If you’re in Miami, Florida and you’re being investigated for Medicare/Medicaid fraud, you need a powerful legal advocate. The Oberheiden, P.C. provides Medicare/Medicaid fraud defense for individual practitioners, entire hospital systems, clinics, and healthcare businesses. Dr. Nick Oberheiden is the managing principal partner.
Defining Medicare/Medicaid Fraud
Medicare/Medicaid fraud is an extremely serious federal offense that can have both civil and criminal penalties. It is the submission of false claims to a federal government healthcare program. It doesn’t have to be Medicare. It can be Medicaid, Tricare, or federal workers’ compensation. It can include a violation of at least one of the following statutes:
- Stark Law (Physician Self-Referral Law)
- False Claims Act
- Anti-Kickback Statute
- Social Security Act
- U.S. criminal code
The goal of Medicare/Medicaid fraud is to receive an illegal payment from a federal government healthcare program. In Miami, Florida there are a large number of Medicare/Medicaid beneficiaries. When a large amount of claims is filed in Miami, Florida through CMS, the government watches the area closely for instance of Medicare/Medicaid fraud. Miami, Florida is one of nine areas in the United States that is monitored by a Medicare Fraud Strike Force. The Medicare Fraud Strike Force is composed of investigators and prosecutors from multiple federal agencies. The ultimate goal is to monitor, investigate, and prosecute Medicare/Medicaid fraud.
Medicare/Medicaid fraud allegations can mean that you come into contact with investigators and prosecutors from many federal agencies including DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and more. Medicare/Medicaid fraud is extremely serious, and you can face civil and criminal penalties in addition to losing your license and your hospital privileges.
The Most Common Form of Medicare/Medicaid Fraud in Miami, Florida
Medicare/Medicaid fraud investigations in Miami, Florida occur most often because of what the government believes to be fraudulent billing practices and reimbursement requests. This most often includes false charges, excessive charges, or charges that weren’t authorized by the federal government healthcare. In Miami, Florida, the most common billing issues that result in Medicare/Medicaid fraud includes:
- Phantom billing (billing for services that weren’t performed)
- Billing for medically unnecessary services or equipment
- Billing for equipment or services that weren’t ordered
- Billing for medically unnecessary services or equipment
- Certifications for medically unnecessary supplies (such as DME) or services (such as hospice care)
- Inflating charges
- Double billing for treatment, services, or equipment
- Upcoding for treatment, disorders, services, or equipment
- Overuse of services or equipment
- Providing or accepting kickbacks
In Miami, Florida, the most common individuals and entities that face Medicare/Medicaid fraud investigations include doctors, nurses, healthcare services, nursing homes, registered care providers and facilities, hospitals and clinics, pharmacies, labs, DME providers, DNA centers, and cancer centers.
Understand the Civil and Criminal Penalties
Medicare/Medicaid fraud investigations have serious civil and criminal penalties. You could face civil penalties, criminal penalties, or both. Civil penalties may include:
- Civil fines up to $11,000 per false claim
- Recoupment requests
- Non-payment of future claims
- Future exclusions from federal healthcare programs
- Treble damages
- Paying attorney fees on behalf of the government
Criminal penalties are also extremely serious:
- Fines that cost you hundreds of thousands of dollars
- A criminal record
- 10 years of federal prison time for each count of Medicare/Medicaid fraud
- 20 years for each count of Medicare/Medicaid fraud if it results in serious bodily injury
- A life sentence if the Medicare/Medicaid fraud results in the death of the patient
In addition to these civil and criminal penalties, you could lose your license to practice or face disciplinary action. You could also lose your hospital privileges.
Choosing the Right Miami, Florida Defense Lawyer
Medicare/Medicaid fraud can affect your entire life. You could lose your license, face criminal charges or even jail, and have to pay fines. It’s extremely important that you choose the right Miami, Florida defense attorney. You need to look for a defense law firm who displays the skills and experience you need to help you with these federal claims.
Many Miami, Florida healthcare practitioners and healthcare businesses initially believe that they should hire a healthcare attorney. The issue here is that Medicare/Medicaid fraud is often charged alongside of serious federal criminal charges such as tax evasion, wire fraud, mail fraud, and money laundering. A healthcare attorney may not have the federal criminal defense skills that you need.
