Experienced Legal Defense You can Trust Serving the St. Louis Area

St. Louis medical providers and business owners face a high risk of being accused of Medicare fraud. Oberheiden & McMurrey, LLP is an experienced Medicare fraud defense law firm. We also assist clients being investigated by the federal government or who have other litigation needs. Our legal defense team is managed by a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office. Team members have prestigious educations and experience. In fact, several attorneys on our team have experience as federal former prosecutors and senior trial attorneys. Oberheiden & McMurrey, LLP serves clients in St. Louis and the surrounding areas.

Health care industry professionals, facilities, businesses, and other entities in St. Louis often face the challenge of Medicare fraud allegations. Doctors, nurses, home health care providers, executives, facilities, clinics, and other industry related businesses and facilities in St. Louis and the surrounding area that are accused of Medicare fraud now have access to health care fraud defense attorneys. Oberheiden & McMurrey, LLP provides legal advocacy for health care providers, hospitals, businesses, clinics, physician-owned entities, lawyers, executives, and related businesses accused of Medicare fraud. Dr. Nick Oberheiden, a Harvard-trained health care fraud defense attorney, is the firm’s managing partner.

The Basics of Medicare Fraud

Medicare fraud happens when there is a submission of a false claim to a government health care program to receive money from the federal program for equipment or services. Medicare fraud is a federal offense with both civil and criminal penalties. The name on its own can be misleading. Medicare fraud includes false claims submitted to Medicare, Medicaid, Tricare, and federal workers’ compensation. An accusation of this nature means that you are being accused of violating at least one of the following statutes:

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

Health care providers, entities, and businesses in St. Louis are investigated more often than most other places in the United States. St. Louis has a large number of federal health care program recipients. Because more claims are filed from St. Louis, the Medicare Fraud Strike Force watches this area and eight others in the United States for Medicare fraud. The government has reason to believe that, because more claims are filed in St. Louis, there is a higher likelihood of Medicare fraud.

The Medicare Fraud Strike Force is a federal team of investigators and prosecutors from multiple agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. An accusation of Medicare fraud is extremely serious. If you’re contacted by the Medicare Fraud Strike Force or by anyone who is employed by a federal agency concerning Medicare fraud, you must protect yourself and your livelihood. Call Oberheiden & McMurrey, LLP right away.

The Main Reasons Medicare Fraud Investigations Occur

We are often asked the common reasons why Medicare fraud investigations occur in St. Louis. There is one common reason, but it has many causes. The main reason why Medicare fraud investigations occur is because of inaccurate claims. These claims include excessive charges, unauthorized charges, and false charges. In St. Louis and the surrounding area, the most common items that cause the government to levy an allegation of Medicare fraud 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

In St. Louis, the most commonly investigated entities 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. This list isn’t all-inclusive. If you work in the health care industry and file claims through a federal health care program for reimbursement or payment, you are at risk of being accused of Medicare fraud.

The Legal Penalties of Medicare Fraud

Medicare fraud allegations in St. Louis may result in harsh civil and criminal penalties. You could be charged in civil or criminal court. Civil penalties for Medicare fraud in St. Louis may include at least one 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

Additionally, you may be called in front of the state disciplinary or licensing board. You may lose your license or your hospital privileges.

Criminal penalties for Medicare fraud may include at least one 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.

You Must Choose the Right St. Louis Defense Attorney

Medicare fraud allegations are incredibly serious in nature. By now, you’re probably thinking about your options for legal help. It is very important that you choose the right St. Louis defense attorney. Here what’s you need to know about your options.

You may also be charged with tax evasion, wire fraud, money laundering, or mail fraud. So, you need an attorney with experience in these charges and fields.

You may also face criminal charges, so you need a St. Louis criminal defense lawyer. That attorney must have experience handling federal criminal matters too. They must also understand health care law or billing, coding, or medical utilization rules.

If you are accused of Medicare fraud in St. Louis or the surrounding area, you have an option for legal representation. You should seek out the services of a health care fraud defense law firm. A health care fraud defense lawyer has experience negotiating with federal prosecutors, developing Medicare fraud defenses, and can assist you with federal criminal charges. As you consider the possible attorneys, 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

The next step is for you to ask the following three questions, so that you can get a good idea of the experience level presented by the attorney:

  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?

Medicare Fraud Defense Strategies

Oberheiden & McMurrey, LLP uses strategic Medicare fraud defenses for each St. Louis client. We’ve taken hundreds of Medicare fraud cases to court within the United States. Many of our Health care Fraud Defense Team lawyers have experience as federal health care prosecutors within the Department of Justice and the Medicare Fraud Strike Force. We use our collective experience to develop and apply the following Medicare fraud defense strategies:

Early contact with the federal government. Our primary objective is to resolve investigations against our clients with minimal risk of criminal charges. We get into contact with federal investigators early in the case. We’ve learned that this is one of the most successful ways to get the information that we need to help you resolve the case. Immediate contact is important because it reduces the time that the federal government has to investigate you without interruption. When it has a large period of time to investigate you, you’re more likely to face 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?

Lack of evidence. Allegations of Medicare fraud must be proven with evidence. 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

Lack of criminal intent. The government must also show that you acted with criminal intent. This means that you intended to commit fraud against the federal government. Yet, this is hard for the government to do because most instances of Medicare fraud in St. Louis happen because an honest mistake was made. The most common reason that errors are made in St. Louis 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 should be addressed and corrected, they aren’t criminal in nature. The objective is to prove to the federal government that our clients did not have a criminal mindset.

Applicable Medicare fraud defenses. Medicare fraud cases are similar since they are all rely on breaking certain laws. But, each case is different. Because of this, Oberheiden & McMurrey, LLP takes the necessary time to analyze each case and its facts. This enables us to prepare and utilize 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.

Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP provides legal assistant for St. Louis Medicare fraud clients. 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 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

Oberheiden & McMurrey, LLP 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, St. Louis or state law enforcement, call us right away. We provide initial consultations free of charge. Initial consultations are 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 St. Louis

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 & McMurrey, LLP
Serving St. Louis, 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. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.