Oberheiden, P.C. is a federal law healthcare fraud defense law firm that represents healthcare providers in Washington D.C and across the nation. With an experienced team that includes veteran former federal prosecutors, we have a significant record of success in Medicare and Medicaid fraud matters.
In more ways than one, healthcare providers in Washington D.C. are at the center of the federal government’s efforts to aggressively target those suspected of engaging in Medicare and Medicaid fraud. The Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services Office of Inspector General (OIG), Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and various other agencies headquartered in Washington D.C. all play central roles in the fight against Medicare and Medicaid fraud and abuse. Therefore, local providers are increasingly finding themselves the targets of invasive audits and exhaustive investigations.
Whether you are a licensed practitioner, you own a business in the healthcare industry, you are responsible for administering a practice’s or facility’s program billings, or you sit on a hospital’s board of directors if there is any evidence to suggest that you may have been involved in Medicare or Medicaid fraud the authorities may come after you. We have a saying, “There are two kinds of healthcare providers: those that have been targeted in federal investigations, and those that will.” With federal authorities ramping up their efforts to fight fraud and seek severe penalties against the individuals and organizations involved, anyone who has received an inquiry from a CMS auditor or federal agent needs to take their situation extremely seriously.
Your Defense Team for Medicare and Medicaid Fraud Allegations in Washington D.C.
At Oberheiden, P.C. we are committed to helping healthcare providers avoid unwarranted consequences from Medicare and Medicaid audits and investigations. While there are unquestionably fraud artists who siphon billions of dollars from these programs each year, the vast majority of program participants are legitimate healthcare providers who play a critical role in our society. Unfortunately, the government’s data analytics software simply cannot without mistake distinguish between a systematic scam and a legitimate record of Medicare or Medicaid billings.
As a result, in many cases our role is to convince federal authorities that their inquiry is entirely misguided. You can do nothing wrong and still be forced to vigorously defend yourself in a Medicare or Medicaid fraud investigation. In cases where our clients have made mistakes, it is our job to show that: (i) any overbillings were indeed mistakes and not intentional attempts to defraud the government, and, (ii) due to the honest nature of these mistakes, severe punishment is unwarranted.
When you choose Oberheiden, P.C. you will have a team of seasoned healthcare fraud litigation veterans on your side. Our attorneys are experienced in healthcare fraud matters, and several members of our firm held senior positions with the DOJ prior to entering private practice. We take a team approach that puts the full weight of our attorneys 100+ years of combined experience on your side. During your case, you will work with:
- Dr. Nick Oberheiden – An experienced Medicare and Medicaid fraud defense and federal law healthcare fraud attorney.
- Lynette S. Byrd – A former senior DOJ prosecutor who has led high-profile investigations involving allegations of Medicare and Medicaid fraud.
Meet the rest of the healthcare fraud defense team at Oberheiden, P.C..
Experience in All Medicare and Medicaid Fraud Matters
Our healthcare fraud defense team represents Washington D.C. healthcare providers in all Medicare and Medicaid fraud matters. Whether you are being audited by a Zone Program Integrity Contractor (ZPIC), have just been served with a grand jury subpoena, have been contacted by agents from the FBI, or are currently under arrest on federal charges, we can use our substantial experience and resources to deal with the government’s actions against you. Contact us now to schedule a confidential initial case assessment regarding any of the issues discussed below.
Medicare or Medicaid Audit
CMS has contracted with private auditing companies to review healthcare providers Medicare and Medicaid billings. These auditing companies get paid on a “fee-for-service” basis, which means that they have a financial incentive to accuse providers of overbilling these healthcare benefit programs.
Although auditors from these companies are not federal agents, CMS contractor audits should generally be treated similarly to federal investigations. Why Because the potential consequences are similar. CMS’s audit contractors have the authority to demand recoupments and institute pre-payment review; and when they find evidence of Medicare or Medicaid fraud, they can refer providers to CMS and the DOJ for civil or criminal prosecution. We represent healthcare providers in all CMS contractor audits, including audits conducted by:
- Zone Program Integrity Contractors (ZPICs)
- Recovery Audit Contractors (RACs)
- Medicare Administrative Contractors (MACs)
- Audit Medicaid Integrity Contractors (MICs)
Unfortunately, if your business or practice is being targeted in an audit, due to the nature of CMS’s fee-for-service recovery program, there may be a good chance that the auditor will issue adverse findings. If this occurs, there is a five-stage appellate process; and if necessary, we can dispute the results of your audit all the way through litigation in federal court.
