Passionate Legal Representation for Health Care Professionals in Southern Florida
The consequences of a health care fraud investigation can turn your world around. You can be hit with everything from hefty fines, to the loss of your credentials, the end of your career, and even time in prison.
It’s a terrifying thought for most people in the medical field, who know that health care laws are constantly changing but who have a hard time keeping up with them. After all, doctors aren’t lawyers.
But the federal government expects steadfast compliance with its complex system of regulations, and it is prepared to bring the full force of its power down on any physician, assistant, pharmacist, or owner who messes up.
In fact, in Miami, the feds have set up an entire office dedicated to that singular goal. The Miami Medicare Fraud Strike Force is one of just nine such offices in the country. It’s part of a national crackdown effort called HEAT (Health Care Fraud and Prevention and Enforcement Action Team). It is backed by the endless resources of numerous federal agencies, including the Department of Justice, the FBI, the U.S. Attorney General, the Inspector General, the Health and Human Services Department, and beyond.
The Strike Force has arrested more than 2,000 people in just ten years, and many of them are health care professionals. Moreover, most of those 2,000 people are located in or near the nine cities that host the Strike Force:
- Miami, FL
- Tampa Bay, FL
- Baton Rouge, LA (covering southern Louisiana)
- Dallas, TX
- Houston, TX (covering southern Texas)
- Brooklyn, NY
- Detroit, MI
- Chicago, IL
- Los Angeles, CA
That means medical practitioners and clinics in Miami are very much on the radar for federal investigators. Indeed, the fact that two of these nine offices are located in Florida means Miami investigators can stay laser-focused on Magic City and its immediate communities. Southern Florida is home to an unusually high number of Medicare and Medicaid beneficiaries, further attracting federal attention.
So how should you handle a federal audit or investigation pertaining to potential health care fraud? Very carefully.
The government’s goal in these cases is to arrest, charge, and convict people of crimes or other legal violations. Agents are under a lot of pressure to crack down on waste and to save taxpayer money, so they are eager ? frequently too eager ??to prove their effectiveness.
If you are currently facing a Miami health care fraud investigation, proceed with caution. Your career and even your freedom may be at stake. Criminal convictions for health care fraud can stem from very small mistakes. In fact, you may not realize you’ve made an illegal error at all.
Contact the Miami health care federal law fraud defense attorneys at Oberheiden, P.C. right away. We can help you navigate the process, negotiate with prosecutors and investigators, and in many cases, steer clear of criminal charges.
Our aggressive team of former federal prosecutors is ready to relentlessly protect your rights and your business interests in the face of overeager federal agents. Contact us today.
Types of Health Care Fraud Cases in Miami, Florida
Health care fraud can involve a wide range of accusations. These include:
- Submitting bogus claims for payment from the U.S. Government (False Claims Act violations)
- Giving or receiving kickbacks in exchange for patient referrals (Anti-Kickback Statute violations)
- Referring patients to organizations with which you have some financial relationship ? which often happens by accident ? but can still result in legal liability under the Stark Law even if the referral is unintentional
- Improper coding when invoicing the government for services payable by Medicare, Medicaid, or other federal health care services
- Performing medically unnecessary services or procedures
- Violating the Controlled Substances Act when writing or filling prescriptions
- Billing inefficiently
- Inflating charges or double billing
- Billing the government for services you did not actually provide (i.e., “phantom billing”)
Examples of Miami Medicare Fraud Strike Force Takedowns
- In 2008, federal prosecutors charged eight Miami-Dade County residents in a 16-count indictment alleging they billed Medicare for fake HIV infusion treatments.
- In 2012, prosecutors negotiated a guilty plea from the owner of a health care organization in Miami on one count of conspiracy to commit health care fraud. The owner also agreed to give the government two of his residential properties and the cash proceeds in his several bank accounts as forfeitures.
- Also in 2012, the FBI partnered with the Strike Force to target a man in Plantation, FL for allegedly recruiting Medicare beneficiaries in a $200 million fraud scheme.
