Missouri Healthcare Fraud Attorneys

Oberheiden, P.C. is a healthcare law defense firm with experience in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our talented Missouri healthcare fraud attorneys have years of relevant experience and education from the country’s best schools such as Harvard and Yale Law Schools. Our Missouri healthcare fraud attorneys serve clients in Missouri as well as surrounding areas.

If you are facing allegations of healthcare fraud in the state of Missouri, make it a priority to call Oberheiden, P.C. as soon as possible. Speak to an experienced Missouri healthcare fraud lawyer about your situation. Oberheiden, P.C. has legal expertise in:

• Healthcare fraud defense,
• Medicare and Tricare audits,
• Protection of assets,
• Compliance programs,
• Jury trials,
• Fraud allegation defense,
• Qui tam defense,
• OIG and grand jury subpoenas,
• Criminal defense, and
• Internal investigations.

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Missouri Is Monitored Closely for Medicare Fraud.
Missouri is one of fifteen areas in the United States monitored by a Medicare Fraud Strike Force. The Medicare Fraud Strike Force is a team of prosecutors and investigators from several federal agencies looking for abuse of the federal healthcare program.

Missouri is monitored closely because a sizable number of its citizens rely on federal healthcare programs. This naturally increases the number of claims filed with the federal government for payment. This, in turn, leads the government to fiercely pursue allegations of healthcare fraud. In 2022, the DOJ collected over $1.7 billion due to healthcare fraud cases nationwide.

What is Healthcare Fraud?
Federal healthcare fraud is an attempt to obtain reimbursement for medical services or equipment from federal healthcare programs by filing one or more fraudulent claims. Most fraud occurs in Medicare, Medicaid, Tricare, or federal workers’ compensation. It likely includes a violation of at least one of the following:

The Anti-Kickback Statute. The statute prohibits offering or providing payment or other valuables in exchange for patient referrals.

Stark Law. Stark Law prohibits referring patients to healthcare entities if the doctor, or a member of the doctor’s immediate family, has an ownership or investment interest. Compensation arrangements also trigger the Stark Law. Note, there are statutory exceptions to this law.

False Claims Act. If a claim you submit is found to be inaccurate, the federal government may launch a criminal probe into your billing practices. Penalties in such cases can be extreme and you can be held liable for paying three times the government’s losses.

Prescription Fraud. The federal government notices practices prescribing a high number of narcotics. If accused of running a “pill mill,” you risk charges of insurance fraud and violating DEA dispensing rules.

Billing Fraud. The federal government investigates the upcoding of claims. Upcoding means that the next higher and more expensive code is used when filing the claim. The federal government is also likely to investigate billing for services that were not provided (phantom billing), billing for patients who do not exist (ghost patients), and billing for medically unnecessary services or equipment.

Certification Errors. The home healthcare and hospice industry is another service where the federal government maintains a close watch. The most common accusations include fraudulent certification for home healthcare and hospice care.

Oberheiden, P.C. has a consistent record of success in assisting clients to avoid criminal charges. If you or your healthcare practice or business are under inquiry for health care fraud in Missouri, call Oberheiden, P.C. now. Initial discussions are free and confidential.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Healthcare Fraud and the Severe Penalties

Healthcare fraud is a serious matter. You can be subject to civil repayment of claims and non-payment of future claims. You may be excluded from federal healthcare programs altogether. In some cases, healthcare providers risk facing the state medical board and losing their license and hospital privileges. Criminal penalties include prosecution, prison time, and huge fines.

If you are found guilty of criminal healthcare fraud, you could receive one of the following prison sentences:

• Up to 10 years for each count of healthcare fraud
• Up to 20 years for each count of fraud that results in serious bodily injury
• Life sentence if the healthcare fraud results in death

We are often asked about the worst-case scenario for healthcare fraud in Missouri. Whether someone will face criminal prosecution or be sent to prison depends on several factors. These include the level of injury suffered, whether the prosecutor seeks a criminal prosecution, and the reason for the investigation.

Oberheiden, P.C. is well-prepared to handle your Missouri healthcare fraud defense case. We rely on our dual experience as former healthcare prosecutors and defense attorneys. If you’re suspected of healthcare fraud or would like to discuss your options, call one of our Missouri healthcare fraud defense attorneys today. An initial discussion is free of charge and confidential.

Is the Investigation a Criminal Matter?