The OIG is the investigative and law enforcement arm of the Department of Health and Human Services. It has broad authority to conduct Medicare and Medicaid fraud investigations, and the OIG subpoena is one of the most powerful tools at its disposal. Although these documents may seem relatively harmless (often arriving by certified mail), they can have severe consequences, and providers who fail to take them seriously will often end up in federal court.
Grand Jury Subpoena
OIG subpoenas and grand jury subpoenas are two very different animals. While the OIG uses its subpoenas to gather information during an investigation (and, in many cases, these investigations are civil in nature), the purpose of a grand jury proceeding is to determine whether there is probable cause to charge an individual or organization with a federal crime. If you or someone within your organization has received a grand jury subpoena, the government could be seeking to indict you, your organization, or potentially an unrelated third party. In any case, you need to be very careful in order to avoid mistakes that could trigger federal prosecution.
False Claims Act Investigation
The False Claims Act (FCA) is a broad federal statute that prohibits any and all forms of “false and fraudulent” requests for payment from the government. This includes Medicare and Medicaid reimbursements. While the government can (and often does) initiate False Claims Act investigations independently, many FCA cases are qui tam actions, or federal lawsuits initiated by whistleblowers.
Federal prosecutors can pursue civil or criminal penalties under the False Claims Act. In criminal cases, licensed practitioners, administrators, executives, and board members can be at risk of facing years if not decades behind bars. While the penalties in civil cases do not include prison time (and for this reason, keeping FCA cases civil is always one of our top priorities), they can still include enormous financial penalties as well as Medicare and Medicaid program exclusion.
Stark Law Investigation
The Stark Law is a federal statute that applies specifically to physicians and physician-owned entities. It prohibits so-called “self-referrals” referrals from a physician to an entity in which that physician has a financial interest, and which results in payment involving Medicare or Medicaid-reimbursed funds. If this sounds broad, that’s because it is. Physicians routinely face federal investigations under the Stark Law. And when prosecutors appear ready to press charges, it is up to these physicians to demonstrate that their referral practices either (i) fall outside of the Stark Law’s prohibitions, or (ii) qualify for a Stark Law safe harbor or exemption.
Anti-Kickback Statute Investigation
The Anti-Kickback prohibits any payment using Medicare or Medicaid funds that is intended to influence either: (i) a patient referral for an item or service, or (ii) the purchase, lease, order, or arrangement for or recommendation to purchase, lease, or order any good, facility, service, or item. If this sounds broad too, once again, you are right. While the Stark Law only includes provisions for civil remedies, physicians and other providers can face civil or criminal penalties under the Anti-Kickback Statute, and providers charged under the Anti-Kickback Statute will often face charges under the FCA and various other federal statutes as well.
Other Medicare or Medicaid Fraud Investigation
While the False Claims Act, the Stark Law, and the Anti-Kickback Statute are the three statutes most-commonly used to specifically target suspected instances of Medicare and Medicaid fraud, federal prosecutors have a variety of other legislative tools at their disposal. From the federal healthcare fraud statute to the laws that impose severe criminal penalties for conspiracy, mail fraud, wire fraud, and money laundering when prosecutors begin to stack charges against healthcare providers, the potential penalties can become insurmountable.
Civil or Criminal Healthcare Fraud Charges
In most cases, healthcare providers will learn that they are under investigation before federal prosecutors issue charges. This provides an opportunity to mount a defense during the investigative process, to keep your case civil in nature, and to work toward a solution that prevents charges from being filed. If you have already been charged, you need to speak with an attorney immediately. Whether you are facing civil monetary penalties or years (or decades) of incarceration, it is not too late to build a successful defense. But you need to get started right away.
5 Ways We Defend Healthcare Providers Accused of Medicare and Medicaid Fraud
While we are more than happy to walk new clients through some of our prior successes and how we have secured favorable results for our clients in the past, we truly believe that our results speak for themselves. We look for ways to win our clients cases at every stage of the process, and have had notable success with:
1. Avoiding Criminal Charges
In many cases, when healthcare providers contacted us early enough, we have been notably successful in helping them avoid criminal charges. In fact, since 2012, less than 2% of our clients that were under grand jury or OIG investigation were prosecuted after we entered the case.
