Wade McFaul Healthcare Fraud Team Former HHS-OIG Assistant Special Agent-in-Charge
The rules for federal healthcare programs are complicated. It is no surprise that sometimes home health providers and business owners become overwhelmed in their attempts to deal with difficult and constantly changing regulations. Occasionally, these business owners find themselves in the middle of a government investigation. These are common reasons for investigations:
Overly Complicated Rules
Untrained or Unmotivated Staff
Unreliable Billing Personnel
Fast Growing Practice
Lack of Compliance Program
What is Medicare Fraud?
Most home healthcare investigations allege that a home health provider committed Medicare Fraud. Typically, what home healthcare providers are accused of is billing fraud, improper cost reports, coding fraud and generally billing for services that are not medically necessary.
Billing fraud means that services were charged that were in fact never provided or in the alternative, the provider billed for the exact same service more than once. Improper cost reports, on the other hand, involve medically unnecessary procedures and at times also include charges for equipment such as DME devices that were never provided to the patient.
Finally, one of the most common form of coding fraud is called up-coding, in which a service will be billed under a code that allows for higher reimbursement rather than the proper code.
Medicare and Medicaid fraud can be charged as criminal felonies. In such a case, federal prosecutors will
typically attempt to indict the responsible owners and staff at the home healthcare company with health
care fraud under 18 U.S.C. § 1347 in addition to other criminal statutes.
The government can simply request recoupment. In this case, the government will ask for the difference
between what was charged and paid to the provider and what should have been charged and paid. In addition to
repaying the difference, the government typically imposes a civil fine that will be a percentage of the
total damage that was caused by the billing error.
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
John W. Sellers
Former Senior Trial Attorney U.S. Department of Justice
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Lynette S. Byrd
Former Assistant U.S. Attorney
Partner
Amanda Marshall
Former U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Gamal Abdel-Hafiz
Former Supervisory Special Agent (FBI)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
What Are the Penalties?
Medicare and Medicaid fraud are serious federal felonies that can be charged in one of two ways.
When is the Investigation Civil? When is the Investigation Criminal?
The question whether an investigation is civil or criminal is among the most important questions clients ask us in initial meetings. While there are indications as to when a case is criminal, it is often not exactly possible to assess the nature of the investigation until and unless an experienced Medicare fraud defense attorney initiates communications with the investigating agencies. To be clear, the mere fact that for example, the FBI shows up at your clinic or your office does not necessarily mean that the case is criminal. This is a critical moment when proper decisions need to be made with your counsel.
If you become aware of a healthcare investigation against you, you have no time to lose. In many instances, experienced defense attorneys are able to keep a case non-criminal in the very beginning of the case.
All home healthcare investigations have three stages. In the first stage, the government investigates alleged wrongdoings and, if convinced that there is a reason to believe that healthcare fraud occurred, the government will either issue a subpoena and request records or ask the court to execute a search warrant. If you have received a subpoena or a search warrant has been executed, it is very important to immediately call experienced defense legal counsel. With the appearance of your counsel, the case enters the second stage, which is mostly characterized by your attorney starting negotiations and a case resolution with government officials. The third stage consists of the resolution of the case, which greatly depends on whether your attorneys were able to keep the case civil or whether the case is criminal and will be resolved by court order.
The Five Goals of Our Defense
In each healthcare fraud case, we have five goals to protect our clients:
Avoiding a Criminal Investigation
Avoiding Media News Coverage
Protecting Your Good Name Keeping the Entire Case Confidential
Protecting Your Financial Future
Our team of former federal healthcare prosecutors and experienced defense counsel have handled many healthcare investigations.
At What Point Should You Hire an Attorney?
The importance of hiring experienced defense counsel at the earliest time possible cannot be overstated. After all, you need experienced fraud defense lawyers that can protect your business and your good name and that will keep the investigation civil, and not criminal. The sooner you call us, the higher your chances will be that we can protect you, your business, and your family.
What is the Emergency Defense Package?
Oberheiden P.C. has developed a so-called “Emergency Defense Package” to provide clients that are under investigations an immediate action plan. The Emergency Defense Package has been featured on news stations and the media and contains protocols, instructions, and defense strategies. Main goal is to keep a case non-criminal.
The Emergency Defense Package Contains:
General Protocols: What to Do
Instructions for Management: How to Deal with Agents
Instructions for Management: How to Deal with Employees
Instructions for Employees
Document Retention Forms
Compliance Examination Instructions
Important Contact Information
Success Stories
The Oberheiden, P.C. appears in governmental investigations across the country. Our healthcare fraud defense attorneys assist service providers and businesses under investigation for alleged Qui Tam Lawsuit, Stark Law, False Claims Act, or Anti-Kickback violations.
Our healthcare fraud defense attorneys have obtained no civil or criminal liability outcomes for their clients and were able to dismiss healthcare fraud investigations involving the following government agencies, among many others.
Successful defense of a healthcare services company against an investigation by the Office of Inspector General for Medicare Fraud
Successful defense of healthcare company against investigations by the Department of Justice for alleged Healthcare Fraud
Successful defense of healthcare company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations
Successful defense of a healthcare company against an investigation by the Office of Inspector General and Department of Health and Human Services
Successful defense of a healthcare company against an investigation by the Office of Inspector General and the Department of Justice for alleged Medicare Fraud
Successful defense of a physician owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations
Successful defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud
Contact our offices today to discuss your situation with our experienced home health agency fraud defense lawyers. We are here to help you.
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