The Oberheiden, P.C. provides Medicare/Medicaid fraud defense for healthcare practitioners and related healthcare businesses in New Orleans, Louisiana. Headed by Dr. Nick Oberheiden, our nationally recognized Healthcare Fraud Defense Group combines the experience of both former federal prosecution and defense competence.
New Orleans, Louisiana and Medicare/Medicaid Fraud
Medicare/Medicaid fraud is a serious federal offense. It’s a very broad reference to the submission of false claims to a government healthcare program. This can include Medicare, Medicaid, Tricare, or federal workers compensation. It includes violations of the False Claims Act, the Anti-Kickback Statute, Stark Law (Physician Self-Referral Laws), Social Security Act, and even criminal laws. Regardless of the involved statutes or federal healthcare program involved, all Medicare/Medicaid fraud cases have one common factor: It involves either a healthcare entity or professional illegally receiving money from a federal healthcare program.
In New Orleans, Medicare/Medicaid fraud is taken very seriously due to the number of retirees. Because New Orleans submits a large amount of Medicare/Medicaid claims, it is one of nine areas in the nation that is closely watched by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force monitors, investigates, and prosecutes Medicare/Medicaid fraud.
It’s important that all healthcare providers, entities, and businesses in New Orleans understand just how serious Medicare/Medicaid fraud allegations can be. If you’re being investigated by the Medicare Fraud Strike Force, you may come into contact with federal agents and prosecutors from the Department of Justice, Department of Health and Human Services, the Office of Inspector General, the Federal Bureau of Investigation, and many other agencies (including the Internal Revenue Service). You could also lose your professional license and hospital privileges.
Common Types of Medicare/Medicaid Fraud
As mentioned earlier, Medicare/Medicaid fraud involves the filing of one or more false claims to a federal healthcare program. Medicare/Medicaid fraud is often a result of alleged fraudulent billing practices and reimbursement requests. They may be totally false, excessive, or simply unauthorized. Common types of Medicare/Medicaid fraud in New Orleans, Louisiana includes:
- Phantom billing billing for services that were never performed
- Billing for medically unnecessary services
- Billing for equipment that was never ordered
- Billing for services that were never ordered
- Billing for medically unnecessary equipment
- Billing for medically unnecessary services
- Certification for medically unnecessary supplies (such as DME)
- Certification for medically unnecessary services (such as home health or hospice)
- Double billing
- Inflating bills
- Upcoding
- Overuse of services
- Overuse of equipment
- Offering or accepting kickbacks
Doctors, nurses, healthcare services, nursing homes, facilities providing registered care, hospitals, pharmacies, labs, DME companies, DNA centers, and other providers are some of the most common targets of Medicare/Medicaid fraud investigations in New Orleans.
Medicare/Medicaid Fraud Penalties Are Extremely Serious
If you or your organization is investigated for Medicare/Medicaid fraud, you face extremely serious consequences. Civil consequences can include recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, future exclusion from federal healthcare programs, treble damages, and paying legal fees for the government. There are potential criminal consequences, too. You may face criminal fines in the hundreds of thousands of dollars, criminal indictment, and be sentenced to federal prison time. You could receive up to 10 years in federal prison for each count of Medicare/Medicaid fraud. If the Medicare/Medicaid fraud results in serious bodily harm (as is often seen in counterfeit or excessive medication) can result in a sentence of up to 20 years per count. A life sentence is possible if the Medicare/Medicaid fraud resulted in the patient’s death.
As a medical provider, you are at risk of being excluded from all federal healthcare programs, being reimbursed by federal programs, face licensing and disciplinary actions, and even lose your hospital privileges.
Choosing the Right New Orleans Defense Lawyer Is Important
Now that you understand the seriousness of the penalties you may face, you can understand the importance of choosing the right New Orleans defense lawyer. You need a defense attorney who has the skills and the experience to fight the federal government on your behalf. You have a lot at stake this isn’t the time to work with a fraud defense attorney who is new to law.
