Florida Medicare/Medicaid Fraud Defense Attorneys

Experienced Legal Defense for Medicare/Medicaid Fraud Charges in Florida

If you’re in the State of Florida and facing an allegation of Medicare/Medicaid fraud, you need an experienced Medicare/Medicaid fraud defense law firm. The Oberheiden, P.C. represents clients in the State of Florida being accused of Medicare/Medicaid fraud, healthcare fraud, during federal criminal matters, and in other legal matters. Additionally, we can help healthcare providers, entities, and businesses minimize the risk of being accused of Medicare/Medicaid fraud. We do this by helping clients with regulatory compliance and corporate structuring. Our team of experienced lawyers is headed by a former Chief Healthcare Fraud Coordinator from a U.S. Attorney’s Office. Oberheiden attorneys have prestigious legal credentials and many have former federal prosecutor and senior trial experience with both the Department of Justice and the Medicare Fraud Strike Force. We serve clients throughout the entire State of Florida.

Oberheiden, P.C. is a law firm practicing in healthcare law defense. We have significant experience in regulatory compliance, corporate structuring, litigation, federal government investigations, and criminal defense. Our attorney roster includes a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, former senior Department of Justice prosecutors, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented and knowledgeable attorneys with years of relevant experience and education from the country’s best schools, including Harvard and Yale Law Schools. Our attorneys provide services throughout the State of Florida.

What You Should Know About Medicare/Medicaid Fraud

Medicare/Medicaid fraud begins when there is a submission of one or more false claims to a federal healthcare program. These claims are filed by healthcare providers, businesses, and entities that are reimbursed for services or equipment provided to the patient. Medicare/Medicaid fraud is a federal offense that has both civil and criminal penalties. It’s not exclusive to the Medicare/Medicaid program, despite its name. It includes false claims filed with any federal healthcare program including Medicare, Medicaid, Tricare, or federal workers’ compensation. Being accused of Medicare/Medicaid fraud means that you’re being investigated for violating at least one of the following laws:

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

Florida healthcare providers, businesses, pharmacies, and entities are investigated for Medicare/Medicaid fraud more often than most other locations in the United States. Florida has a large number of citizens who are recipients of federal healthcare program benefits. Because of this, more claims are filed in the area. This makes it one of nine locations in the United States that is more closely watched by the Medicare Fraud Strike Force. The federal government believes that the increase in claims directly relates to an increase in instances of Medicare/Medicaid fraud.

The Medicare Fraud Strike Force watches for, investigates, and prosecutes Medicare/Medicaid fraud. This is a federal team of investigators and prosecutors from various federal agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. Being contacted by the Medicare Fraud Strike Force is a grave concern. Contact Oberheiden, P.C. immediately to book your confidential initial consultation.

Medicare/Medicaid Fraud Investigations in Florida

Medicare/Medicaid fraud investigations in Florida happen when a provider, entity, or business files a claim that has inaccuracies with a federal healthcare program. The federal government catches the inaccuracies and labels the claims as a fraudulent billing or reimbursement request. These claims may include unauthorized, false, or excessive charges. The most common Florida inaccuracies that trigger a Medicare/Medicaid fraud investigation 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 healthcare)
• Double billing
• Upcoding
• Inflating charges
• Overusing medical equipment or services
• Providing or accepting kickbacks

One of the most common questions that we’re asked is: Who in Florida is most susceptible to Medicare/Medicaid fraud investigations? The answer is doctors, nurses, healthcare service providers, physician owned entities, nursing homes, registered care facilities, hospitals, clinics, laboratories, pharmacies, DNA centers, cancer centers, and DME providers. However, regardless of what service or equipment you provide in the Florida healthcare industry, if you file claims with a federal healthcare program, you are at risk of being investigated for Medicare/Medicaid fraud.

Civil and Criminal Penalties

Medicare/Medicaid fraud investigations in Florida can culminate into civil and criminal penalties. You could be charged in civil or criminal court. Civil penalties for Medicare/Medicaid fraud in Florida 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 healthcare programs
• Treble damages
• Attorney fees

Additionally, you could be called before the state disciplinary or licensing board. You could lose your professional license and your hospital privileges.

Criminal penalties for Florida Medicare/Medicaid fraud are very serious. You may be subject to 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.

