If you’re in Miami, Florida and you’re being investigated for Medicare fraud, you need a powerful legal advocate. The Oberheiden Law Group, PLLC provides Medicare fraud defense for individual practitioners, entire hospital systems, clinics, and health care businesses. Dr. Nick Oberheiden is the managing principal partner.

Defining Medicare Fraud

Medicare fraud is an extremely serious federal offense that can have both civil and criminal penalties. It is the submission of false claims to a federal government health care program. It doesn’t have to be Medicare. It can be Medicaid, Tricare, or federal workers’ compensation. It can include a violation of at least one of the following statutes:

The goal of Medicare fraud is to receive an illegal payment from a federal government health care program. In Miami, Florida there are a large number of Medicare beneficiaries. When a large amount of claims is filed in Miami, Florida through CMS, the government watches the area closely for instance of Medicare fraud. Miami, Florida is one of nine areas in the United States that is monitored by a Medicare Fraud Strike Force. The Medicare Fraud Strike Force is composed of investigators and prosecutors from multiple federal agencies. The ultimate goal is to monitor, investigate, and prosecute Medicare fraud.

Medicare fraud allegations can mean that you come into contact with investigators and prosecutors from many federal agencies including DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and more. Medicare fraud is extremely serious, and you can face civil and criminal penalties in addition to losing your license and your hospital privileges.

The Most Common Form of Medicare Fraud in Miami, Florida

Medicare fraud investigations in Miami, Florida occur most often because of what the government believes to be fraudulent billing practices and reimbursement requests. This most often includes false charges, excessive charges, or charges that weren’t authorized by the federal government health care. In Miami, Florida, the most common billing issues that result in Medicare fraud includes:

  • 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
  • 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

In Miami, Florida, the most common individuals and entities that face Medicare fraud investigations 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.

Understand the Civil and Criminal Penalties

Medicare fraud investigations have serious civil and criminal penalties. You could face civil penalties, criminal penalties, or both. Civil penalties may include:

  • 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 are also extremely serious:

  • 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

In addition to these civil and criminal penalties, you could lose your license to practice or face disciplinary action. You could also lose your hospital privileges.

Choosing the Right Miami, Florida Defense Lawyer

Medicare fraud can affect your entire life. You could lose your license, face criminal charges or even jail, and have to pay fines. It’s extremely important that you choose the right Miami, Florida defense attorney. You need to look for a defense law firm who displays the skills and experience you need to help you with these federal claims.

Many Miami, Florida health care practitioners and health care businesses initially believe that they should hire a health care attorney. The issue here is that Medicare fraud is often charged alongside of serious federal criminal charges such as tax evasion, wire fraud, mail fraud, and money laundering. A health care attorney may not have the federal criminal defense skills that you need.

Despite their knowledge of health care laws, they may not have the skills to negotiate with the federal government or to face federal prosecutors in court.

When health care providers and businesses discover that they may be facing criminal charges, they look to hire a Miami, Florida criminal defense attorney. However, most criminal defense lawyers are experienced in DUI, assault, burglaries, and drug crimes. They don’t have federal crime experience. They also may not have the necessary experience and knowledge pertaining to billing, coding, and medical utilization rules. Despite their experience with criminal law, you need to understand the seriousness of your charges. You will not have time to teach the attorney about health care law.

Your ideal choice is health care fraud defense lawyer serving the Miami, Florida area. As you consider your options, consider the following four traits:

  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?

Using Proven Medicare Fraud Defense Strategies in Miami, Florida

The Oberheiden Law Group, PLLC provides Miami, Florida health care entities and practitioners with strategic and applicable defenses. Many of our Medicare fraud defense attorneys hold previous experience in senior positions from the Department of Justice. Our clients receive a defense that is crafted for their specific facts that is based off of the incredible insight provided by our valued team members. Our goal is to resolve the investigation with a minimal risk of criminal charges for our clients.

It starts with early intervention. Over the years, we’ve learned that the best way to resolve these matters is to get involved early. If the government has too much time to investigate you without interruption, you’ll likely face criminal charges. We contact the investigating federal agencies and get answers 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?

We question their evidence. The federal government must prove beyond a reasonable doubt that you’ve committed a crime. To do this, they must present evidence. We question the evidence in each case that we take on. 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

We point out lack of criminal intent. In addition to the government’s requirement to provide evidence that you’ve committed a crime, they must also show that you had criminal intent. This is a burden to the government because most of the items that prompt a Medicare fraud investigation in Miami, Florida occur because of someone making an honest mistake. These mistakes 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

Miami, Florida actually sees very few instances of legitimate Medicare fraud. Yet, businesses and practitioners who make honest mistakes are prone to believing that their mistake is tantamount to a criminal act. They’re willing to accept the criminal repercussions of their actions. Many are not able to continue to work in the medical field. We address the lack of criminal intent and work to show the government that you made an honest mistake that should be treated like a criminal matter even if the mistake shows that you do have problems within your business that must be addressed.

The use of applicable defenses. Every case is different. The Oberheiden Law Group, PLLC reviews each case and determines strategic and applicable defenses that are available. 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.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides experienced Medicare fraud defense for Miami, Florida 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

The Oberheiden Law Group represents individual providers and health care entities in Miami, Florida. If you’re under investigation 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 Miami 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.

Miami, 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 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 Law Group, PLLC
Serving Miami, FL 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. The Oberheiden Law Group PLLC is a Texas PLLC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.