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

San Diego, California Medicare Fraud Defense Attorneys

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California Office
550 W C St #1150
San Diego, CA 92101

(Meeting location by appointment only)

Experienced Defense Attorneys Serving the San Diego Area

The Dallas-based health care law defense firm, Oberheiden, P.C., has significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our tested and experienced group of attorneys includes 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 many other talented lawyers with years of relevant experience and educational backgrounds from the country’s best law schools. Our attorneys serve clients throughout San Diego and California.

If you are a health care provider, or own or run a health care facility or business in San Diego, California, you face a high risk of being under investigation for health care fraud. If you learn that you are in the process of being investigated, you need the aid of legal specialists skilled in the practice of health care fraud defense. Oberheiden, P.C. is now serving clients in the city of San Diego, California.

Defining Medicare Fraud

Medicare fraud is considered a federal offense and carries with it severe civil and criminal penalties. However, “Medicare fraud” is a broad term, as it doesn’t exclusively pertain to Medicare. In actuality, it involved any federal health care program, including (but not limited to) Medicaid, Tricare, and federal worker’s compensation. The act of committing Medicare fraud is the submission of false claims to any federal government health care program, involving at least one violation of any one or more following laws:

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

The result of a Medicare fraud is an illegal payment being made by the federal government to a provider, entity, or business after a false or fictitious claim is filed.

In San Diego, California, there is a higher risk of Medicare fraud investigation than there is in the vast majority of other areas in the United States. The city is one of nine locations that is under the close surveillance of the Medicare Fraud Strike Force. This is due to the fact that there are a large number of beneficiaries for federal health care programs. Simply put, more claims are filed in the state of California, which is why the federal government watches the state, and San Diego by proxy. The job of the Medicare Fraud Strike Force is to monitor, investigate, and prosecute Medicare fraud.

The Medicare Fraud Strike Force Team is a unit of investigators and prosecutors from a variety of federal agencies, including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, and the IRS. However, this list is not exhaustive.

Furthermore, it is a possibility that you could come into contact with one or more representatives from each of any of the given agencies. In addition, you are also at 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 city of San Diego, California are the result of billing errors. Such billing errors are proclaimed bogus billing practices and reimbursement requests. They can involve fraudulent charges, unauthorized charges, and excessive charges. Common 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 San Diego, 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 severe matters, and can result in civil and criminal 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 are currently under investigation for Medicare fraud, it is of the utmost importance that you select the right San Diego defense attorney. Your attorney should possess the skills and experience that you are going to need during the investigation, for negotiation, and even for trial.

A notably large number of practitioners in San Diego are under the impression that they should choose a health care attorney. When Medicare fraud is alleged, you face a very likely risk of being charged with other federal crimes such as tax evasion, wire fraud, mail fraud, and money laundering. While it is true that a health care attorney may be familiar with health care law, he or she may not have the experience and knowledge of federal criminal defense that you may require. In addition, he or she may not possess the necessary negotiation skills to confront the federal government or to face federal prosecutors in a court of law.

Many others instead opt to seek a San Diego criminal defense attorney. However, the majority of criminal defense attorneys who are serving San Diego lack the experience required to handle federal criminal charges. They may not have the knowledge that is necessary to understand the complexities of the billing, coding, and medical utilization rules that are involved. Medicare fraud is an extremely serious allegation. As such, you should not place the fate of your practice into the hands of someone who doesn’t have the right experience. The risks are simply too great.

Seek out a health care fraud defense attorney serving San Diego, California. As you comb through 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 after you’ve discovered a firm that carries those traits, your research has not yet ended. You should proceed to ask the following three questions in order to obtain a sufficient 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 San Diego, California health care providers, entities, organizations, and businesses by putting to use our three core principles and by providing strategic defenses. Many of the attorneys within our organization demonstrate previous experience as federal health care prosecutors with the Department of Justice. Such experience has played a large part in assisting us to craft our core principles. Our objective is to resolve the investigation while reducing the risk of criminal charges.

Early contact with the government. During our tenure serving clients, we have learned that one of the most effective strategies we can employ in Medicare fraud cases is to get involved early with the investigating agencies. If the government has an abundance of uninterrupted time to investigate you, you are more likely to face criminal charges as a result. Usually, we get into contact with the investigating agencies and get answers on your behalf 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?

Lack of evidence. The federal government is required to use evidence to prove that you’ve committed a crime. Their evidence has to meet a standard known as “beyond a reasonable doubt.” When we put the validity of their evidence into question, we have routinely 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. Furthermore, the government also is obligated to prove that your actions possessed criminal intent. This is often difficult for the government to prove, as most Medicare fraud investigations in San Diego, California are the result of honest mistakes and not due to 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 the city of San Diego, there are very few truly legitimate cases of Medicare fraud, many businesses and providers who are accused of Medicare fraud because of an honest mistake may just assume they must have somehow committed a crime, accepting whatever penalties the government levies against them; this includes criminal penalties. Because of this, many practitioners are no longer able to work in the medical field.

Developing applicable defenses for each case. Though many common characteristics and similarities are shared between Medicare fraud cases, each individual case is unique. We here at Oberheiden, P.C. take the appropriate amount of time that is needed to review and examine each case and develop strategic and applicable defenses. Recently, we managed a Medicare fraud case wherein the government contended 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. 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. provides vigorous and strategic Medicare fraud defense for San Diego, California 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 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 San Diego, California. If you’re currently under investigation by the Department of Defense, the Department of Justice, the FBI, DEA, Office of Inspector General, Medicare Fraud Control Unit, the IRS, San Diego or California state law enforcement, make it your top priority to call us as soon as possible. Our initial consultations are confidential and completely 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 San Diego, California

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

714-294-2000
Including Weekends
Oberheiden, P.C.
Serving San Diego, CA and Surrounding Areas
CriminalDefense.com
Not all attorneys of Oberheiden, P.C. are licensed in California and nothing contained in here is meant to constitute the unauthorized practice of law.
Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503