attorney. Your attorney should have the skills and experience that are required for you to succeed during the investigation, negotiation, and even in the trial if the occasion arises.

A noticeably large number of practitioners in the Missouri area are under the impression that they should select a health care attorney. Once you are alleged of Medicare fraud, you are confronted with the extremely likely risk of facing direly serious federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. While it may be true that a health care attorney could be familiar with health care law, he or she may not possess adequate experience and understanding of federal criminal defense that you may be in need of. In addition, the attorney may not have the negotiation skills necessary to confront the federal government or to face federal prosecutors in a court of law.

Rather than choosing to procure the services of a health care fraud defense attorney, many others opt to seek out a Missouri criminal defense attorney. Nevertheless, a vast amount of criminal defense attorneys that practice their skillset in Missouri often lack the experience that is required to handle federal criminal charges. They may not have the knowledge that is necessary in order to understand the complex details of the billing, coding, and medical utilization rules that are involved. Medicare fraud is a severe and extremely serious allegation. Therefore, you should not place the well-being of your practice into the care of someone who doesn’t have the right experience. The risks are simply far too high.

Search for a health care fraud defense attorney serving the State of Missouri. As you measure and investigate your options, look for these four key areas:

  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 following your discovery of a firm that displays those traits, your search has yet to be concluded. You should move on to ask the following three questions if you want to obtain an ample 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

Oberheiden, P.C. serves health care providers, entities, organizations, and business in the State of Missouri by practicing our three core principles and by providing strategic defenses. Many of the attorneys working within our organization exhibit previous experience as federal health care prosecutors with the Department of Justice. This kind of relevant experience has played a large part in assisting us to craft our core principles. Our primary goal is to resolve the investigation while curtailing the risk of criminal charges.

Early contact with the government. All through our tenure of serving clients, we have discovered that one of the most effective strategies we can put to use in Medicare fraud cases is to get involved early with the investigating agencies. If the government has a bountiful amount of unending time to investigate you, then you are at a much higher risk to be faced with criminal charges as a result. Generally, 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 obligated to demonstrate evidence that you’ve committed a crime. It is a requirement for their evidence to meet a standard known as “beyond a reasonable doubt.” When we place the validity of their evidence into question, we have procedurally 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. Additionally, the government is necessitated to prove that your actions were executed with criminal intent. This is constantly difficult for the government to prove, because most Medicare fraud investigations in Missouri are the consequence of honest mistakes rather than the outcome 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

In spite of the reality that the State of Missouri sees very few truly authentic cases of Medicare fraud, many business and providers are accused of Medicare fraud as a result of an honest mistake, and often may assume that they must have by some mean committed a crime. The business or provider will then go on to accept whatever penalties the government may raise against them, including criminal penalties. Because of this, many practitioners are no longer able to work in the medical field.

Developing applicable defenses for each case. While every Medicare fraud case shares a variety of recurrent similarities and characteristics, each independent case is distinct. Oberheiden, P.C. takes the time that is needed to analyze and examine each case and formulate 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 within 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.

Oberheiden, P.C.

Oberheiden, P.C. produces resilient and tactical Medicare fraud defense strategies for health care businesses, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities in the State of Missouri 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

Oberheiden, P.C. offers legal advocacy of providers, businesses, and facilities in Missouri. 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 Missouri 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 Missouri

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

1 (888) 727-5159
Including Weekends
Oberheiden, P.C.
Serving Missouri 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.

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