Missouri Medicare/Medicaid Fraud Defense Lawyer

Experienced Legal Defense Team Fighting Medicare/Medicaid Fraud Charges in Missouri

Medicare/Medicaid fraud allegations are frequent in Missouri. If you’re being investigated by the federal government for Medicare/Medicaid fraud, call Oberheiden, P.C.. We are a Medicare/Medicaid fraud defense law firm serving the State of Missouri. Our defense team is comprised of lawyers with outstanding credentials and former federal experience as both prosecutors and senior trial attorneys. Oberheiden’s lead defense attorney is a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office. We assist our clients with Medicare/Medicaid fraud defense, government investigations, and in other legal matters. We represent clients in the entire State of Missouri.

Missouri healthcare industry professionals, businesses, entities, and facilities are at risk of being accused of Medicare/Medicaid fraud. Doctors, nurses, hospice care providers, executives, lawyers, facilities, clinics, and other healthcare industry businesses and facilities in Missouri that are accused of Medicare/Medicaid fraud now have the ability to retain top healthcare fraud defense lawyers to protect their livelihood. Oberheiden, P.C. provides legal advocacy for healthcare practitioners, clinics, hospitals, businesses, physician-owned entities, businesses, and other to other healthcare industry professionals and organizations accused of Medicare/Medicaid fraud. Dr. Nick Oberheiden, a Harvard-trained lawyer who works in Medicare/Medicaid fraud defense, is the firm’s managing partner.

Medicare/Medicaid Fraud Basics

Medicare/Medicaid fraud is the submission of one or more false claims to a federal healthcare program in order to receive federal reimbursement for equipment or services. Medicare/Medicaid fraud breaks more than one federal law. You may face civil or criminal penalties. Medicare/Medicaid fraud also includes false claims submitted to Medicaid, Tricare, and federal workers compensation. The federal statutes that are broken include one or more of the following:

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

Healthcare practitioners, entities, and businesses in Missouri are investigated more frequently than in most other areas of the United States. Since Missouri has a large number of people who rely on a federal healthcare program, it is closely watched by the Medicare Fraud Strike Force. It is one of nine locations in the United States that is closely monitored. Missouri, and eight other areas, submit a large number of claims through CMS. The federal government believes that an increase in claims directly relates to an increase in Medicare/Medicaid fraud.

The Medicare Fraud Strike Force is a federal investigative team made up of prosecutors and investigators from multiple agencies. It includes members of the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. Medicare/Medicaid fraud allegations are extremely serious. If you’re contacted by the Medicare Fraud Strike Force, you should contact Oberheiden, P.C. right away.

The Main Causes of Medicare/Medicaid Fraud Allegations in Missouri

We’re often asked why Medicare/Medicaid fraud allegations occur in Missouri. Although there is one common reason, that reason also has several components. The main cause of Medicare/Medicaid fraud in Missouri is the submission of inaccurate claims. These claims are flagged by the government as fraudulent billing or reimbursement requests. It includes excessive charges, unauthorized charges, and false charges. The common components that lead to Medicare/Medicaid fraud allegations in Missouri 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

The most commonly investigated individuals and entities in Missouri include doctors, nurses, healthcare services, physician-owned entities, nursing facilities, registered care providers and facilities, hospitals, clinics, laboratories, pharmacies, DME providers, cancer treatment centers, and DNA centers. If you don’t fall into one of these categories, you’re not necessarily safe. If your business or facility submits claims to the federal government for reimbursement, you are at risk of facing Medicare/Medicaid fraud allegations.

Civil and Criminal Legal Penalties

Medicare/Medicaid fraud in Missouri may result in harsh civil and criminal penalties. Civil penalties for Medicare/Medicaid fraud may include:

• Recoupment requests
• Non-payment of claims
• Up to $11,000 in fines for each false claim
• Future exclusion from federal healthcare programs
• Treble damages
• Legal fees

In addition to penalties from the civil court, you could also be called in front of the state disciplinary board. You may lose your professional license and your hospital privileges.

Criminal penalties for Medicare/Medicaid fraud include:

• 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.

Choosing the Right Defense Attorney in Missouri

Medicare/Medicaid fraud allegations are extremely serious matters. You’re likely considering your legal options. It is imperative that you choose the right healthcare defense attorney in Missouri. There are three types of attorneys that you are likely considering. Here’s what you need to know.

A healthcare lawyer in Missouri certainly knows healthcare law. However, they may not be trained to handle the associated federal criminal charges. You may also be charged with mail fraud, wire fraud, tax evasion, or money laundering. Therefore, you need a defense law firm that has trial experience with these types of cases.

You do have another choice. This choice has experience in both healthcare law and federal criminal offenses. Look for a healthcare fraud defense law team. A healthcare fraud defense lawyer can negotiate on your behalf with federal prosecutors, can develop a Medicare/Medicaid fraud defense, and can help you with any federal criminal charges that are levied against you. 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

Once you’ve made a list of possible criminal defense lawyers, you should ask the following three questions to learn about 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?

The Importance of Medicare/Medicaid Fraud Defense Strategies

Oberheiden, P.C. uses strategic Medicare/Medicaid fraud defenses for Missouri clients. With hundreds of trials under our belt and our combined experience as both former prosecutors and healthcare fraud defense attorneys, we’ve developed integral Medicare/Medicaid fraud defense strategies that we use with each case.

Contacting federal investigators. Our primary objective is to minimize the risk of criminal charges against our Missouri clients, while resolving the Medicare/Medicaid fraud allegations. We contact federal investigators right away. This one strategy may seem simple, but it is vital to resolution of the allegations. It reduces the time that the federal government has to investigate you without interruption. If they have too much uninterrupted time, you have a higher risk of facing federal criminal charges. Our Healthcare Fraud Defense Team will contact the federal government on your behalf. We can usually get answers to important questions within hours:

• 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?

Evidence. The federal government must present evidence to prove that you are guilty of Medicare/Medicaid fraud. The government’s evidence must meet a high Constitutional standard known as beyond a reasonable doubt. By testing the evidence, 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

No criminal intent. In addition to providing evidence, the federal government must also prove that you acted with criminal intent. With Medicare/Medicaid fraud, criminal intent means that you set out with the intention to defraud the government. Intentional Medicare/Medicaid fraud rarely occurs in Missouri. Generally, the allegation comes up because of a mistake that was made. The most common mistakes in Missouri 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

Although these mistakes certainly must be addressed and, ultimately, corrected and prevented from occurring again, they aren’t criminal acts. Our goal is to prove to the government that you made a mistake and should not have to face criminal penalties because of it.

Applicable Medicare/Medicaid fraud defenses. Oberheiden, P.C. takes the necessary time to analyze each case and its facts. This enables us to prepare the proper strategic defenses. Recently, we handled a Medicare/Medicaid fraud case where the government alleged fraudulent certification for home 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 legal assistance for healthcare industry professionals in Missouri who are facing an allegation of Medicare/Medicaid fraud. We’ve represented 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 help 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 St. Louis and the surrounding areas. 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 Missouri state law enforcement, you should contact us right away. We provide initial consultations free of charge. Initial consultations are also totally confidential.

Medicare/Medicaid Fraud Defense Lawyers Serving Missouri

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.