- In 2016, the Strike Force arrested the owner of more than 30 Miami-area skilled nursing and assisted living facilities, alleging a decade-long conspiracy to submit fraudulent invoices to Medicare. Two other Miami health care providers were charged as co-conspirators.
Defense Strategies for Miami Health Care Fraud Cases
Investigations for health care fraud are scary. If you’ve been accused of wrongdoing, it’s easy to feel like you’ve abruptly reached the end of the road in your career ? but there is hope.
As you will see below, our office has helped many business owners, doctors, and other health care providers. Together, we have overcome everything from high-profile audits and multi-agency investigations, to full-blown felony charges.
Our Miami health care federal law fraud defense attorneys are good at what they do. Drawing on their experience from years as federal prosecutors on health care fraud cases, our attorneys understand the strategies that work. Depending on the circumstances of your case, these might include:
- Negotiating with the government early in the process. In many of these cases, the government is trying to make something out of nothing ??but by the time they realize that, your business and reputation might already have been turned upside down. An experienced defense attorney may be able to negotiate with the government to facilitate an early endgame such that investigations are halted quickly. This is often the single most effective strategy. The longer investigations go on, the more likely the government is to find something it is willing to prosecute.
- Challenging the intent element. Most (though not all) health care fraud offenses require the government to prove the defendant knowingly or willfully violated the law. An attorney can argue aggressively against this intent element in your case, holding the government to the highest legal standard. Examples of unintentional errors that commonly trigger investigations into health care fraud include:
- Using unqualified or untrained staff
- Providing inadequate supervision for staff
- Delegating or outsourcing work
- Structural or organizational mistakes
- Human errors
- Simple oversight
- Overwhelmed employees
- Failure to implement a Medicare compliance program
- Complying with outdated law rather than recent changes
- Finding relevant exceptions. Most health care fraud laws include various exceptions and safe harbor provisions, and you may very well qualify for them ??but you shouldn’t expect the government to tell you that. Always remember that federal prosecutors do not represent your best interests, but a Miami health care defense lawyer can. For example, we recently handled a case in which the government accused our client of fraudulently certifying home health care services to Medicare. We successfully argued that our client was protected under a safe harbor exception that rendered them fully compliant with applicable health care law.
- Defending your medical expertise. Prosecutors aren’t doctors. When they try to argue that the treatment of a patient was “medically unnecessary,” we may be able to challenge that assertion. The government has the burden of proof.
- Questioning evidence. The Federal Rules of Evidence are numerous, very strict, and often work in the defendant’s favor. Our defense attorneys have the legal expertise it takes to successfully challenge prosecutors on the relevance, persuasiveness, and admissibility of purported evidence.
Our Results in Medicare & Health Care Fraud Defense Cases
The Miami health care federal law fraud defense attorneys at Oberheiden, P.C. achieve the following kinds of results in health care fraud cases on a regular basis:
- Case dismissed
- No criminal charge
- No civil liability
- No prison sentence
- Investigation comes to a close
- Clients maintain their professional license
- Civil fine without a criminal plea
- Reduction of a felony to a misdemeanor
Our Miami Health Care Federal Law 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 health care law, including health care fraud, federal enforcement actions and the Medicare Fraud Strike Force (Miami). He has successfully defended numerous individuals and corporate clients (including doctors and health care 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 the Miami 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 health care 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 health care providers and their organizations against enforcement actions brought on by the Strike Force and other federal offices.
Contact the Aggressive Federal Defense Lawyers at Oberheiden, P.C.
If you or your practice is currently facing an audit or investigation involving an alleged violation of federal health care law in southern Florida, you should take immediate action to protect your legal interests. Please contact Oberheiden, P.C. right away.
To schedule a free and confidential consultation with a federal health care law defense attorney for Miami, simply dial (888) 727-0472 or contact us online as soon as possible.