2. Dismissing Federal Indictments
Many lawyers think that receiving a federal indictment means that it is time to prepare for trial. But, we know differently. Despite the fact that a grand jury indictment requires the joint opinion of 16 jurors who have heard evidence and arguments from federal prosecutors, we have succeeded in having clients grand jury indictments dismissed prior to trial.
3. Avoiding Conviction at Trial
When going to trial is our client’s best option, we prepare meticulously to challenge each and every aspect of the prosecution’s case. We leave nothing to chance, and we leave no room for error. Having conducted more than 500 trials, we are veteran litigators with experience of what it takes to convince the judge and jury that our client’s time has been wasted.
4. Obtaining Probation at Sentencing
In some cases, there is simply nothing that can be done to avoid sentencing. When we represent clients at sentencing hearings, we take a strategic approach focused on obtaining the best possible outcome in light of the verdict rendered at trial and the circumstances involved in the case. Even when years of imprisonment have been on the table, we have been successful in reducing our client’s sentence even to to probation.
5. Fending Off Medicare and Medicaid Audits
To date, we have a 100% success rate in preventing our clients Medicare and Medicaid audits from resulting in loss of licensure or referral to the U.S. Attorney’s Office. We also have notable success avoiding and mitigating our clients repayment and recoupment liability, and we have been victorious in CMS contractor audit determination appeals for clients across the nation.
Answers to FAQs: Defending Against Medicare and Medicaid Audits and Investigations in Washington D.C.
Q: Can your attorneys represent my business or practice located in Washington D.C.?
Yes, with multiple offices, we maintain a national reach practice representng clients in all regions of the country. Our attorneys travel nationally to meet with clients, negotiate with prosecutors, and represent clients in person during audits and investigations.
Q: What types of healthcare providers are most likely to be targeted in audits and investigations?
While federal law enforcement agencies have certain priorities (such as the current administration’s focus on combatting opioid fraud and abuse), all healthcare providers in Washington D.C. are at risk for being targeted in audits and investigations. We have recently represented clients including, but not limited to:
- Home Health Centers
- Hospice Care Centers
- Healthcare Executives
- Hospitals & Surgery Centers
- Marketing Groups
- Medical Device and Durable Medical Equipment (DME) Companies
- Physicians, Nurses, and Staff
- Physician-Owned Entities
- Psychologists and Psychiatrists
- Social Workers
- Toxicology Laboratories
Q: What are some examples of your recent case results?
We represent the majority of our clients during the investigative process, and the majority of our clients investigations end without our client facing any civil or criminal liability. Some examples of our recent case results include:
- No civil or criminal liability for a national toxicology laboratory being investigated by the DOJ and U.S. Attorney’s Office
- No civil or criminal liability for a healthcare marketing company under investigation by the OIG
- No civil or criminal liability for a healthcare provider under investigation by the FBI and OIG
- No civil or criminal liability for a physician under investigation by the OIG
See more examples of our experience in Medicare fraud investigations.
Q: What strategies do you use to defend clients against allegations of Medicare and Medicaid fraud?
When defending healthcare providers in Medicare and Medicaid fraud investigations, we take a comprehensive approach that focuses on challenging the government’s case from all angles. We tailor our representation to the unique facts and circumstances of each individual case. However, broadly speaking, our defense strategies include:
- Contacting the auditors, agents, or prosecutors involved to gather key information and let them know that you are represented;
- Conducting a strictly-confidential internal assessment to determine any potential exposure;
- Proactively addressing any deficiencies, including correcting internal procedures and self-reporting as required by law or as may be in your best interests;
- Asserting multiple defenses based upon the facts, applicable laws, and any safe harbors or exemptions that may be available; and,
- Negotiating with the goal to achieve a favorable resolution as quickly, quietly, and cost-effectively as possible.
Contact Us for a Free and Confidential Case Assessment
If your business or practice is facing an audit or investigation, you do not have time to lose. From Washington D.C., call (888) 356-4634 or contact us online to get started with a free and confidential case assessment.