Louisiana Office
9655 Perkins Rd, Suite C-203
Baton Rouge, LA 70810
(Meeting location by appointment only)

Health care practitioners and related health care businesses in Louisiana who are being investigated for Medicare fraud now have a powerful advocate on their side. Oberheiden & McMurrey, LLP provides Medicare fraud defense for individuals, entire hospitals, and health care businesses. Dr. Nick Oberheiden is the managing principal partner.

What Is Medicare Fraud?

Medicare fraud is a federal offense with serious civil and criminal consequences. It is the submission of false claims to a government health care program. Although it is called Medicare fraud, it includes false claims submitted to Medicaid, Tricare, or federal workers’ compensation. It includes violations of at least one of the following laws:

Medicare fraud, regardless of the involved federal government health care program or law that is violated, involves an individual or an entity illegally receiving money from a federal health care program. In Louisiana, there are a large number of Medicare recipients. The federal government watches Louisiana and eight other areas in the United States because of the increased number of claims. Louisiana is monitored by the Medicare Fraud Strike Force. They monitor, investigate, and prosecute Medicare fraud.

Medicare fraud allegations are incredibly serious matters. If you’re being investigated by the Medicare Fraud Strike Force, you may hear from various federal agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and more. You could end up facing civil and criminal penalties and you could lose your license and your hospital privileges.

Billing Fraud: The Most Common Form of Medicare Fraud

Medicare fraud investigations in Louisiana often result because of what the federal government alleges to be fraudulent billing practices and reimbursement requests. This can include false charges, excessive charges, or charges that weren’t authorized. The most common types of billing issues that turn into a Medicare fraud investigation include:

  • Billing for services that weren’t performed (commonly referred to as phantom billing)
  • Billing for medically unnecessary services
  • Billing for equipment or services that were never ordered
  • Billing for medically unnecessary equipment or services
  • Certification of medically unnecessary supplies (such as DME) or services (such as home health or hospice)
  • Double billing
  • Inflating charges
  • Upcoding
  • Overuse of services
  • Overuse of equipment
  • Providing or accepting kickbacks

The most common Louisiana providers and entities who are investigated include doctors, nurses, health care services, nursing homes, registered care providers and facilities, hospitals and clinics, pharmacies, labs, DME providers, DNA centers, and cancer centers.

Civil and Criminal Penalties

Medicare fraud investigations can result in serious civil and criminal penalties. You could be held liable for civil penalties, criminal penalties, or both. Civil penalties may include recoupment requests, non-payment of claims, civil fines of up to $11,000 per false claim, future exclusion from federal health care programs, treble damages, and paying the legal fees to the government’s attorneys.

Criminal penalties can include fines in the hundreds of thousands of dollars, a criminal record, and you may also be sentenced to federal prison time. Each count of Medicare fraud could cause you to be sentenced to up to 10 years for each. If the Medicare fraud resulted in serious bodily injury (as is often in the case in excessive or counterfeit medication), you could receive up to 20 years per count. If the Medicare fraud resulted in the death of a patient, you could receive a life sentence.

You could also be excluded from all federal health care programs. You may no longer have your costs reimbursed. You could also face licensing or disciplinary action in Louisiana or lose your hospital privileges.

You Must Choose the Right Louisiana Defense Lawyer

Medicare fraud affects your entire life. You could lose your livelihood. This is why it is so important that you choose the right Louisiana defense lawyer if you’re being investigated for Medicare fraud. You need a fraud defense lawyer with the skills and experience to defend you against the allegations levied against you by the federal government. Your entire life is on the line. You need to choose the right attorney.

Many Louisiana practitioners and facilities facing Medicare fraud investigations often believe that they need a health care attorney. However, Medicare fraud is often charged in addition to serious federal criminal charges such as mail fraud, wire fraud, tax evasion, and money laundering.

Health care fraud defense attorneys may not have the appropriate amount of criminal procedure knowledge that will be needed to develop the best defense for you. They may not have the experience or the training to negotiate with the federal government or to face federal prosecutors in court.

Other people think that they should hire a Louisiana criminal defense attorney if they learn that they are facing criminal charges. Yet, most criminal defense attorneys have experience with drug charges, DUIs, and assault. They may not have the required experience you really need for federal criminal charges. They may not understand or even know about the billing, coding, or medical utilization rules. Because this matter is so sensitive, you really don’t have the time or the luxury to educate a criminal defense lawyer in health care law.

The ideal choice is a health care fraud defense lawyer serving Louisiana. As you are researching your options, keep these four traits in mind:

  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 Defense Strategies

Oberheiden & McMurrey, LLP provides strategic defenses for each of our Louisiana clients. We’ve taken hundreds of Medicare fraud cases to trial. Many of our Medicare fraud defense attorneys have previous experience as senior prosecutors with federal agencies. This gives our clients incredible insight, and we are able to use our government contacts to get the answers that you need. Our goal is to resolve Medicare fraud investigations in Louisiana with minimal risk of facing criminal charges.

Early contact with the federal government. From our experience, we’ve learned that early contact with the federal government is best. It gets answers that you need about the investigation and reduces the likelihood that you’ll face criminal charges. The longer that the government has to investigate you without interruption, the more likely it is that you’ll be charged with a criminal offense. Oberheiden & McMurrey, LLP uses our open lines of communication to get answers to the most important questions within hours of our engagement:

  • 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?

Lack of evidence. The United States government faces a Constitutional hurdle when they’re trying to levy criminal charges. They must prove beyond a reasonable doubt that you’ve committed a crime. We look at this Constitutional standard in each and every case that we take. We’ve routinely seen the following results:

  • 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 proving that you committed a crime, the government must also show that you acted with criminal intent. This is a huge burden because most incidents that prompt a Medicare fraud investigation in Louisiana are just honest mistakes. These mistakes occur because you’re busying taking care of your patients. They also happen when health care businesses grow fast. The most common errors include:

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

In Louisiana, intentional Medicare fraud is rare. However, many businesses and practitioners in Louisiana who find out they’re being investigated will simply assume they’ve committed a crime. They accept the life-altering consequences. Honest mistakes should not be made into a crime. We address the lack of criminal intent and we work to prove to the government that there was no criminal intent.

Strategic and applicable defenses. Oberheiden & McMurrey, LLP provides a thorough analysis of each case that we take. This helps us find strategic and applicable defenses for each individual case. Recently, we handled a Medicare fraud case where the government alleged fraudulent certification for 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 & McMurrey, LLP

Oberheiden & McMurrey, LLP provides zealous legal representation for Louisiana 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

Oberheiden & McMurrey, LLP provides legal representation of individual providers and entire health care systems in Louisiana. 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 Louisiana state law enforcement, call us. Initial consultations are free and totally confidential.

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.

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

1 (888) 997-2520
Including Weekends
Oberheiden & McMurrey, LLP
Serving Louisiana and Surrounding Areas
www.medicare-lawyer.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 & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.