Orange County, California Medicare/Medicaid Fraud Defense Attorneys

Experienced Legal Defense for Medicare/Medicaid Fraud Charges throughout Orange County

Orange County, California is a hotbed of Medicare/Medicaid fraud allegations. If you’re being investigated, you should immediately contact Oberheiden, P.C. Our highly experienced defense attorneys can assist you in Medicare/Medicaid fraud defense, during government investigations, and with other legal concerns related to your practice or medical business. Oberheiden, P.C. routinely assists clients in minimizing the risk of being investigated for Medicare/Medicaid fraud by helping our clients implement appropriate policies related to regulatory compliance. Our defense team is managed by a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office. The team is made up of educated and experienced defense lawyers. Many on our defense team have former experience as federal prosecutors and senior trial attorneys. Oberheiden, P.C. serves clients in Orange County, California and in the surrounding areas.

The healthcare industry in Orange County, California have the unpleasant reality of being confronted with an allegation of Medicare/Medicaid fraud. Doctors, nurses, home health workers, other individual healthcare providers, hospitals, clinics, entities, and related businesses that provide services in Orange County, California now have a powerful legal advocate on their side: Oberheiden, P.C. We provide Medicare/Medicaid fraud defense for individuals, entire hospital conglomerations, businesses, clinics, physician-owned entities, and other industry professionals and businesses.

Explaining Medicare/Medicaid Fraud

Medicare/Medicaid fraud is a federal offense with both civil and criminal penalties. It occurs when there is a submission of a false claim made to a government healthcare program in order to receive money from that program. It includes Medicare, Medicaid, Tricare, and federal workers’ compensation. Being accused of Medicare/Medicaid fraud means that the government is alleging that you broke at least one of the following laws:

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

Healthcare providers, businesses, and associated entities have a higher risk of being investigated because of the number of recipients in Orange County, California who rely on a federal healthcare program. It is one of nine locations in the United States that is closely monitored for Medicare/Medicaid fraud. There are more claims filed in the area, and this leads the federal government to believe that there is a higher instance of Medicare/Medicaid fraud. The Medicare Fraud Strike Force monitors claims in the area. They investigate and prosecute Medicare/Medicaid fraud cases.

The Medicare Fraud Strike Force is a hybrid agency of federal investigators and prosecutors. The team includes agents from the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. Medicare/Medicaid fraud is an extremely serious matter. If you’re contacted by the Medicare Fraud Strike Force, contact Oberheiden, P.C. right away.

Medicare/Medicaid Fraud’s Common Triggers in Orange County, California

Medicare/Medicaid fraud is commonly triggered in Orange County, California because the federal government notices issues from claims received. These issues are labeled as fraudulent billing and reimbursement requests. They usually include false charges, excessive charges, or unauthorized charges. The most common billing issues in Orange County that trigger an investigation into Medicare/Medicaid fraud are:

• 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
• Charge inflation
• Overuse of equipment or services
• Providing or accepting kickbacks

The most commonly investigated entities include doctors, nurses, healthcare services, physician-owned entities, nursing homes, registered care providers and facilities, hospitals, clinics, pharmacies, laboratories, DME providers, DNA centers, and cancer centers. However, this list isn’t all-inclusive. Any healthcare provider, business, or entity that submits claims to a federal healthcare program can be the subject of a Medicare/Medicaid fraud investigation.

Civil and Criminal Penalties Associated with Medicare/Medicaid Fraud Allegations

Medicare/Medicaid fraud allegations in Orange County, California can result in serious civil and criminal penalties. You may be charged in civil or criminal court. Civil penalties 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 facing disciplinary proceedings over your professional license or even be subject to losing your hospital privileges.

Criminal penalties for Medicare/Medicaid fraud may expose you to one or more of the following:

• 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 Orange County Defense Lawyer

Now that you understand all that is at stake from facing a single allegation of Medicare/Medicaid fraud, you’re probably thinking about choosing the right defense attorney in Orange County. Do you know the type of lawyer you should hire? Should you hire a healthcare lawyer? What about a criminal defense lawyer? Is there another option that you should consider?

