Experienced Legal Defense Team Fighting Medicare/Medicaid Fraud Charges throughout California

Medicare/Medicaid fraud in California is an allegation that is frequently made against providers, medical clinics, and businesses. If you’re being accused of Medicare/Medicaid fraud, call Oberheiden, P.C. now. We are a healthcare fraud defense law firm that provides legal representation for Medicare/Medicaid fraud, federal criminal matters, and with other legal issues. Additionally, we assist clients with problems involving federal compliance or who are involved in civil or criminal government investigations. Oberheiden, P.C.’s defense team is managed by a former Chief healthcare Fraud Coordinator from the U.S. Attorney’s Office. Our fraud defense lawyers have educations from some of the best law schools in the nation and many have former federal prosecutor and trial experience. We serve clients in the entire State of California.

Nurses, doctors, other healthcare providers, entities, and businesses operating in California are often faced with allegations of Medicare/Medicaid fraud by the federal government. Now, healthcare providers, hospice centers, hospitals, physician owned entities, and other related healthcare businesses accused of Medicare/Medicaid fraud in California can retain one of the nation’s best healthcare fraud defense teams: Oberheiden, P.C. They provide Medicare/Medicaid fraud defense for individual healthcare practitioners, hospital systems, businesses, clinics, lawyers, executives, and other healthcare entities. Dr. Nick Oberheiden is a Harvard-trained healthcare fraud defense lawyer and negotiator. Dr. Oberheiden is known for his healthcare defense experience. He is the managing partner of the Oberheiden, P.C..

Definition of Medicare/Medicaid Fraud

Medicare/Medicaid fraud happens when there is a submission of one or more false claims to a federal government healthcare program. These claims are filed to receive money from the program for equipment or services provided to the patient. Medicare/Medicaid fraud is a federal offense with both civil and criminal penalties. Despite the name, Medicare/Medicaid fraud isn’t just relegated to false claims under that specific federal healthcare program. Rather, it includes claims submitted to Medicare, Medicaid, Tricare, or federal workers’ compensation. When the federal government accuses you of Medicare/Medicaid fraud, you’re being accused of breaking 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

California healthcare providers, businesses, pharmacies, and other related healthcare entities are investigated more frequently than the majority of the peers in the United States. This is because California has a high number of citizens who rely on a federal healthcare program for their care. It is one of nine locations in the United States that is directly monitored for Medicare/Medicaid fraud by the Medicare Fraud Strike Force. A higher number of program recipients means that more claims are filed through CMS. The government believes that there is a higher likelihood that Medicare/Medicaid fraud will happen in California because of the increase in the number of claims that are filed.

The Medicare Fraud Strike Force is an investigative agency created by investigators and prosecutors from various federal agencies. The Medicare Fraud Strike force has representatives from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. If you are contacted by the Medicare Fraud Strike Force, you must understand that this is an extremely concerning matter. Protect yourself and your business by calling Oberheiden, P.C. right away.

Medicare/Medicaid Fraud Investigations in California

Medicare/Medicaid fraud investigations in California are often triggered because a provider, business, or other entity files a claim that is inaccurate in some way. The federal government receives the claim, reviews it, and determines that it is a fraudulent billing or reimbursement request. These claims often include charges that weren’t authorized, false charges, or excessive charges. In California, the most common billing inaccuracies that begin a Medicare/Medicaid fraud investigation are:

  • 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 healthcare)
  • Double billing
  • Upcoding
  • Inflating charges
  • Overusing medical equipment or services
  • Providing or accepting kickbacks

Most Medicare/Medicaid fraud investigations are instigated against doctors, nurses, healthcare services, physician owned entities, nursing and registered care facilities, hospitals, clinics, pharmacies, laboratories, DNA centers, cancer centers, and DME providers operating in California. However, any healthcare industry-related provider, business, or facility that files claims for reimbursement with a federal healthcare program may confront the allegation of Medicare/Medicaid fraud.

Civil and Criminal Penalties for Medicare/Medicaid Fraud

Medicare/Medicaid fraud allegations include stern civil and criminal penalties. You may be charged in civil or criminal court. Civil penalties for Medicare/Medicaid fraud in California 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 healthcare programs
  • Treble damages
  • Attorney fees

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

Criminal penalties for Medicare/Medicaid fraud are also severe. They 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/Medicaid fraud
  • Prison sentence of up to 20 years for each count of Medicare/Medicaid fraud that resulted in serious bodily harm
  • Life sentence if the Medicare/Medicaid fraud results in the death of the patient.

