Ohio Medicare/Medicaid Fraud Defense Attorneys

Experienced Legal Defense Against Medicare/Medicaid Fraud Charges for all of Ohio

Medicare/Medicaid fraud in the State of Ohio is a serious federal offense. The Oberheiden, P.C. is a Medicare/Medicaid fraud defense law firm serving clients in the State of Ohio. Our talented and experienced legal team assists clients in litigation and during government investigations. Additionally, we assist clients with their corporate structuring and regulatory compliance needs. Ohio clients benefit from the immense experience of our former Chief Healthcare Fraud Coordinator from the U.S. Attorney’s Office, former federal prosecutors, and former senior federal trial attorneys. We serve clients in the entire State of Ohio.

Individual healthcare providers, entities, and businesses in Ohio have a higher likelihood of being investigated for Medicare/Medicaid fraud by the federal government than most other places in the United States. If you’re a healthcare provider, hospice center, hospital, physician-owned entity, or other related business accused of Medicare/Medicaid fraud in Ohio, you now have the option of retaining one of the nation’s most well-known Medicare/Medicaid fraud defense firms: Oberheiden, P.C.. Oberheiden, P.C. provides Medicare/Medicaid fraud defense for individual providers, entire hospital systems, businesses, clinics, lawyers, executives, and others in the industry.

What Is Medicare/Medicaid Fraud?

Medicare/Medicaid fraud happens when there is a submission of a false claim to a federal government-provided healthcare program. The claims are filed by entities, businesses, and providers to receive money from the program for services or equipment provided to the patient. Medicare/Medicaid fraud is a serious federal offense. It carries with it both civil and criminal penalties. Medicare/Medicaid fraud doesn’t just cover Medicare/Medicaid . It covers false claims filed in any federal healthcare program. This includes Medicare, Medicaid, Tricare, and federal workers compensation. If you’re accused of Medicare/Medicaid fraud, you’re being accused of violating at least one of these laws:

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

Ohio healthcare providers, businesses, pharmacies, and other related healthcare entities are investigated for Medicare/Medicaid fraud more frequently than the majority of their professional equals in the United States. Ohio has a large number of people who receive benefits through a federal healthcare program. This increases the number of claims that are filed with federal healthcare programs. Because of this, it is one of nine locations directly monitored by the Medicare Fraud Strike Force. The monitoring occurs because the government believes that there is a bigger risk of Medicare/Medicaid fraud occurring in Ohio because of the number of claims that are filed.

The Medicare Fraud Strike Force monitors, investigates, and prosecutes instances of Medicare/Medicaid fraud in Ohio. It is a team of investigators and prosecutors with representatives from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. If you’re contacted by the Medicare Fraud Strike Force, you should contact Oberheiden, P.C. immediately to learn about your legal defense options.

Medicare/Medicaid Fraud Investigations in Ohio

Medicare/Medicaid fraud investigations in Ohio occur most often when a provider, business, or other healthcare entity files a claim that is inaccurate. The federal government receives the claim, reviews it, and determines that it is a fraudulent billing or reimbursement request. They often include charges that were false, excessive, or unauthorized. In Ohio, the most common billing inaccuracies result from:

• 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

In Ohio, most Medicare/Medicaid fraud investigations are prompted against doctors, nurses, healthcare service providers, physician-owned entities, nursing and registered care facilities, hospitals, clinics, pharmacies, laboratories, cancer centers, DNA centers, and DME providers. Yet, it’s important for you to recognize that, if you submit claims to any federal healthcare program for reimbursement, you could eventually be charged with Medicare/Medicaid fraud.

Civil and Criminal Penalties

Medicare/Medicaid fraud allegations include harsh civil and criminal penalties. You could be charged in civil or criminal court. Civil penalties for Medicare/Medicaid fraud in Ohio may include one or more 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

You may also be subject to appearing before the state disciplinary or licensing board. You could lose your professional license and your hospital privileges.