Many people facing Medicare/Medicaid fraud allegations in New Orleans think of hiring a healthcare lawyer. Because Medicare/Medicaid fraud is often charged concurrently with mail fraud, wire fraud, money laundering, or tax evasion, a healthcare attorney may not be prepared to deal with federal criminal charges. They may lack the deep understanding of criminal procedure that is needed in order to present the best defense on your behalf. They often do not have the training or experience to negotiate with the federal government or to go to trial against federal prosecutors.
The ideal lawyer for New Orleans Medicare/Medicaid fraud investigations is a healthcare fraud defense lawyer. As you’re looking for the right attorney, look for these four keys:
- 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
Oberheiden, P.C. stands out because of our unique blend of experience and our proven track record of success. During our careers, we’ve taken hundreds of cases to trial. Since many of our Healthcare Fraud Defense Team attorneys joined us after leaving senior positions with the Department of Justice, our clients receive incredible insight. We are able to use our government contacts to get the answers that our clients need, and we develop applicable strategic defenses for each case. Our goal is to resolve New Orleans Medicare/Medicaid fraud investigations and minimize the risk of criminal charges for our clients.
The Use of Early Intervention. From our experience, we’ve learned that the earlier we make contact with the federal government on behalf of clients, the better it is. The idea is to get involved and learn what our clients can do to resolve the matter before it becomes criminal. The longer that the federal government can investigate you without interruption, the more likely it is that you’ll face criminal charges. Oberheiden, P.C. has open lines of communication with the federal government through our contacts. We can get answers to your most important questions:
- 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?
Our goal is to get answers to these questions within the first few hours following our engagement.
Addressing the Lack of Evidence. Our justice system places a burden on the federal government to prove that you committed a crime. They must prove beyond a reasonable doubt that you committed a crime and that you did so with criminal intent. This is a Constitutional standard that our defense attorneys test in each and every Medicare/Medicaid fraud case. We’ve routinely seen the following results:
- Dismissal of case
- 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’ve learned throughout our time as lawyers that most incidents that prompt a Medicare/Medicaid fraud investigation in New Orleans are simply human or business mistakes. These mistakes occur because providers are busy caring for their patients. Healthcare businesses who have rapid growth also experience mistakes that can cause these investigations. Common errors include:
- The use of unqualified staff
- Lack of adequate supervision
- Delegation and outsourcing
- Structural or organizational mistakes
- Human errors
- Oversight
- Overwhelmed employees
- No compliance program
- Quickly changing healthcare laws and rules
Addressing the Lack of Intent. Intentional Medicare/Medicaid fraud in New Orleans, Louisiana is extremely rare. Yet, when businesses, hospitals, and providers find they’re being investigated, they often just assume they’re guilty and accept criminal penalties for what was really just an honest mistake. Honest mistakes shouldn’t be subject to criminal liability. We address the lack of intent and work to prove that our clients made honest mistakes.
Using Applicable and Strategic Defenses. Oberheiden, P.C. performs a thorough analysis of the facts in each case. This often reveals strategic and applicable defenses that we can use. For instance, in a recent Medicare/Medicaid fraud case that we handled, 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 zealous representation for New Orleans healthcare business owners, executives, attorneys, providers, hospitals, pharmacies, labs, and other entities that are under investigation for illegal kickbacks, fraudulent billing, and allegations of medically unnecessary services, services not rendered, or unlawful joint ventures. We can assist with:
- Healthcare fraud defense
- Compliance program creation and implementation
- Internal investigations
- Asset protection
- Licensure or disciplinary proceedings
- Jury trials
We represent individual providers and entire healthcare systems. We represent New Orleans clients who are 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, New Orleans and Louisiana law enforcement, and the IRS.
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/Medicaid 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.
New Orleans 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.
We are available every day of the year. You can call us directly or complete our contact form or by emailing us directly.
Including Weekends