With a health care fraud defense team comprised of seasoned attorneys and former federal prosecutors, we bring well over 100 years of experience to representing Medicare and Medicaid providers in Arkansas. If your business or practice is being targeted in an audit or investigation, we can help protect you against severe civil and criminal penalties.
Arkansas health care providers that bill Medicare and Medicaid are subject to stringent guidelines and strict state and federal laws that impose severe penalties for billing violations. At the federal level, the Centers for Medicare and Medicaid Services (CMS), Department of Justice (DOJ), Department of Health and Human Services Office of Inspector General (OIG) and other agencies devote substantial resources to combatting waste, fraud, and abuse affecting these health care benefit programs. At the state level, the Arkansas Medicaid Fraud Control Unit (MFCU) and Office of the Medicaid Inspector General (OMIG) aggressively pursue charges against providers suspected of fraud, as evidenced by frequent updates from the OMIG’s News Room.
If your business or practice is being targeted for Medicare or Medicaid fraud, it is critical that you seek legal representation. An audit or investigation does not have to lead to charges. Every day, providers in Arkansas and across the country face prosecution for alleged billing violations they have not actually committed. Even in cases where billing violations have occurred, prosecutors will often seek extraordinarily-harsh penalties because it is their job to do so, and because laws such as the False Claims Act encourage aggressive prosecution. Avoiding unjust consequences requires the advice and representation of a team of experienced health care fraud defense attorneys.
Health Care Fraud Defense Attorneys for Medicare and Medicaid Providers in Arkansas
Oberheiden, P.C. is a team of health care fraud defense lawyers who bring well over 100 years of combined experience to representing Arkansas Medicare and Medicaid providers. Led by notably experience defense attorney Dr. Nick Oberheiden, our team is comprised primarily of former state and federal prosecutors with specific experience in health care fraud investigations and prosecutions. All members of our team are proven litigators who have successfully represented providers nationwide in audits, investigations, trials, and appeals.
When we represent you, we will put the full weight of our experience on your side. Unlike other firms that tout their collective experience only to assign clients to individual attorneys, we work as a team to evaluate potential defenses, scrutinize potential weaknesses, and develop comprehensive case strategies focused on protecting our clients’ interests as quickly and cost-effectively as possible. Along with the other members of our health care fraud defense team, the attorneys working on your case will include:
- Dr. Nick Oberheiden – Founder and managing principal of Oberheiden, P.C., Dr. Nick Oberheiden has successfully represented clients in Medicare and Medicaid fraud matters across the country. Often representing clients in times of crisis, Dr. Oberheiden understands the significant challenges facing health care providers in high-stakes audits and investigations.
- Lynette S. Byrd – During her tenure with the U.S. Attorney’s Office, Ms. Byrd prosecuted health care cases involving the OIG, Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), and various other federal agencies. Ms. Byrd also has state prosecutorial experience, and brings a notable level of insight to developing health care fraud defense strategies in both state and federal matters.
Health care providers across the nation have put their trust in the health care fraud defense team at Oberheiden, P.C. when their finances and freedom are on the line. If you are facing an audit, investigation, or prosecution in Little Rock, Fayetteville, or any other area of Arkansas, we encourage you to contact us. Let us show you exactly what we can do to help.
About Our Medicare and Medicaid Fraud Practice
We represent health care providers in all Medicare and Medicaid fraud matters. From licensed professionals and business executives to medical clinics and home health care agencies, we have experience securing favorable outcomes for all types of providers in all matters listed below, and more.
Medicare and Medicaid Audits
Medicare and Medicaid audits are invasive and potentially dangerous intrusions into a health care provider’s billing and patient practices. These audits are conducted by private contractors operating under the Centers for Medicare and Medicaid Services’ (CMS) “fee-for-service” recovery program. They focus on identifying any and all potential billing errors – with particular emphasis on overbillings that can justify demands for recoupments and other penalties.