Criminal penalties for Medicare/Medicaid fraud are also very serious. You may receive one or more of the following penalties:

• 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 Ohio Defense Attorney

Medicare/Medicaid fraud allegations have the potential of ruining your life. Now that you understand the penalties associated with Medicare/Medicaid fraud in Ohio, you’re likely considering your legal options. You must choose the right Ohio defense lawyer. Should you choose an Ohio healthcare attorney? Should you choose a criminal defense attorney? Is there a more ideal choice to handle the intricacies of a Medicare/Medicaid fraud case?

When considering an Ohio attorney, you should choose one that has handled federal criminal charges and Medicare/Medicaid fraud cases in the past. You also want a defense lawyer that understands charges like mail fraud, wire fraud, money laundering, or tax fraud.

You will also need an attorney that is knowledgeable about Ohio criminal defense. They should understand healthcare law, billing, coding, and medical utilization rules.

There is a better option for Medicare/Medicaid fraud defense in Ohio: A healthcare fraud defense lawyer. A healthcare fraud defense attorney has experience in both healthcare law and federal criminal law. They have experience in negotiating with the federal government, and understand federal trials. As you consider your options, look for these 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

Next, you’ll want to ask your potential attorney these three important questions to ascertain 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?

Established Medicare/Medicaid Fraud Defense Strategies

Oberheiden, P.C. evaluates each Medicare/Medicaid fraud case that we take on, and use established defense strategies for each of our Ohio clients. Although we settle cases with the federal government as often as we can do so, we’ve also taken hundreds of cases to federal trial. Many of our Healthcare Fraud Defense Team attorneys have experience as senior-level federal healthcare fraud prosecutors and with the Medicare Fraud Strike Force. We use our combined experience to create the best possible defense for our Medicare/Medicaid fraud clients. We capitalize on the following established Medicare/Medicaid fraud defense strategies:

Contacting the federal government. The primary goal in each Ohio Medicare/Medicaid fraud case is to resolve the investigation and minimize the risk of federal criminal charges against our clients. We immediately contact the federal government. We’ve noted that this strategy is vital to a successful resolution. It gives us the opportunity to get answers to important questions and to advocate for our clients. Within hours of being retained, we can usually get the answers to the following 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?

Analyzing federal evidence. When an allegation is made about any sort of crime, including Medicare/Medicaid fraud, evidence must be presented by prosecutors. In this instance, federal prosecutors must present evidence that meets a Constitutional standard that is known as beyond a reasonable doubt. By analyzing the evidence presented by the federal government, we are able to evaluate whether it meets the standard. Using this strategy, we often receive 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

Lack of criminal intent. The federal government must also show that you intentionally set out to commit Medicare/Medicaid fraud. This is difficult for them because intentional Medicare/Medicaid fraud in Ohio is rare. Medicare/Medicaid fraud investigations in Ohio usually start because a healthcare provider, facility, or business made a mistake in their billing and coding. The most common issues that cause 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

These mistakes are certainly serious and should be addressed and corrected. However, they are not crimes. Our goal is to prove to the federal government that our clients did not act with criminal intent. They made an honest mistake that should be rectified, but they do not deserve to face criminal penalties over a mistake.

Developing applicable Medicare/Medicaid fraud defenses. Medicare/Medicaid fraud cases all have some similarities since they involve the same principle matter. However, not every case can use the same defense. Each case has its own set of surrounding facts. Oberheiden, P.C. evaluates each case to develop the most applicable 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 Ohio 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 and illegal kickbacks. We also assist 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 from medicaid
• Licensure or disciplinary proceedings
• Jury trials

Oberheiden, P.C. represents individual providers and entire healthcare systems in the State of Ohio. 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 Ohio state law enforcement, call us right away. Our initial consultations are free of charge and confidential.

Medicare/Medicaid Fraud Defense Lawyers Serving Ohio

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.