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

Ohio Medicare Fraud Defense Lawyers

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Experienced and Aggressive Health Care Fraud Defense Team

Oberheiden, P.C. is a health care law defense firm that primarily deals with the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our attorneys are experienced and well-respected, such as 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. Many of the lawyers at our firm received law degrees from the most prestigious institutions in the country, such as Harvard Law School and Yale Law School. We serve clients throughout Ohio as well as the surrounding areas.

Health care providers, facilities, and businesses in Ohio face a grave risk: Being accused of committing Medicare fraud. If you’re notified of an investigation, call Oberheiden, P.C. We’re here to help Ohio doctors, nurses, clinics, hospitals, other health care facilities, and businesses through the both investigations and prosecutions. Harvard-trained health care fraud defense attorney Dr. Nick Oberheiden is the managing partner.

Medicare Fraud Basics

Medicare fraud is a federal offense. It can cause you to face both civil and criminal penalties. It doesn’t just include Medicare. It involves filing a false claim through any federal health care program. This includes Medicare, Medicaid, Tricare, and federal workers’ compensation. The filing of the false claim results in the receiving of an illegal payment from the government. If you are accused of committing Medicare fraud, you’re being accused of violating at least one of the following statutes:

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

In Ohio, health care facilities, businesses, and providers face a much higher risk of Medicare fraud investigation when compared to most of the United States. This is because there is a large group of people in Ohio who are recipients of federal health care. This causes more claims to be filed. The increase in claims causes the federal government to watch the area closely for instances of Medicare fraud. Ohio is one of nine areas in the United States that is closely watched by the Medicare Fraud Strike Force. The job of this task force is to monitor, investigate, and prosecute Medicare fraud.

The Medicare Fraud Strike Force is a combination of federal investigators and prosecutors. If you’re being investigated, you’ll likely come into contact with representatives from the DEA, DOJ, DOD, FBI, IRS, the Office of Inspector General, and Department of Human Services. This list isn’t all-inclusive. There are often other federal agencies involved.

Common Reasons of Medicare Fraud Investigation

Many Medicare fraud investigations that take place in Ohio begin because of billing errors. When billing mistakes are made by providers, facilities, and businesses, the federal government often deems those actions as fraudulent billing practices and reimbursement requests. The most common billing issues in Ohio include:

  • Billing for medically unnecessary supplies
  • Billing for unnecessary services
  • Billing for services that were never performed (referred to as phantom billing)
  • Billing for equipment or services that were never ordered
  • Certification for medically unnecessary supplies or services (including hospice care and medical devices)
  • Inflating charges
  • Double billing
  • Upcoding
  • Overuse of services or equipment
  • Providing kickbacks
  • Accepting kickbacks

Doctors, nurses, physician assistants, health care services, nursing and registered care facilities, clinics, hospitals, pharmacies, DME providers, labs, DNA centers, and cancer treatment facilities are some of the most common investigated outlets in Ohio.

Risk of Civil and Criminal Penalties

Medicare fraud investigations can eventually mean that you face penalties in civil or criminal court. You could face both types of penalties. You could also lose your state license, face disciplinary actions, or lose your hospital privileges.

Civil penalties may include one or more of the following:

  • Treble damages
  • Payment of civil fines of up to $11,000 per false claim
  • Recoupment requests
  • Non-payment of future federal health care program claims
  • Federal health care program exclusion
  • Attorney fees

Criminal penalties may be assessed in one or more of the following ways:

  • Criminal indictment
  • Fines in the hundreds of thousands of dollars
  • 10 years in federal prison for each count of Medicare fraud
  • 20 years in federal prison if the Medicare fraud resulted in serious bodily injury
  • A life sentence in federal prison if the Medicare fraud resulted in the patient’s death

Choosing the Best Ohio Medicare Fraud Attorney

If you’re investigated for Medicare fraud in Ohio, it is imperative that you choose the best Ohio medicare fraud defense attorney. The attorney should have the experience with Medicare fraud and should be trained and experienced in negotiation with the federal government. Your attorney should also be prepared to go to trial on your behalf.

Some in Ohio choose to hire a health care attorney. However, these allegations are often charged with federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. A health care attorney may understand the associated laws, but he or she likely isn’t prepared to negotiate on your behalf. He or she may not know enough about federal criminal law to prepare your defense.

Some decide to hire an Ohio criminal defense attorney when they know that they are facing criminal charges. However, average criminal defense attorneys may not be significantly trained to assist you with your federal criminal charges. They also won’t know the rules associated with billing, coding, and medical utilizations.

You must find an Ohio health care fraud defense attorney with these four qualifications:

  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 determined that a lawyer has those four qualifications, ask these questions to know more about his or her experience:

  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 Ohio

Oberheiden, P.C. services Ohio health care providers, facilities, and businesses. We have three guiding principles that we use in every case to locate and develop strategic Medicare fraud defense arguments. Several of our attorneys have previous experience as senior health care prosecutors with the Department of Justice. This experience, along with our defense experience, provides valuable insight for each and every client. Our guiding principles are:

Early intervention. Our first guiding principle is to get involved early with the federal government on behalf of our clients. The longer the government has to investigate you or your business, the more likely it is that you will face criminal charges. This is why we get into contact with investigating officials as soon as we can. Usually, we’re able to contact them within hours and get answers to some of your most pressing questions such as:

  • 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 evidence. The federal government must present evidence that meets the Constitutional standard of proving beyond a reasonable doubt that you committed a crime. We examine and test the evidence in every case. Because of 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
  • Reducing a felony to a misdemeanor
  • No prison time

No criminal intent. The government must also prove that you acted with criminal intent. Most cases of Medicare fraud in Ohio don’t happen because someone set out to defraud the system. Rather, mistakes made by providers, facilities, and businesses are cause of the investigation. The most common mistakes include:

  • The use of 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

Although these mistakes generally do need to be corrected, you shouldn’t have to face criminal penalties. Yet, many in Ohio simply accept the charges and the penalties, even if it means that they can no longer work in the medical field.

The use of applicable Medicare fraud defenses. Medicare fraud cases all revolve around the same key concept: The government believes that a false claim was filed and that they issued an illegal payment because of the claim. Yet, each case is different because of its surrounding facts. Oberheiden, P.C. takes the time to review and analyze each case to develop applicable and strategic Medicare fraud defenses for our Ohio clients. We recently handled a 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 within the law. In 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. provides Medicare fraud defense strategies to Ohio health care businesses, lawyers, executives, providers, clinics, hospitals, labs, pharmacies, and other health care related businesses being investigated 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

Oberheiden, P.C. provides legal advocacy and advisement for providers, businesses, and facilities in Ohio. If you’re being investigated by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, or Ohio state law enforcement, call us right away. Our initial consultations are confidential and totally 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 Ohio

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) 736-3082
Including Weekends
Oberheiden, P.C.
Serving Ohio 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