Experienced Legal Defense Team Fighting Medicare Fraud Charges in Missouri

Medicare fraud allegations are frequent in Missouri. If you’re being investigated by the federal government for Medicare fraud, call The Oberheiden Law Group. We are a Medicare fraud defense law firm serving the State of Missouri. Our defense team is comprised of lawyers with outstanding credentials and former federal experience as both prosecutors and senior trial attorneys. Oberheiden’s lead defense attorney is a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office. We assist our clients with Medicare fraud defense, government investigations, and in other legal matters. We represent clients in the entire State of Missouri.

Missouri health care industry professionals, businesses, entities, and facilities are at risk of being accused of Medicare fraud. Doctors, nurses, hospice care providers, executives, lawyers, facilities, clinics, and other health care industry businesses and facilities in Missouri that are accused of Medicare fraud now have the ability to retain top health care fraud defense lawyers to protect their livelihood. The Oberheiden Law Group, PLLC provides legal advocacy for health care practitioners, clinics, hospitals, businesses, physician-owned entities, businesses, and other to other health care industry professionals and organizations accused of Medicare fraud. Dr. Nick Oberheiden, a Harvard-trained lawyer who works in Medicare fraud defense, is the firm’s managing partner.

Medicare Fraud Basics

Medicare fraud is the submission of one or more false claims to a federal health care program in order to receive federal reimbursement for equipment or services. Medicare fraud breaks more than one federal law. You may face civil or criminal penalties. Medicare fraud also includes false claims submitted to Medicaid, Tricare, and federal workers’ compensation. The federal statutes that are broken include one or more of the following:

Health care practitioners, entities, and businesses in Missouri are investigated more frequently than in most other areas of the United States. Since Missouri has a large number of people who rely on a federal health care program, it is closely watched by the Medicare Fraud Strike Force. It is one of nine locations in the United States that is closely monitored. Missouri, and eight other areas, submit a large number of claims through CMS. The federal government believes that an increase in claims directly relates to an increase in Medicare fraud.

The Medicare Fraud Strike Force is a federal investigative team made up of prosecutors and investigators from multiple agencies. It includes members of the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. Medicare fraud allegations are extremely serious. If you’re contacted by the Medicare Fraud Strike Force, you should contact the Oberheiden Law Group right away.

The Main Causes of Medicare Fraud Allegations in Missouri

We’re often asked why Medicare fraud allegations occur in Missouri. Although there is one common reason, that reason also has several components. The main cause of Medicare fraud in Missouri is the submission of inaccurate claims. These claims are flagged by the government as fraudulent billing or reimbursement requests. It includes excessive charges, unauthorized charges, and false charges. The common components that lead to Medicare fraud allegations in Missouri include:

  • Phantom billing (billing for services that were never performed)
  • Submitting a claim for medically unnecessary services or equipment
  • Submitting a claim for medical supplies, equipment, or services that were never ordered
  • Submitting a claim of certification for medically unnecessary supplies (such as DME)
  • Submitting a claim of certification for medically unnecessary services (such as hospice or home health care)
  • Double billing
  • Upcoding
  • Inflating charges
  • Overusing medical equipment or services
  • Providing or accepting kickbacks

The most commonly investigated individuals and entities in Missouri include doctors, nurses, health care services, physician-owned entities, nursing facilities, registered care providers and facilities, hospitals, clinics, laboratories, pharmacies, DME providers, cancer treatment centers, and DNA centers. If you don’t fall into one of these categories, you’re not necessarily safe. If your business or facility submits claims to the federal government for reimbursement, you are at risk of facing Medicare fraud allegations.

Civil and Criminal Legal Penalties

Medicare fraud in Missouri may result in harsh civil and criminal penalties. Civil penalties for Medicare fraud may include:

  • Recoupment requests
  • Non-payment of claims
  • Up to $11,000 in fines for each false claim
  • Future exclusion from federal health care programs
  • Treble damages
  • Legal fees

In addition to penalties from the civil court, you could also be called in front of the state disciplinary board. You may lose your professional license and your hospital privileges.

Criminal penalties for Medicare fraud include:

  • Hundreds of thousands of dollars in fines
  • Criminal charges
  • Prison sentence of up to ten years for each count of Medicare fraud
  • Prison sentence of up to 20 years for each count of Medicare fraud that resulted in serious bodily harm
  • Life sentence if the Medicare fraud results in the death of the patient.

Choosing the Right Defense Attorney in Missouri

Medicare fraud allegations are extremely serious matters. You’re likely considering your legal options. It is imperative that you choose the right health care defense attorney in Missouri. There are three types of attorneys that you are likely considering. Here’s what you need to know.

A health care lawyer in Missouri certainly knows health care law. However, they may not be trained to handle the associated federal criminal charges. You may also be charged with mail fraud, wire fraud, tax evasion, or money laundering. Therefore, you need a defense law firm that has trial experience with these types of cases.

You do have another choice. This choice has experience in both health care law and federal criminal offenses. Look for a health care fraud defense law team. A health care fraud defense lawyer can negotiate on your behalf with federal prosecutors, can develop a Medicare fraud defense, and can help you with any federal criminal charges that are levied against you. Look for these 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

Once you’ve made a list of possible criminal defense lawyers, you should ask the following three questions to learn about their 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?

The Importance of Medicare Fraud Defense Strategies

The Oberheiden Law Group uses strategic Medicare fraud defenses for Missouri clients. With hundreds of trials under our belt and our combined experience as both former prosecutors and health care fraud defense attorneys, we’ve developed integral Medicare fraud defense strategies that we use with each case.

Contacting federal investigators. Our primary objective is to minimize the risk of criminal charges against our Missouri clients, while resolving the Medicare fraud allegations. We contact federal investigators right away. This one strategy may seem simple, but it is vital to resolution of the allegations. It reduces the time that the federal government has to investigate you without interruption. If they have too much uninterrupted time, you have a higher risk of facing federal criminal charges. Our Health Care Fraud Defense Team will contact the federal government on your behalf. We can usually get answers to important questions within hours:

  • 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?

Evidence. The federal government must present evidence to prove that you are guilty of Medicare fraud. The government’s evidence must meet a high Constitutional standard known as “beyond a reasonable doubt.” By testing the evidence, 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

No criminal intent. In addition to providing evidence, the federal government must also prove that you acted with criminal intent. With Medicare fraud, criminal intent means that you set out with the intention to defraud the government. Intentional Medicare fraud rarely occurs in Missouri. Generally, the allegation comes up because of a mistake that was made. The most common mistakes in Missouri include:

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

Although these mistakes certainly must be addressed and, ultimately, corrected and prevented from occurring again, they aren’t criminal acts. Our goal is to prove to the government that you made a mistake and should not have to face criminal penalties because of it.

Applicable Medicare fraud defenses. The Oberheiden Law Group takes the necessary time to analyze each case and its facts. This enables us to prepare the proper strategic 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.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides legal assistance for health care industry professionals in Missouri who are facing an allegation of Medicare fraud. We’ve represented health care businesses, owners, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other health care entities under investigation for fraudulent billing and illegal kickbacks. We also help with 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 entire health care systems in St. Louis and the 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 Missouri state law enforcement, you should contact us right away. We provide initial consultations free of charge. Initial consultations are also 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.

Medicare Fraud Defense Lawyers Serving Missouri

Nick OberheidenDr. Nick 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.

888-997-2520
Including Weekends
Oberheiden Law Group, PLLC
Serving the State of Missouri 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.