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San Diego, CA 92101
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Defense Attorneys Fighting Medicare Fraud Charges in the San Diego Area

Medicare fraud defense cases are on the rise in San Diego, California and the surrounding areas. The Oberheiden Law Group is a Medicare fraud defense law firm with a track record of success. Our legal defense team is managed by a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office. Oberheiden’s team of criminal defense lawyers have impressive educational backgrounds and many have former federal prosecutorial and trial experience. The Oberheiden Law Group provides legal services in San Diego, California and in the surrounding areas.

Health care industry professionals, entities, and businesses in San Diego, California are often confronted with allegations of Medicare fraud. Doctors, nurses, hospice providers, other health care providers, hospitals, entities, clinics, and health care-related businesses in San Diego and the surrounding area being accused of Medicare fraud have access to health care fraud defense. The Oberheiden Law Group provides Medicare fraud defense for individual providers, entire hospital systems, health care businesses, clinics, physician-owned entities, lawyers, executives, and related health care businesses. Dr. Nick Oberheiden, a Harvard-trained health care fraud defense attorney, is the managing partner. Clients gain valuable insight in their Medicare fraud cases from our powerful combination of experience.

What Is Medicare Fraud?

Medicare fraud occurs when there is a submission of a false claim to a government health care program in an effort to receive money from the program for equipment or services. It is a federal offense that carries both civil and criminal penalties. While the name may lead you to believe that it only covers Medicare, that’s simply not the case. This includes false claims submitted to Medicare, Medicaid, Tricare, and federal workers’ compensation. If you are accused of Medicare fraud, you are being accused of breaking at least one of the following laws:

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

Health care practitioners, businesses, and entities in San Diego are investigated more often than in other parts of the country. This is because San Diego has a large number of citizens who rely on federal health care programs. It is one of nine areas in the United States closely monitored for Medicare fraud by the Medicare Fraud Strike Force. The high number of federal health care program beneficiaries means that the federal government receives more claims for reimbursement from the area. The government pays special attention and believes that more Medicare fraud is likely to occur in the area.

The Medicare Fraud Strike Force is a mixed federal team of investigators and prosecutors. The team includes representatives from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. An accusation of this nature is extremely concerning. If you’re contacted by the Medicare Fraud Strike Force or by a representative of the federal government concerning Medicare fraud, you should protect yourself and your practice or business by calling the Oberheiden Law Group immediately.

Common Causes of Medicare Fraud Investigations in San Diego

Medicare fraud investigations in San Diego are commonly caused by inaccurate claims. The federal government labels these claims as fraudulent billing or reimbursement requests. These claims may include excessive charges, charges that weren’t authorized, and false charges. In San Diego and the surrounding area, the most common causes of a Medicare fraud investigation 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

Those most commonly investigated in San Diego include doctors, nurses, health care services, physician-owned entities, nursing homes, registered care providers and facilities, hospitals, clinics, pharmacies, laboratories, DME providers, DNA centers, and cancer centers. Yet, it is important that you do not see this list as all-inclusive. Any individual, business, facility, or entity in the health care industry that submits a false claim to a federal health care program, even if they do not realize that the claim will be classified as false, may end up as the subject of a Medicare fraud investigation.

Legal Penalties for Medicare Fraud

Medicare fraud allegations in San Diego, California may result in stern civil and criminal penalties. You may be charged in civil or criminal court. Civil penalties for Medicare fraud in San Diego may include one or more of the following:

  • 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
  • Attorney fees

Further, you may also be called before the state disciplinary or licensing board. You could lose your professional license and your hospital privileges.

Criminal penalties for Medicare fraud may include one or more of the following:

  • 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.

The Importance of Choosing the Right San Diego Defense Lawyer

Medicare fraud allegations can change your entire life. You’re probably thinking about choosing the right defense attorney to defend you against the federal government’s allegations. It’s imperative that you choose the right type of lawyer. Let’s look at some options that you’re likely considering.

Are you considering a San Diego health care lawyer? You need one with specific training to understand health care law, so you are not unprotected in other areas of your case. Medicare fraud often includes additional federal criminal charges, such as money laundering, wire fraud, tax fraud, or mail fraud. You need an attorney experienced in federal criminal charges.

If you know that you will likely face criminal charges, you may be considering a San Diego criminal defense lawyer. However, you need one with experience in handling federal criminal matters. You also need an attorney with the experience and knowledge in health care law or billing, coding, and medical utilization rules.

If you’re facing Medicare fraud allegations in San Diego or the surrounding area, you have an option. Look for a health care fraud defense attorney. A health care fraud defense attorney has experience with health care fraud defense and health care law and has the experience you need for both negotiation and criminal charges. As you consider your options, look for these four signs:

  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

Next, you’ll want to ask your potential attorney these three important questions to ascertain 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?

Defense Strategies for Medicare Fraud Allegations

The Oberheiden Law Group determines and utilizes thorough and strategic Medicare fraud defenses for our San Diego clients. We’ve taken hundreds of cases to trials throughout the United States. Many of our Health Care Fraud Defense Team members have previous experience as federal health care prosecutors with the Department of Justice. We also have team members who have experience working with the Medicare Fraud Strike Force. Combining both prosecutorial and defense experience has led us to develop the following Medicare fraud defense strategies.

Contact with the federal government. The primary objective in each Medicare fraud case that we take on is to resolve the investigation against our clients with minimal exposure to criminal charges. We immediately make contact with the federal government. We’ve learned during our years of experience that this one strategy is one of the most vital keys to a successful resolution. We are able to get answers to important questions and reduce the likelihood of criminal charges. Immediate contact is also important because it reduces the amount of time that the federal government has to investigate you without interruption. When the government has too much uninterrupted time to investigate you, it’s likely that you’ll receive criminal charges. Our Health Care Fraud Defense Team opens the lines of communicate to advocate on your behalf. Within hours, we can usually get answers to these 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?

Testing presented evidence. Allegations of any type must be proven with evidence. The government must present evidence that meets a Constitutional standard known as “beyond a reasonable doubt.” By reviewing and testing presented evidence, we’re able to determine whether the government is able to meet the standard. With this strategy, we routinely see 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. We also review the government’s ability to prove that you committed Medicare fraud with criminal intent. This means that you actually had the goal of submitting a false claim. This doesn’t usually happen in San Diego. Rather, these investigations start because a provider, entity, or business made a mistake, since they weren’t paying sufficient attention to the happenings of the billing and coding. The most common reason errors are made in San Diego 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

While these mistakes certainly should be addressed and corrected, they aren’t criminal actions. Our objective is to prove to the federal government that our clients did not have a criminal mindset. They just made an honest mistake that should be corrected.

Determining and utilizing applicable Medicare fraud defenses. Although Medicare fraud cases have many similarities because they involve a specific set of actions and laws, each case is unique because of its facts. So, all Medicare fraud cases cannot use the same defenses. The Oberheiden Law Group analyzes each case to determine the best 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.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides legal advocacy on behalf of San Diego, California Medicare fraud clients. We’ve helped 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 assist 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, PLLC represents individual providers and entire health care systems in San Diego, California 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, San Diego or California state law enforcement, call us immediately. We provide confidential initial consultations at no 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 Lawyers Serving San Diego, California

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.

714-294-2000
Including Weekends
Oberheiden Law Group, PLLC
Serving San Diego, CA 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.