The Oberheiden, P.C., PLLC provides experienced and strategic representation for healthcare providers facing Medicare/Medicaid fraud investigations in Baton Rouge, Louisiana. Headed by senior attorney Dr. Nick Oberheiden, the firm’s Healthcare Fraud Defense Group is comprised of experienced defense attorneys and former federal healthcare prosecutors who have decades of experience and collectively have handled cases involving in excess of 500,000 billed claims.
Medicare/Medicaid Fraud in Baton Rouge, LA
Federal Investigators are Targeting Healthcare Companies in Baton Rouge
Currently, healthcare service providers and other companies and individuals in Baton Rouge’s healthcare sector are among the federal government’s primary targets in Medicare/Medicaid fraud investigations. In fact, Baton Rouge is one of only nine cities nationwide where the federal government has placed a team from its elite “HEAT” task force. The Healthcare Fraud Prevention and Enforcement Action Team (HEAT), is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies that was established specifically to monitor, investigate, and prosecute healthcare providers suspected of Medicare/Medicaid fraud.
The Centers for Medicare and Medicaid Services (CMS) is keeping a close eye on local Medicare/Medicaid providers in Baton Rouge as well, and each year, numerous providers in Baton Rouge, Louisiana and around the country face prosecution as a result of investigations initiated by CMS. As a result, healthcare companies in Baton Rouge must be extremely cautious to avoid putting themselves in the federal government’s sights.
The Risks for Healthcare Companies in Baton Rouge, Louisiana
Unfortunately, even following a comprehensive compliance program may not be enough to spare your company from an invasive federal investigation. This is because HEAT uses data analysis to identify potential targets for investigations. This analysis focuses primarily on the volume of claims submitted not necessarily whether all (or any) of those claims indicate potential fraud on their own merits. The result of this is that many high-volume healthcare providers are becoming targets of unwarranted but still potentially costly investigations.
Medicare/Medicaid Fraud: An Overview
“Medicare/Medicaid fraud” is a general term that refers to submitting false, fictitious, or otherwise wrongful claims for reimbursement under the federal Medicare/Medicaid program. The federal government is actively targeting providers suspected of a wide variety of forms of fraud. These include:
- Billing for services never performed (commonly referred to as “phantom billing”)
- Billing for supplies and equipment that were never ordered
- Billing for medically unnecessary services, supplies and equipment
- Obtaining certification for medically unnecessary services and supplies
- Falsifying patient records
- Double billing
- Upcoding, unbundling services, and other coding violations
- Offering and accepting kickbacks
Medicare/Medicaid fraud potentially implicates a number of different federal statutes, including:
- False Claims Act – The False Claims Act prohibits knowingly making false statements or misrepresentations of fact in order to illegally obtain reimbursements from CMS or another federal healthcare benefit program provider.
- Anti-Kickback Statute – The Anti-Kickback Statute prohibits knowingly soliciting, paying, or accepting any form of compensation for referrals for services, medication, supplies, or equipment reimbursed through a federal healthcare benefit program (including Medicare/Medicaid).
- Physician Self-Referral Laws (Stark Law) – The Stark Law prohibits physicians from making referrals to entities in which the referring physician or an immediate family member has an ownership or financial interest for “designated health services” provided to Medicare and Medicaid beneficiaries.
Depending on the specific allegations involved, Medicare/Medicaid fraud can potentially be charged under the Social Security Act and various provisions of the U.S. Criminal Code as well.
Potential Penalties in Medicare/Medicaid Fraud Investigations
The DOJ has recently made clear that it fully intends to prosecute both companies and individuals suspected of Medicare/Medicaid fraud. As a result, physicians, nurses, home healthcare centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, and other healthcare service providers in Baton Rouge, Louisiana are all potentially at risk for facing severe civil and criminal penalties. Depending on whether your investigation is civil or criminal in nature, these penalties may include:
- Recoupment requests
- Non-payment of future claims
- Civil fines of up to $11,000 per false claim
- Exclusion from future participation in federal healthcare programs (including Medicare/Medicaid)
- Treble damages
- Government attorney’s fees
- Criminal fines
- Incarceration in federal prison
The federal prison sentences for Medicare/Medicaid fraud are as follows:
- Medicare/Medicaid Fraud – Up to 10 years in prison for each count of fraud.
- Medicare/Medicaid Fraud Resulting in Serious Bodily Injury – Up to 20 years in prison (common in cases involving reimbursement requests for counterfeit or excessive medication).
- Medicare/Medicaid Fraud Resulting in Death – Life imprisonment.
Physicians and other medical professionals charged with Medicare/Medicaid fraud will frequently face professional disciplinary action and loss of hospital privileges, as well.
Three Key Defense Strategies for Medicare/Medicaid Fraud Investigations
Early Intervention is the Key to Success
In a Medicare/Medicaid fraud investigation, early intervention can be critical to securing a favorable outcome. The longer you wait to engage a medicare/medicaid fraud defense attorney, the longer the government will have to build its case against you without interruption. To protect yourself as much as possible, you need to hire a defense team that can immediately establish a dialogue with the prosecutor’s office and get answers to key questions like:
- Is the case civil or criminal?
- What prompted the investigation?
- What is the case about?
- Who else is under investigation?
- Which agencies are involved?
- What is the government’s ultimate goal?
- How can the investigation be resolved?