Despite their knowledge of healthcare laws, they may not have the skills to negotiate with the federal government or to face federal prosecutors in court.
When healthcare providers and businesses discover that they may be facing criminal charges, they look to hire a Miami, Florida criminal defense attorney. However, most criminal defense lawyers are experienced in DUI, assault, burglaries, and drug crimes. They don’t have federal crime experience. They also may not have the necessary experience and knowledge pertaining to billing, coding, and medical utilization rules. Despite their experience with criminal law, you need to understand the seriousness of your charges. You will not have time to teach the attorney about healthcare law.
Your ideal choice is healthcare fraud defense lawyer serving the Miami, Florida area. As you consider your options, consider the following four traits:
- A proven track record of success in Medicare/Medicaid fraud cases
- Industry knowledge
- Deep familiarity with healthcare laws and their exceptions
- Litigation and trial experience
Before you pay a retainer, you should ask three specific questions to ascertain the true nature of the attorney’s experience in Medicare/Medicaid fraud:
- How many Medicare/Medicaid fraud cases have you handled during your career in law?
- How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
- How many Medicare/Medicaid fraud cases did you try in court?
Using Proven Medicare/Medicaid Fraud Defense Strategies in Miami, Florida
Oberheiden, P.C. provides Miami, Florida healthcare entities and practitioners with strategic and applicable defenses. Many of our Medicare/Medicaid fraud defense attorneys hold previous experience in senior positions from the Department of Justice. Our clients receive a defense that is crafted for their specific facts that is based off of the incredible insight provided by our valued team members. Our goal is to resolve the investigation with a minimal risk of criminal charges for our clients.
It starts with early intervention. Over the years, we’ve learned that the best way to resolve these matters is to get involved early. If the government has too much time to investigate you without interruption, you’ll likely face criminal charges. We contact the investigating federal agencies and get answers within hours of our engagement.
- 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?
We question their evidence. The federal government must prove beyond a reasonable doubt that you’ve committed a crime. To do this, they must present evidence. We question the evidence in each case that we take on. We’ve routinely seen 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
We point out lack of criminal intent. In addition to the government’s requirement to provide evidence that you’ve committed a crime, they must also show that you had criminal intent. This is a burden to the government because most of the items that prompt a Medicare/Medicaid fraud investigation in Miami, Florida occur because of someone making an honest mistake. These mistakes include:
- The use of unqualified or untrained staff
- Lack of adequate supervision
- Delegation and outsourcing of work
- Structural or organizational mistakes
- Human errors
- Oversight
- Overwhelmed employees
- No Medicare/Medicaid compliance program
- Quickly changing healthcare laws and rules
Miami, Florida actually sees very few instances of legitimate Medicare/Medicaid fraud. Yet, businesses and practitioners who make honest mistakes are prone to believing that their mistake is tantamount to a criminal act. They’re willing to accept the criminal repercussions of their actions. Many are not able to continue to work in the medical field. We address the lack of criminal intent and work to show the government that you made an honest mistake that should be treated like a criminal matter even if the mistake shows that you do have problems within your business that must be addressed.
The use of applicable defenses. Every case is different. Oberheiden, P.C. reviews each case and determines strategic and applicable defenses that are available. Recently, we handled a Medicare/Medicaid fraud case where the government alleged fraudulent certification for healthcare services by our client. We were able to prove to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant within the law. In another Medicare/Medicaid fraud case, we refused to admit liability. We were able to prove to prosecutors that our client acted within a safe harbor exception.
Oberheiden, P.C.
Oberheiden, P.C. provides experienced Medicare/Medicaid fraud defense for Miami, Florida 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 healthcare entities in Miami, Florida. If you’re under investigation 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 Miami or Florida law enforcement, call us right away. Initial consultations are confidential and free of charge.
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 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.
Miami, Florida Medicare/Medicaid Fraud Defense Attorneys
Dr. Nick Oberheiden is a Harvard-trained and internationally educated healthcare fraud defense attorney. Dr. 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.
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Including Weekends