Strategic Legal Representation for Healthcare Professionals in Michigan

Oberheiden, P.C. is a Federal Healthcare Law Criminal Defense Law Firm that represents private individuals who are being charged, audited, or investigated by the federal government. We also provide legal services to the companies and clinics affected by these investigations. We have an experienced and proven Detroit Healthcare Fraud Defense Lawyer to help.

While our firm’s practice federal healthcare law practice has a multistate presence, much of our healthcare defense work is focused on the nine cities the federal government has identified as a target for Medicare and healthcare fraud, including Detroit.

Healthcare fraud can happen anywhere and may take many forms, but providers working in Detroit are at a higher risk of investigation and prosecution because of the Detroit HEAT Strike Force (more below).

These investigations are serious and the potential consequences are dire but our experienced attorneys can take a determined stand against the government. We fight to end investigations, negotiate away any potential criminal charges, and protect the people we represent.

Medicare Fraud in Detroit

Detroit’s Medicare Fraud Strike Force is part of the federal government’s HEAT program (the Healthcare Fraud and Prevention and Enforcement Action Team). It is a cooperative effort by the United States Department of Health and Human Services (HHS) and Department of Justice (DOJ) not only to punish fraud, but also to prevent it.

Unfortunately, those efforts often come at the expense of caution, prudence, and justice. Failing to exercise appropriate prosecutorial discretion, the federal government tends to swoop in and apply hefty felony charges in cases where the so-called “crime” amounts to little more than an accidental error.

The Detroit Strike Force is supposed to have a national focus, but in truth, its crackdown efforts are focused on the Detroit metro area, where scores of healthcare professionals have been directly targeted in the last ten years alone.

Most allegations of Medicare fraud in Detroit trace back to a billing error, which the government will insist was an intentional attempt to defraud the U.S. of taxpayer dollars. That is rarely the case. Our federal criminal defense law firm can help to fight back against excessive investigations and trumped-up charges. Having a dedicated and proven Detroit Healthcare Fraud Defense Lawyer on your side can help you through this.

False Claims Act Cases in Detroit

The False Claims Act is a federal law that targets waste, fraud, and abuse affecting numerous federal agencies. It applies to anyone who enters into a contract with the United States government wherein the U.S. will pay that person for services.

Under the False Claims Act, anyone who knowingly submits a bogus or otherwise fraudulent claim for payment (e.g., an invoice) is legally liable. Both civil and criminal penalties can apply.

Whereas most Medicare Fraud Strike Force investigations begin because of a billing error, most False Claims Act cases begin when a private third party files a civil qui tam lawsuit against you in a Michigan state district court.

Qui tam is Latin for “he who sues for the king and for himself.” It happens when a private party sues you on behalf of the government. The lawsuit itself isn’t a government enforcement action, but it usually gets the attention of federal investigators, who then pile on with False Claims Act charges.

Unfortunately, the motives in qui tam lawsuits are seldom pure. The person suing you may be a disgruntled employee, patient, or competitor, and they are often eligible for a reward for bringing the suit on the government’s behalf. It’s a distinctly unfair system that disproportionately targets hardworking healthcare providers.

If you’ve been accused of violating the False Claims Act in Detroit, our Detroit Healthcare Fraud Defense Lawyer can help. Please contact us right away.

Stark Law Violations in Detroit

Stark Law refers to a series of federal provisions that prohibit physicians from referring Medicare or Medicaid patients to certain healthcare service providers if the physician has a financial relationship with that provider (commonly known as a “self-referral”).

In the early days of Stark Law, the prohibition applied only to referrals from doctors to labs. But the federal government has consistently expanded its application to cover many other kinds of relationships, including:

  • Home health agencies
  • Pharmacists
  • Therapists
  • And a wide range of other providers

The Stark Law carries stiff penalties, which is a concern because, unlike the False Claims Act, it is a strict liability law. In other words, the government does not need to prove you intended to violate the law. Merely making an improper referral (or billing for a so-called self-referral) will make you liable, whether you realized you were doing it or not.

It’s a broad law, and in today’s complicated and interconnected commercial world, navigating it is very difficult. For example, many doctors own stock in various private corporations. They might unwittingly refer a patient in good faith to a service provider owned by a company in which the doctor holds stock. These kinds of cases should not be able to derail a doctor’s career.

Fortunately, there are several exceptions and “safe harbor” provisions in place. An experienced Detroit Healthcare Fraud Defense Lawyer can fight Stark Law application by showing that these exceptions apply.

Anti-Kickback Statute Violations in Detroit

The Anti-kickback statute refers to a similar provision that punishes physicians for exchanging “anything of value” for a referral (or any other business opportunity). It applies to all federal healthcare benefit programs. Unfortunately, the statute’s definition of “kickback” and “referral” is much broader than most care providers realize.