You Must Choose the Right California Defense Lawyer

Medicare/Medicaid fraud allegations have the distinct and dangerous possibility of affecting your life. Now that you understand the severity of the penalties associated with Medicare/Medicaid fraud, you’re most likely thinking about how to choose the right California defense lawyer. As you think about your choices, keep in mind that it is imperative that you choose the right type of lawyer. Should you choose a healthcare lawyer? Should you choose a criminal defense attorney? Is there another choice?

If you’re considering a California healthcare lawyer, keep the following thoughts in mind. Although a healthcare attorney will have specific training and experience in healthcare law, they may not be prepared to advocate for you in federal court or negotiate with federal prosecutors. Medicare/Medicaid fraud is often charged along with tax fraud, mail fraud, wire fraud, and money laundering. That means you need a defense attorney that has experience handling multiple federal charges.

If you were informed by the federal government that you will be facing federal criminal charges, you may be considering a California criminal defense lawyer. Most criminal defense lawyers are experienced with drug charges, DUIs, and assaults that are addressed at the state level. Therefore, you need a federal attorney with the experience and knowledge that you need about healthcare law or billing, coding, and medical utilization rules.

There is another option for Medicare/Medicaid fraud defense in California. You should look for a healthcare fraud defense attorney. A healthcare fraud defense lawyer has experience in healthcare law and in federal criminal law. They also have experience negotiating with federal prosecutors and appearing in federal court on behalf of clients. As you complete your research, look for these traits:

  1. A proven track record of success in Medicare/Medicaid fraud cases
  2. Industry knowledge
  3. Deep familiarity with healthcare 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/Medicaid 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/Medicaid fraud cases did you try in court?

Solid Medicare/Medicaid Fraud Defense Strategies

Oberheiden, P.C. analyzes each Medicare/Medicaid fraud case and develops solid defense strategies for California clients. We’ve taken hundreds of cases to trial. Many of our Healthcare Fraud Defense Team lawyers have previous experience as senior federal healthcare prosecutors and with the Medicare Fraud Strike Force. We combine our prosecutorial and defense experience to provide valuable insight for each of our Medicare/Medicaid fraud clients. We implement the following Medicare/Medicaid fraud defense strategies:

Early contact with federal agents. The primary objective in each California Medicare/Medicaid fraud case is to resolve the investigation and minimize the likelihood of criminal charges. To do this, we contact the involved federal agents as soon as we can. We’ve learned that this strategy is vital in successfully resolving Medicare/Medicaid fraud investigations. It provides us with the opportunity to get answers to important questions and to advocate on behalf of our clients. Within hours of being retained, we can usually get answers to the following 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?

Scrutinizing federal evidence. Legal allegations must be proven with evidence, and Medicare/Medicaid fraud is no exception. In these cases, the federal government must present evidence that meets a Constitutional standard known as “beyond a reasonable doubt.” By scrutinizing the evidence presented by the federal government, we’re able to establish whether the government is able to meet this standard. Utilizing this strategy, we often 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

Addressing the lack of criminal intent. The federal government must also show that you acted with criminal intent. This means that you had the intention of defrauding the government by submitting a false claim. This isn’t a common occurrence in California. Generally, Medicare/Medicaid fraud investigations start because a provider, entity, facility, or business made an honest mistake. They weren’t paying enough attention to their billing and coding. The most common cause of these errors include:

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

While these mistakes are serious and should be addressed and corrected, they’re not crimes. Our goal is to prove to the federal government that our clients did not act with criminal intent. They made an honest mistake that should be corrected.

Applicable Medicare/Medicaid fraud defenses. Medicare/Medicaid fraud cases all have some similarities since they revolve around the same principle. However, that doesn’t mean that each case can have the same defense. Since each case has its own set of facts that led up to the charges, Oberheiden, P.C. reviews each case. Doing so enables us to determine the best applicable Medicare/Medicaid fraud defenses for our clients. Recently, one of our clients was accused of fraudulently certifying home healthcare services. We proved to the government that our client was legally protected by a recognized delegation exception that made the certification fully compliant with the law. In another recent case, we refused to admit liability on behalf of our client. We were able to show prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. provides legal advocacy on behalf of California Medicare/Medicaid fraud clients. We’ve helped healthcare businesses, owners, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other healthcare 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:

  • Healthcare fraud defense
  • Compliance program creation and implementation
  • Internal investigations
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

Oberheiden, P.C. represents individual providers and entire healthcare systems in the State of California. 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 California state law enforcement, call us right away. Our initial consultations are free of charge and confidential.

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.

Medicare/Medicaid Fraud Defense Lawyers Serving California

Nick OberheidenDr. Nick Oberheiden has successfully represented healthcare 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 healthcare 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 healthcare fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with healthcare 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.

Including Weekends
Oberheiden, P.C.
Serving the State of California 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, P.C. is a Texas firm with headquarters in Dallas. The attorney on record limits his practice to federal law.