Although there are multiple types of audit contractors that work with CMS, most Medicare and Medicaid audits involve:
- Zone Program Integrity Contractors (ZPICs)
- Recovery Audit Contractors (RACs)
- Medicare Administrative Contractors (MACs)
- Audit Medicaid Integrity Contractors (MICs)
In Arkansas, the companies that conduct audits on behalf of CMS include, but are not limited to: Novitas, CGS Administrators, Palmetto GBA, Cotiviti, and AdvanceMed.
If you have received an unfavorable audit determination, your next step is to file an appeal. You only have a limited amount of time to file, and you may need to file even sooner in order to avoid immediate recoupment liability. At Oberheiden, P.C., we represent health care providers in all stages of the audit appeals process, including:
- Requests for Redetermination
- Requests for Reconsideration
- Administrative Appeals with the Office of Medicare Hearings and Appeals (OMHA)
- Administrative Appeals with the Medicare Appeals Council
- Civil Appeals in Federal District Court
Each stage of appeal involves its own unique process, standards, and procedures. For example, Requests for Redetermination and Requests for Reconsideration involve a review of the legitimacy of the auditor’s conclusions. However, in federal court the focus is on the procedural aspects of the appellate process (i.e., whether any prior appellate decision was “arbitrary and capricious”). Successfully navigating the appellate process requires a thorough understanding of the nuances involved, and audit appeals are best handled by a team of experienced health care fraud attorneys.
Many Medicare and Medicaid fraud investigations begin with OIG subpoenas. Receiving an OIG subpoena can indicate that you are being targeted in an investigation that is either civil or criminal in nature. So one of the first steps involved in responding to an OIG subpoena is to understand whether you are being targeted for civil or criminal prosecution.
Mistakes in responding to OIG subpoenas can have dire consequences. Disclose too much information, and you could expose yourself to penalties unnecessarily. Disclose too little, and you could face additional charges for obstruction of justice. Our attorneys have defended numerous health care providers targeted with OIG subpoenas. We can read between the lines to determine whether you are being investigated civilly or criminally, and we can help you prepare an appropriate response with the goal to preserve all available defenses.
Grand Jury Subpoenas
In the context of a Medicare or Medicaid investigation, the purpose of a grand jury subpoena is to determine whether there is probable cause to pursue criminal charges for fraud. A grand jury can compel both records and testimony, and government attorneys can obtain subpoenas for individuals in their personal capacity and as custodians of corporate billing records. If a grand jury determines that probable cause exists, the U.S. Attorney’s Office will pursue charges in federal court. If not, the grand jury will issue a “no-bill” and you will be released without prosecution. As a result, the grand jury process is make-or-break time for the prosecution’s case, and providers being targeted for prosecution need to do everything possible to avoid an indictment.
False Claims Act Investigations
Under the False Claims Act (FCA), federal prosecutors can seek civil and criminal penalties for Medicare and Medicaid billing violations. The FCA prohibits any form of “false or fraudulent claim” for payment from the federal government, and this includes both intentional and unintentional billing mistakes. While providers who unintentionally submit improper reimbursement claims can face fines, recoupments, program exclusion, and other financial penalties – providers accused of intentionally defrauding Medicare or Medicaid can face enormous fines and long-term imprisonment under the FCA.
Kickback and Referral Fee Investigations
Payment of illegal kickbacks and referral fees are among the most-common allegations in Medicare and Medicaid fraud investigations. In addition to constituting violations of the False Claims Act, improper compensation arrangements involving Medicare and Medicaid-reimbursed services can also trigger liability under the Stark Law and the Anti-Kickback Statute. Under the primary operative provisions of these statutes, most types of compensation arrangements involving payments from Medicare and Medicaid are illegal, and it is up to the physician or other provider under investigation to demonstrate that one or more safe harbors or exceptions applies. The safe harbors and exceptions for the Stark Law and the Anti-Kickback Statute include (but are not limited to) protections for:
- Ambulance services and supplies
- Ambulatory surgery centers
- Charitable donations by physicians
- Employment relationships
- Fair market value compensation
- Group practice arrangements
- Group purchasing organizations
- In-office ancillary services
- Isolated transactions
- Personal service arrangements
- Preventing screenings and vaccinations
- Referral agreements for specialty services
- Sales of health care practices
- Waivers of coinsurance and deductibles
Other Medicare and Medicaid Fraud Investigations
In addition to representing providers in False Claims Act, Stark Law, and Anti-Kickback Statute investigations, we also have extensive experience protecting our clients against charges under a broad range of other state and federal laws. This includes laws such as the Arkansas Medicaid Fraud False Claims Act, as well as the federal criminal statutes that impose fines and prison sentences for conspiracy to commit fraud, money laundering, mail and wire fraud, and other offenses.
