Litigation. Compliance. Defense. Health Care Fraud & Criminal Defense Trial Lawyers
Orange County 714-294-2000
Los Angeles 310-873-8140
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Tampa, Florida Medicare Fraud Defense Lawyers

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Providing Experienced Legal Defense Against Medicare Fraud Charges in Tampa

Oberheiden, P.C. is a health care law defense firm that practices in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our experienced attorneys 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 with years of relevant experience and degrees from the country’s best law schools. Our firm serves clients in Tampa as well as throughout the state of Florida.

Tampa, Florida health care providers, facilities, and companies who are being investigated for Medicare fraud need a powerful legal advocate. Oberheiden, P.C. provides strategic Medicare fraud defense for individual providers, hospitals, clinics, and related businesses. Harvard-trained Dr. Nick Oberheiden is the managing principal partner.

What Is Medicare Fraud?

Medicare fraud is a federal statute. An allegation of Medicare fraud is extremely serious and can lead to both civil and criminal penalties. By definition, Medicare fraud is the submission of one or more false claims to a federal government health care program. Although it’s referred to as ‘Medicare fraud,’ this is a bit of a misnomer. It also includes false claims filed through Medicaid, Tricare, or federal workers’ compensation. It also means that you violated 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

Medicare fraud involves individuals, facilities, or businesses essentially receiving an illegal payment from a federal government health care plan.

Health care providers, businesses, and organizations face a higher possibility of investigation than most other places in the United States. Although the federal government monitors the entire country for Medicare fraud, Tampa is one of nine areas that faces a higher level of monitoring and prosecution. This is because Tampa, Florida and its surrounding areas have a large number of federal health care program recipients. Because of this, more claims are filed through CMS. Since more claims are filed, the government is more cognizant of the possibility of Medicare fraud.

Tampa is monitored by the Medicare Fraud Strike Force. This is a 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. The Medicare Fraud Strike Force monitors, investigates, and prosecutes Medicare fraud. During the time that you’re investigated, you may come into contact with representatives from several federal agencies.

Tampa’s Most Common Trigger: Billing Mistakes

Medicare fraud investigations in Tampa, Florida are most commonly triggered because the government notices billing mistakes on invoices. These mistakes are often labeled as fraudulent billing practices and reimbursement requests. They include excessive charges, charges that weren’t authorized by the federal government, and false charges. The most common issues in Tampa 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

The most commonly accused entities are doctors, nurses, health care services, nursing or registered care facilities, hospitals, clinics, pharmacies, laboratories, medical device providers, DNA centers, and cancer treatment centers.

Serious Civil and Criminal Penalties

Medicare fraud investigations are serious matters. You could face civil or criminal penalties. 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 can 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

Additionally, you could lose your license, face disciplinary action, or you could lose your hospital privileges. An allegation of Medicare fraud can change your entire life.

Finding the Right Tampa Defense Attorney

Because Medicare fraud is so serious, you must find the right Tampa defense attorney to assist you. You need a defense attorney with negotiation skills and someone who has experience dealing with Medicare fraud cases and with the federal government.

A notably large number of Tampa health care providers and businesses believe that they should hire a health care attorney. Medicare fraud is often charged alongside of federal criminal matters such as tax evasion, money laundering, and mail fraud. While a health care attorney in Tampa may understand health care law, he or she may not have the experience and skill needed to handle the federal criminal charges. He or she may not be prepared to negotiate with the federal government or to go up against federal prosecutors in court on your behalf.

Some look to hire a Tampa criminal defense attorney when they find out that they are facing criminal charges. Yet, most criminal defense attorneys aren’t well-versed in federal criminal matters. They likely also won’t know the nuances of medical utilization, billing, and coding rules.

Medicare fraud cases can take a lot of time – to get the best results, you need someone with the right combination of experience. You need a health care fraud defense attorney serving Tampa, Florida and its surrounding areas. As you research your options, watch 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

Before you pay a retainer, 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?

Proven Medicare Fraud Defense Strategies

Oberheiden, P.C. services Tampa, Florida health care providers, businesses, and organizations by providing proven Medicare fraud defense strategies. Several of our Medicare fraud defense lawyers have previous experience from holding senior positions within the Department of Justice. We utilize a combination of our defenses along with the prosecutorial experience to develop defenses that are applicable to each case based on the involved facts. To start, we use four guiding principles.

Early involvement with the investigating agencies. Throughout our experience, we’ve learned that the best way to resolve a Medicare fraud investigation and reduce the risk of criminal charges is to get involved early with the investigating agencies. When the government has too much time to investigate you, you’re more likely to face criminal charges. Our goal is to minimize that risk. We contact the investigating agencies and ask the important questions:

  • 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.

Questioning evidence. The federal government must present evidence that proves you committed a crime. This evidence must meet a high standard known as ‘beyond a reasonable doubt.’ In each case, we question the evidence to test this high standard. 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. In addition to the evidence requirement, the federal government must also show that you acted with criminal intent. This is another high standard to meet because most cases of Medicare fraud in Tampa, Florida don’t occur out of criminal intent. Very few people go to work with the intent of defrauding the government. Rather, Medicare fraud often happens because someone makes a mistake. The most common mistakes made in Tampa, Florida that trigger an investigation 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

Although these mistakes may ultimately need to be addressed, they aren’t criminal in nature. Honest mistakes shouldn’t be subject to criminal penalties. However, when most health care providers and businesses discover that they’re being accused of Medicare fraud, they assume that they must be guilty of committing a crime and accept whatever penalties are levied upon them.

Using applicable defenses. Although Medicare fraud cases have the same basic premise of an allegation of a false claim that resulted in an illegal payment, each case is different. This is why Oberheiden, P.C. reviews each case to determine strategic and applicable Medicare fraud defenses. 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 Tampa, Florida and its surrounding areas with Medicare fraud defense services. We’ve worked with health care businesses, owners, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation for 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 represent both individuals and entire systems in Tampa or its surrounding areas. 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 Tampa or Florida law enforcement, call us right away. Initial consultations are confidential and 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.

Tampa, Florida Medicare Fraud Defense Attorneys

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 anytime. Simply call us, email us, or complete our contact form.

1 (888) 727-5159
Oberheiden, P.C.
Serving Tampa, 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.

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