St. Louis Medicare/Medicaid Fraud Defense Attorney

Experienced Legal Defense You can Trust Serving the St. Louis Area

St. Louis medical providers and business owners face a high risk of being accused of Medicare/Medicaid fraud. Oberheiden, P.C. is an experienced Medicare/Medicaid fraud defense law firm. We also assist clients being investigated by the federal government or who have other litigation needs. Our legal defense team is managed by a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office. Team members have prestigious educations and experience. In fact, several attorneys on our team have experience as federal former prosecutors and senior trial attorneys. Oberheiden, P.C. serves clients in St. Louis and the surrounding areas.

Healthcare industry professionals, facilities, businesses, and other entities in St. Louis often face the challenge of Medicare/Medicaid fraud allegations. Doctors, nurses, home healthcare providers, executives, facilities, clinics, and other industry related businesses and facilities in St. Louis and the surrounding area that are accused of Medicare/Medicaid fraud now have access to healthcare fraud defense attorneys. Oberheiden, P.C. provides legal advocacy for healthcare providers, hospitals, businesses, clinics, physician-owned entities, lawyers, executives, and related businesses accused of Medicare/Medicaid fraud. Dr. Nick Oberheiden, a Harvard-trained healthcare fraud defense attorney, is the firm’s managing partner.

The Basics of Medicare/Medicaid Fraud

Medicare/Medicaid fraud happens when there is a submission of a false claim to a government healthcare program to receive money from the federal program for equipment or services. Medicare/Medicaid fraud is a federal offense with both civil and criminal penalties. The name on its own can be misleading. Medicare/Medicaid fraud includes false claims submitted to Medicare, Medicaid, Tricare, and federal workers compensation. An accusation of this nature means that you are being accused of violating at least one of the following statutes:

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

Healthcare providers, entities, and businesses in St. Louis are investigated more often than most other places in the United States. St. Louis has a large number of federal healthcare program recipients. Because more claims are filed from St. Louis, the Medicare Fraud Strike Force watches this area and eight others in the United States for Medicare/Medicaid fraud. The government has reason to believe that, because more claims are filed in St. Louis, there is a higher likelihood of Medicare/Medicaid fraud.

The Medicare Fraud Strike Force is a federal team of investigators and prosecutors from multiple agencies including the DOJ, DEA, DOD, Department of Human Services, the Office of Inspector General, the FBI, the IRS, and other federal agencies. An accusation of Medicare/Medicaid fraud is extremely serious. If you’re contacted by the Medicare Fraud Strike Force or by anyone who is employed by a federal agency concerning Medicare/Medicaid fraud, you must protect yourself and your livelihood. Call Oberheiden, P.C. right away.

The Main Reasons Medicare/Medicaid Fraud Investigations Occur

We are often asked the common reasons why Medicare/Medicaid fraud investigations occur in St. Louis. There is one common reason, but it has many causes. The main reason why Medicare/Medicaid fraud investigations occur is because of inaccurate claims. These claims include excessive charges, unauthorized charges, and false charges. In St. Louis and the surrounding area, the most common items that cause the government to levy an allegation of Medicare/Medicaid fraud 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

In St. Louis, 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. This list isn’t all-inclusive. If you work in the healthcare industry and file claims through a federal healthcare program for reimbursement or payment, you are at risk of being accused of Medicare/Medicaid fraud.

The Legal Penalties of Medicare/Medicaid Fraud

Medicare/Medicaid fraud allegations in St. Louis may result in harsh civil and criminal penalties. You could be charged in civil or criminal court. Civil penalties for Medicare/Medicaid fraud in St. Louis may include at least one 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

Additionally, you may be called in front of the state disciplinary or licensing board. You may lose your license or your hospital privileges.

Criminal penalties for Medicare/Medicaid fraud may include at least one 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.

You Must Choose the Right St. Louis Defense Attorney

Medicare/Medicaid fraud allegations are incredibly serious in nature. By now, you’re probably thinking about your options for legal help. It is very important that you choose the right St. Louis defense attorney. Here what’s you need to know about your options.

You may also be charged with tax evasion, wire fraud, money laundering, or mail fraud. So, you need an attorney with experience in these charges and fields.

You may also face criminal charges, so you need a St. Louis criminal defense lawyer. That attorney must have experience handling federal criminal matters too. They must also understand healthcare law or billing, coding, or medical utilization rules.

If you are accused of Medicare/Medicaid fraud in St. Louis or the surrounding area, you have an option for legal representation. You should seek out the services of a healthcare fraud defense law firm. A healthcare fraud defense lawyer has experience negotiating with federal prosecutors, developing Medicare/Medicaid fraud defenses, and can assist you with federal criminal charges. As you consider the possible attorneys, 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

The next step is for you to ask the following three questions, so that you can get a good idea of the experience level presented by the attorney:

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. uses strategic Medicare/Medicaid fraud defenses for each St. Louis client. We’ve taken hundreds of Medicare/Medicaid fraud cases to court within the United States. Many of our Healthcare Fraud Defense Team lawyers have experience as federal healthcare prosecutors within the Department of Justice and the Medicare Fraud Strike Force. We use our collective experience to develop and apply the following Medicare/Medicaid fraud defense strategies:

Early contact with the federal government. Our primary objective is to resolve investigations against our clients with minimal risk of criminal charges. We get into contact with federal investigators early in the case. We’ve learned that this is one of the most successful ways to get the information that we need to help you resolve the case. Immediate contact is important because it reduces the time that the federal government has to investigate you without interruption. When it has a large period of time to investigate you, you’re more likely to face criminal charges. Our Healthcare Fraud Defense Team opens the lines of communicate to advocate on your behalf. Within hours, we can usually get answers to these 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?

Lack of evidence. Allegations of Medicare/Medicaid fraud must be proven with evidence. 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

Lack of criminal intent. The government must also show that you acted with criminal intent. This means that you intended to commit fraud against the federal government. Yet, this is hard for the government to do because most instances of Medicare/Medicaid fraud in St. Louis happen because an honest mistake was made. The most common reason that errors are made in St. Louis 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 should be addressed and corrected, they aren’t criminal in nature. The objective is to prove to the federal government that our clients did not have a criminal mindset.

Applicable Medicare/Medicaid fraud defenses. Medicare/Medicaid fraud cases are similar since they are all rely on breaking certain laws. But, each case is different. Because of this, Oberheiden, P.C. takes the necessary time to analyze each case and its facts. This enables us to prepare and utilize 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 assistant for St. Louis Medicare/Medicaid fraud clients. 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 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 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, St. Louis or state law enforcement, call us right away. We provide initial consultations free of charge. Initial consultations are totally confidential.

Medicare/Medicaid Fraud Defense Lawyers Serving St. Louis

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.