Because kickbacks are defined as “anything of value,” they might include:

  • Bribes
  • Rebates
  • Gifts
  • Leases
  • Equipment
  • Employment contracts
  • Other arrangements that allegedly depart from “fair market value”

To take action under the Anti-kickback statute, the government must prove the defendant knowingly and willfully gave, received, or solicited a remuneration in return for patient referrals. Our Detroit Healthcare Fraud Defense Lawyer fights aggressively against the intent element, which the prosecution must prove in order to convict.

Other Healthcare Fraud Cases in Detroit

The Detroit healthcare fraud defense attorneys at Oberheiden, P.C. are also available to assist with:

  • Prescription fraud
  • Fraudulent billing
  • IRS tax fraud
  • DEA investigations
  • Controlled Substance Act violations
  • Federal drug charges
  • Government audits
  • Any other legal issue related to healthcare fraud

Get good advice on your side. Contact Oberheiden, P.C. right away.

Examples of the Detroit Medicare Fraud Strike Force Taking Action in Michigan

  • In 2015, the Detroit Medicare Fraud Strike Force arrested 16 individuals, including six doctors, a social worker, a pharmacist, and two physical therapists on a variety of purported kickback schemes and other alleged healthcare fraud efforts.
  • In 2016, the owner and operator of a Detroit-area home healthcare agency entered a guilty plea in connection with a $4 million healthcare fraud scheme.
  • In March 2016, a Detroit-area doctor was sentenced to 45 months in prison for prescribing medically unnecessary controlled substances and billing for bogus diagnostic tests and office visits.
  • Also in 2016, the Justice Department accused a Detroit clinic of operating as a front for a narcotics diversion scheme responsible for $36 million in fraudulent Medicare billing.
  • In 2017, a Detroit podiatrist was charged with participating in a $13.9 million healthcare fraud scheme in which he allegedly performed unnecessary foot surgeries on patients. He was also alleged to have filed claims for other podiatric services he never actually performed.
  • Also in 2017, a Michigan federal jury found a Detroit-area doctor, as well as the owner of a medical billing company, guilty of perpetrating a $28 million Medicare fraud scheme involving pain treatments that were billed for but never actually provided.

Who Are the Most Common Defendants in Detroit Healthcare Crime Cases?

Common targets for investigation and prosecution related to healthcare fraud in Detroit include:

Individuals

  • Business owners / co-owners
  • Dentists
  • Directors
  • Doctors
  • Executives
  • Nurses
  • Nursing home employees
  • Pharmacists
  • Physician’s Assistants
  • Registered Nurses
  • Surgeons
  • Other healthcare service providers

Businesses

  • Cancer treatment centers
  • Clinics
  • DNA Centers
  • Healthcare marketing companies
  • HMOs
  • Hospitals
  • Laboratories
  • Medical equipment vendors
  • Nursing homes
  • Pharmacies
  • Registered care facilities

It is vital that you contact our Detroit Healthcare Fraud Defense Lawyer to discuss your situation soon.

Our Detroit Healthcare Fraud Defense Attorneys

Dr. Nick Oberheiden is an experienced attorney, author, and legal contributor to media outlets. He has significant experience on issues pertaining to federal healthcare law, including healthcare fraud, federal enforcement actions and the Medicare Fraud Strike Force (Detroit). He has successfully defended numerous individuals and corporate clients (including doctors and healthcare practices) against federal criminal charges and regulatory enforcement actions. Dr. Oberheiden holds a PhD in law, a Juris Doctorate from the UCLA School of Law, and has been trained in negotiation at Harvard Law School.

Lynette S. Byrd defends both individual and corporate clients who are accused of federal crimes or under investigation by state / federal agencies, including by Detroit’s Medicare Fraud Strike Force. Ms. Byrd is a former federal prosecutor, and she served for several years as an Assistant U.S. Attorney for the Northern District of Texas. While representing the federal government, she worked on a number of high-profile cases, including one of the largest healthcare fraud cases in her district, and collected millions of dollars for the government on behalf of taxpayers. Today, she puts her experience as a former prosecutor to work for healthcare providers and their organizations against enforcement actions brought on by the Strike Force and other federal offices.

Talk to the Experienced Medicare Fraud Legal Representatives at Oberheiden, P.C. Today

If you or your practice is currently facing an audit or investigation involving an alleged violation of federal healthcare law, you should take immediate action to protect your legal interests. Please contact a Detroit Healthcare Fraud Defense Lawyer at Oberheiden, P.C. as soon as possible.

We are pleased to offer free and confidential consultations. To speak with our Detroit Healthcare Fraud Defense Attorneys, simply dial (888) 727-0472 or contact us online as soon as possible.