When you choose Oberheiden, P.C. to represent you, the attorneys in our Healthcare Fraud Defense Group will reach out to their government contacts and strive to obtain answers to these questions within the first hours of our engagement.
Statutory Defenses to Allegations of Medicare/Medicaid Fraud
Once we have made contact with the prosecutors assigned to your investigation and determined whether your case is civil or criminal in nature, we can then begin to assess the defenses that you may have available. The Stark Law, the Anti-Kickback statute and other healthcare laws contain a variety of safe-harbor provisions and other exceptions that we are frequently able to use to help our clients avoid facing civil and criminal charges.
Lack of Evidence and Criminal Intent
If your Medicare/Medicaid fraud investigation ends up resulting in criminal charges, the government will need to prove its case beyond a reasonable doubt. In healthcare fraud matters, this requires substantial evidence of two key elements: (i) that you committed a fraudulent act and (ii) that you committed the fraudulent act with criminal intent. If you committed a fraudulent act (i.e., you double-billed a reimbursement claim), but lacked criminal intent (i.e., you did so accidentally), then you should not be found guilty of Medicare/Medicaid fraud.
Despite the headlines and DOJ press releases announcing stings involving multi-million-dollar Medicare/Medicaid fraud scams, intentional healthcare fraud in Baton Rouge, Louisiana is rare. In fact, most incidents that trigger fraud investigations involve simple organizational and human errors. For example, the following are all common mistakes that frequently lead to fraud investigations, but which typically do not rise to the level of criminal intent:
- Hiring and using unqualified employees
- Inadequate supervision
- Relying heavily on delegation or outsourcing
- Corporate error
- Human error from oversight or from feeling overwhelmed
- No effective Medicare/Medicaid compliance program in place
When facing a federal investigation, you should never assume that you have done something wrong. You should not give in to the investigators tactics, and you should never suggest that you think you may have violated the law. Our track record speaks to the fact that facing an investigation does not amount to a guilty verdict, and when we take your case, we will fight to help you emerge from your investigation with no civil or criminal liability.
Choose Your Legal Representation Wisely
Make the Right Choice: A Healthcare Fraud Defense Lawyer
You need an experienced healthcare fraud defense lawyer. An experienced fraud defense lawyer will combine the best qualities of criminal lawyers and healthcare attorneys, and will have specific experience with your type of case. The healthcare fraud defense attorney whom you choose should be intimately familiar with Medicare/Medicaid billing practices and the nuances of federal healthcare law, and should also have proven experience preventing investigations from turning into criminal prosecutions.
As a result, before paying any money to a defense attorney, we recommend that you test the lawyer’s experience with the following important questions:
- How many Medicare/Medicaid Fraud cases have you handled so far?
- How many of the healthcare fraud cases that you handled resulted in no civil and no criminal charges or dismissals for your clients?
- How many healthcare fraud cases have you tried in court?
Why Choose Oberheiden, P.C.?
Oberheiden, P.C. brings decades of experience to help defend clients in Medicare/Medicaid fraud investigations in Baton Rouge. Our healthcare fraud defense attorneys have handled over 1,000 healthcare proceedings and conducted more than 200 criminal trials, and many come from senior positions within the DOJ. In short, we offer:
- A proven track record of success
- In-depth industry knowledge
- Familiarity with federal healthcare and criminal laws
- Experience in litigation and trials
Our clients range from individuals to entire healthcare systems. We regularly represent business owners, healthcare executives, lawyers, healthcare providers, hospitals, hospices, pharmacies, laboratories, medical device companies, and other entities in the healthcare industry in Baton Rouge. If you are facing a Medicare/Medicaid fraud investigation involving any of the following agencies, we encourage you to contact us immediately for a free case evaluation:
- The Department of Defense
- The Department of Justice
- The Drug Enforcement Administration
- The Federal Bureau of Investigation
- The Internal Revenue Service
- The Medicaid Fraud Control Unit
- The Office of Inspector General
- Baton Rouge law enforcement
- Other state and federal law enforcement agencies
Our Track Record
- Defense of Medicare/Medicaid laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare/Medicaid fraud.
Result: No civil or criminal liability.
- Defense of a healthcare 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/Medicaid laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged healthcare fraud.
Result: No civil or criminal liability.
- Defense of nationally operating healthcare company against an investigation by the Department of Defense for alleged Tricare fraud.
Result: No civil or criminal liability.
- Defense of healthcare marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare/Medicaid 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/Medicaid 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/Medicaid 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 healthcare 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/Medicaid 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.
Defense Attorneys Serving Baton Rouge
Dr. Nick Oberheiden is a Harvard-trained and internationally educated healthcare fraud defense attorney who helps clients in the Baton Rouge, Louisiana area. Dr. Oberheiden has successfully represented healthcare executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during political corruption charges, government investigations, and with media campaigns, including 60 Minutes. He is best known for his ability to stop federal investigations before criminal charges can be filed. In addition to his healthcare defense practice, he leads internal investigations, implements corporate compliance programs to assist his clients, and teaches U.S. criminal law and federal litigation in the United States and abroad.
Lynette S. Byrd is a former Assistant United States Attorney (AUSA). Clients located in Baton Rouge will greatly benefit from her experience of prosecuting healthcare fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. She has immense experience with healthcare law enforcement, and she regularly argues federal matters for her clients.
We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form to request a free consultation.
Including Weekends