Civil and Criminal Fraud Prosecutions
While we have avoided criminal indictments in the lion’s share of the cases we have handled, no outcome is ever guaranteed. If it is not possible to protect you against civil or criminal charges, we will work tirelessly to protect you from the consequences of a guilty verdict at trial. Our health care fraud defense attorneys are skilled litigators who have handled hundreds of trials in state and federal courts across the country. We build and execute aggressive trial strategies that are custom-tailored to the unique circumstances of each individual case, and we work closely with our clients to make sure that we have every possible opportunity to help them avoid civil and criminal punishment.
What Arkansas Health Care Providers Need to Know about Medicare and Medicaid Fraud: Answers to FAQs
Q: What authorities prosecute Medicaid fraud in Arkansas?
In Arkansas, the two authorities that are primarily responsible for investigating and prosecuting providers suspected of Medicaid fraud are the Arkansas Medicaid Fraud Control Unit (MFCU) and Office of the Medicaid Inspector General (OMIG).
The MFCU, which is a division of the Attorney General’s Office, “fights Medicaid fraud by investigating and prosecuting violations of State and federal law involving Medicaid providers and the abuse or neglect of nursing home residents.” The OMIG focuses on, “finding those providers who commit fraud and abuse to ensure that these individuals will no longer be able to participate in the State’s Medicaid program.” When the OMIG discovers that a provider has defrauded the state’s Medicaid system, it can refer the case to the MFCU for criminal prosecution.
Q: What are the penalties for Medicare and Medicaid fraud in Arkansas?
At the federal level, the penalties for Medicare and Medicaid fraud include civil and criminal fines, recoupments, treble damages (three times the government’s actual losses), loss of program eligibility, and imprisonment in criminal cases. The False Claims Act and Anti-Kickback Statute both include provisions for civil and criminal prosecution, while the Stark Law is exclusively a civil statute.
The penalties under Arkansas law are similar:
- Loss of Medicaid eligibility (or temporary suspension of Medicaid privileges)
- Recovery of Medicaid funds (recoupment)
- Professional license revocation
Q: How do state and federal authorities identify targets for Medicare and Medicaid fraud investigations?
There are three primary ways that state and federal authorities identify targets for Medicare and Medicaid fraud investigations. The first is through CMS contractor audits. When audit contractors discover evidence of billing fraud, they can refer providers to CMS or the OIG for further investigation. The second is through analysis of Medicare and Medicaid billing data. CMS, the OIG, the Medicare Fraud Strike Force, and other federal authorities rely heavily on data analytics software to identify “anomalies” that are indicative of potential fraud.
Third, both state and federal authorities rely heavily on public citizens to report suspected instances of fraud. Patients, competitors, and disgruntled former employees can all file whistleblower (or “qui tam“) complaints with the DOJ and the MFCU. If their complaints lead to successful prosecution, they are entitled to receive a portion of any amounts recovered.
Q: What do I need to do if I am facing an audit or investigation?
If you are facing an audit or investigation involving state or federal authorities, you need to seek legal representation immediately. Even seemingly-minor mistakes and oversights can have drastic consequences, and you need to make sure that you and your personnel know exactly what you need to do (and not do) in order to avoid unnecessary exposure. When you contact us, we will arrange for you to meet with our health care fraud defense team as soon as possible, and we will begin working with you immediately to make sure you are able to present the strongest possible defense strategy.
Request a Free and Confidential Case Assessment
To schedule an appointment with our health care fraud defense team, please call (888) 356-4634 or contact us online. You can reach out to us 24/7, and if we are not available immediately we will be in touch as soon as possible.