Kevin McCarthy
Former House Speaker
Lynette Byrd
Former Assistant
U.S. Attorney
John Sellers
Former DOJ
U.S. Attorney
Michele A. Ratcliffe
Former Assistant U.S. Attorney
Dr. Nick Oberheiden
Attorney & Founder
Assisted Living Fraud Defense
Experienced Defense Counsel for Individuals and Assisted Living Facilities Accused of Fraud Oberheiden P.C. is a criminal defense law firm that represents assisted living facilities and associated individuals in state and federal law enforcement matters. If the U.S. Department of Justice (DOJ), U.S. Department of Health and Human Services’ Office...
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What Happens When You Receive an ADR from a CMS Auditor?
If you have received an additional documentation request (ADR) from your CMS auditor (i.e., a MAC, RAC, UPIC, or SMRC), you might be wondering what happens next. At this stage, the short answer is, “It’s up to you.” If you respond to the ADR letter and provide documentation to support...
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DOJ Targets Medicare Fraud Involving Ambulance and Ambulette Transportation Services
The U.S. Department of Justice (DOJ) has recently pursued multiple cases involving allegations of Medicare fraud against the owners of ambulance and ambulette companies. The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) has pursued similar cases in recent years as well. As a result, it...
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How Long Does a Medicaid Investigation Take?
Medicaid investigations present substantial risks for participating healthcare providers, health care facilities and nursing homes, medical supply companies, and pharmacies. Knowing what to expect during the process is critical—as this is the only way to develop and execute a targeted and timely defense strategy. One aspect of knowing what to...
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How to Win a Medicare Appeal
If you own or operate a medical practice or other business in the healthcare industry and have questions about Medicare appeals, you are not alone. According to data from the U.S. Department of Health and Human Services (DHHS), about 10% of all Medicare fee-for-service claims are denied, and about 3%...
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U.S. Department of Justice (DOJ) Targets Podiatrists for Alleged Foot Bath Schemes
The U.S. Department of Justice (DOJ) has recently targeted multiple podiatrists suspected of defrauding Medicare and other healthcare benefit programs. Each case has involved allegations of operating an unlawful “foot bath scheme” with medically unnecessary treatments that are not eligible for reimbursement. It seems that podiatrists are now squarely within...
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CMS and DOJ Target Healthcare Providers Offering Sanexas Pain Management and Treatment Services
The Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Justice (DOJ) are targeting healthcare providers that offer Sanexas pain management and treatment services to their patients. Targeted healthcare providers face substantial risks—including the risk of recoupment liability, Medicare exclusion, criminal fines, and even federal imprisonment in some...
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Possible Statutory Violations for Medicare Billing Fraud Involving Amniotic Fluid Injections
Fraudulent Billing for Amniotic Injections "Fraudulent billing" is a broad term referring to a healthcare provider’s fraudulent requests for reimbursement that are submitted to Medicare, Medicaid, or any other government healthcare benefit program. Allegations for fraudulent billings can be investigated and prosecuted as civil or criminal offenses under various statutes...
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Medicare Audits and Fraud Investigations for Amniotic Fluid Injection Billings and How to Respond
What are Amniotic Fluid Injections? Amniotic fluid injections are amniotic cells that are injected into damaged tissues to help them recover and regrow. Their purpose is to reduce inflammation of the damaged tissue, cut down the individual’s recovery time, and regenerate tissue. These injections are prescribed for patients suffering from...
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How CGX Laboratories Can Be Compliant
Medicare began providing coverage for genetic cancer screening (CGX) in 2018. While this was a positive development for testing laboratories, some labs that have been billing Medicare for CGX have run into compliance issues. If your testing laboratory bills Medicare for CGX, this article provides an overview of what you...
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