Identifying the Best Florida Defense Attorney

Now that you know just how serious Medicare/Medicaid fraud penalties can be, you’re likely considering your legal options. It is imperative that you are able to identify, select, and retain the best Florida defense attorney. Should you hire a Florida healthcare attorney? Should you hire a Florida criminal defense lawyer? Is there an option specifically for Medicare/Medicaid fraud?

Although a Florida healthcare attorney understands the complexities involved in healthcare law, you may still be left vulnerable in a Medicare/Medicaid fraud case. Generally, Medicare/Medicaid fraud will result in additional criminal charges such as tax fraud, wire fraud, money laundering, and mail fraud. Most healthcare lawyers do not have experience with federal criminal charges. Instead, you need a criminal defense attorney that has trial or negotiation experience for these types of cases.

Florida criminal defense attorneys often practice in state courts. Most do not have federal experience. This could leave you susceptible to facing federal criminal charges.

There is a legal option available specifically for Medicare/Medicaid fraud defense in Florida. You should look for a healthcare fraud defense attorney. A healthcare fraud defense lawyer is experienced in both healthcare law and federal criminal law. This defense attorney will also have negotiating experience with the federal government and federal trial experience. As you research healthcare fraud lawyer options, look for these four signs:

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

To learn more about the experience level of the healthcare fraud defense attorney, ask the following three questions:

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?

Compelling Medicare/Medicaid Fraud Defense

Oberheiden, P.C. looks specifically at each Florida Medicare/Medicaid fraud case to develop compelling Medicare/Medicaid fraud defenses. While we do seek a peaceful resolution with the federal government outside of the court, we are also prepared to go to trial when necessary. To date, we’ve taken more than 200 cases to trial. Several attorneys with our firm have experience as senior level federal healthcare fraud prosecutors and with the Medicare Fraud Strike Force. We use the following compelling Medicare/Medicaid fraud defense principles to assist our clients:

Prompt contact with the federal government. The primary goal of Oberheiden, P.C. for our clients is to successfully resolve Medicare/Medicaid fraud investigations and protect our clients from federal criminal charges. The best strategy to accomplish this is prompt contact with the federal government. This provides our Healthcare Fraud Defense Team the opportunity to get answers to important questions related to the case and to begin to advocate on your behalf. Within hours of our engagement, we can usually get answers to the following questions about your case:

• 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?

If you’re being investigated for Medicare/Medicaid fraud, call Oberheiden, P.C. right away. It is imperative that you do not allow the federal government to have too much uninterrupted time to investigate you.

Assessing federal evidence. The federal government must present evidence to show that you committed Medicare/Medicaid fraud. The evidence must meet a high standard known as “beyond a reasonable doubt.” We assess the presented evidence to determine whether it meets this standard. Because we do this, we see the following results on a regular basis:

• 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. In addition to evidence, the federal government must also show that you acted with criminal intent. Criminal intent means that you planned to commit Medicare/Medicaid fraud. This is a difficult standard for the federal government because most instances of Medicare/Medicaid fraud in Florida are started because of mistakes made by a provider, facility, or business in regard to their billing or coding. The most common issues that result in these mistakes 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 should be addressed and corrected, they should not be treated as criminal activities. Mistakes should not be subject to criminal penalties. Our objective is to show the federal government that you did not commit a crime, but that you do understand the importance of addressing and correcting your mistakes.

Strategic Medicare/Medicaid fraud defenses. Medicare/Medicaid fraud cases need strategic defenses. Each case is different because of the surrounding facts. Oberheiden, P.C. analyzes each case to develop strategic and appropriate Medicare/Medicaid fraud defenses. One of our recent clients was accused of fraudulently certifying home healthcare services. We proved to the federal government that our client was legally protected by a recognized delegation exception that made their certification fully compliant within the law. In another recent case, we would not admit liability on behalf of our client. We were able to prove to prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. provides legal representation for Florida healthcare providers, entities, and related businesses accused of Medicare/Medicaid fraud. We’ve assisted healthcare businesses, owners, executives, lawyers, individual providers, hospitals, clinics, pharmacies, labs, and other healthcare entities under investigation for fraudulent billing, illegal kickbacks, and 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 Florida. 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 Florida state law enforcement, call Oberheiden, P.C. right away. Initial consultations are free and confidential.

Medicare/Medicaid Fraud Defense Lawyers Serving Florida

Dr. 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 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.