If you’re thinking about hiring an attorney who serves Orange County, California, there are some things that you should consider. You may also face a federal criminal charge like tax evasion, wire fraud, mail fraud, or money laundering in addition to healthcare fraud. That means you need lawyers who have the specific training or the experience needed to handle federal criminal charges.

You also need someone that is experienced in criminal defense. As you know, Medicare/Medicaid fraud is a serious charge. So, it is imperative you choose the right attorney the first go around.

There is a better choice for those facing an allegation of Medicare/Medicaid fraud. A healthcare fraud defense attorney who serves Orange County, California has experience with healthcare fraud defense and the associated federal criminal charges. As you investigate your options, watch for these four 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

When you narrow down your possibilities, interview your potential candidates using these three questions:

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?

Medicare/Medicaid Fraud Defense Strategies

Oberheiden, P.C. utilizes comprehensive and strategic defenses for our Orange County, California clients who are accused of Medicare/Medicaid fraud. We’ve taken hundreds of cases to trials across the United States. Several of our Medicare/Medicaid fraud defense attorneys have previous experience as senior level federal healthcare fraud prosecutors with the Department of Justice. We also have team members who were once part of the Medicare Fraud Strike Force. We combine their prosecutorial experience with our healthcare fraud defense experience. This had led to our development of the following Medicare/Medicaid fraud defense strategies that we deploy in each Medicare/Medicaid fraud case that we take on:

Immediate contact with federal investigators. Our primary objective is to resolve the investigation against our clients with minimal risk of criminal charges against them. That’s why we immediately make contact with the involved federal investigators. In our years of experience, we’ve learned that immediate contact with the federal government is key to a successful resolution. With this one strategy, we are able to get answers to important questions and reduce the possibility of criminal charges. When the government has too much uninterrupted time to investigate our clients, there is a higher risk of future criminal charges. Our Healthcare Fraud Defense Team immediately opens the lines of communication to advocate on behalf of our Orange County, California clients. Within hours, we can usually get answers to the following question:

• 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?

Reviewing and testing federal evidence. Allegations in any charge must be proven with the use of evidence. The federal government must present evidence that meets a Constitutional standard known as “beyond a reasonable doubt.” By reviewing and testing the evidence to determine whether or not it meets this high standard, we routinely see the following results for our clients:

• 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

Criminal intent. Next, we look at the government’s ability to prove that you acted with criminal intent. This means that you had the goal of defrauding the government. This usually doesn’t happen in Orange County, California. Very few people wake up one day and hatch a plan to commit Medicare/Medicaid fraud. Rather, Medicare/Medicaid fraud investigations start because a mistake is made by a provider or a business who was simply paying more attention to their actual tasks than their coding, billing, and other back office requirements. The most common errors made 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

Although those mistakes are serious matters that should be addressed and corrected, mistakes aren’t criminal actions. Our objective is to show the federal government that our client did not act with criminal intent, but made a mistake.

The use of applicable Medicare/Medicaid fraud defenses. Although all Medicare/Medicaid fraud cases have some similarities because they involve the same general allegations, each case is inherently different because of the associated facts. This is why Oberheiden, P.C. analyzes each Medicare/Medicaid fraud case. This process enables us to find the best applicable Medicare/Medicaid fraud defenses for each case on its own merits. 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 aggressive legal advocacy for our Orange County, California Medicare/Medicaid fraud clients. 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
• Licensure or disciplinary proceedings
• Jury trials

Oberheiden, P.C. represents individual providers and entire healthcare systems in Orange County, California. 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, Orange County or California state law enforcement, call us. Initial consultations are free and totally confidential.

Medicare/Medicaid Fraud Defense Attorneys Serving Orange County, California

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.