Under federal and state laws, healthcare fraud cases can be civil or criminal. Through our time-tested early intervention method and compelling defense strategies, Oberheiden, P.C. has an exceptional reputation for helping clients avoid criminal charges. Call one of our Missouri healthcare fraud lawyers today if you’re under investigation for healthcare fraud in Missouri. We will develop your custom healthcare fraud defense plan.

Receiving contact from a prosecutor is not a certain indicator that you will face criminal charges. All federal agencies with prosecutors maintain both a civil and a criminal division. This makes it difficult to determine the nature of the charges. Knowing if the investigation is criminal can depend on the legal review of many elements, such as OIG subpoenas or how the inquiry or allegations are made. Criminal prosecution may come with the following:

• Search warrants,
• Seizure warrants,
• Arrest warrants,
• Target letters,
• Involvement of federal criminal prosecutors,
• IRS involvement, or
• Grand jury subpoenas.

If you have questions about facing civil or criminal charges, call Oberheiden, P.C., as soon as you can. Our Missouri healthcare fraud attorneys represent a variety of providers, including individuals, entire healthcare systems, and other related businesses in and around Missouri. Federal agencies typically involved are:

• The Department of Justice,
• The Department of Health and Human Services,
• The Department of Defense,
• The Office of Inspector General,
• The Drug Enforcement Administration,
• The Federal Bureau of Investigation,
• Medicare Fraud Control Unit,
• Missouri state law enforcement, or
• The IRS.

Missouri Healthcare Fraud Defense Lawyers

Oberheiden, P.C. is a healthcare fraud defense law firm providing services in the state of Missouri. Throughout our careers, we have handled hundreds of healthcare fraud cases and tried a great number of criminal cases in court. A number of our lawyers have previous experience as healthcare auditors and healthcare fraud prosecutors with the Department of Justice. We provide their valuable insight directly to our clients.

Advocacy begins immediately for our clients. In every case, our primary goal is to help our clients avoid criminal charges. Our experience and record prove the best way to defend against criminal prosecution is to intervene early. The longer the government has to investigate, the greater your chance of criminal charges. We work around the clock to safeguard your freedom and your professional aspirations. We advocate for you as soon as we possibly can by immediately getting in contact with federal prosecutors. Generally speaking, we get answers to these important questions within a few hours:

• What is the investigation about?
• What is the purpose of it?
• How long will the investigation take?
• What is the most likely outcome?

Testing the standards. The federal government must prove beyond a reasonable doubt that you committed a crime and that you did so with criminal intent. In each case the government plans to file federal criminal charges, we put this high standard to the test. Prosecutors may cite billing errors as an example to prove criminal intent. We have learned that mistakes happen and those mistakes do not and should not be equal to criminal activity. Oberheiden, P.C. has provided successful legal defense for clients all across the United States by proving that inaccuracies in billing are results of organizational or human error. Errors do not occur as an intention to defraud the government. The following are the most likely reasons for errors:

• Unqualified workers,
• Delegation errors,
• Outsourcing errors,
• Lack of oversight,
• Insufficient supervision, and
• Frequently changing laws and rules

Although these issues should be corrected, they should not lead to criminal liability.

The use of strategic defenses. Oberheiden, P.C. has the legal experience you need to develop a strategic defense. Many of our cases have been successful based on our use of legal exceptions. For example, in the context of Stark Law involving medical necessity certifications, we have highlighted exceptions to either weaken or entirely resolve a health care fraud case.

Protecting your professional reputation. We are committed to not only defending you in court but also protecting your professional reputation. Accusations of Medicare or Medicaid fraud can damage your career. Many of our clients are very concerned about how these accusations will affect their future. The media has the power to spread rumors and ruin reputations. Reports are prone to being one-sided and rarely tell the entire story. Our attorneys frequently address concerns about slander and seek chances to correct falsehoods.

Contact the healthcare fraud defense team of Oberheiden, P.C. immediately to discuss the details of your case. Initial calls are free and confidential.

Our Track Record

• Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
  Result: No civil or criminal liability.
• Defense of a healthcare services company against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act and Stark Law violations.
  Result: No civil or criminal liability.
• Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Healthcare Fraud.
  Result: No civil or criminal liability.
• Defense of nationally operating healthcare company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.
• Defense of healthcare marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
  Result: No civil or criminal liability.
• Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
  Result: No civil or criminal liability.
• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.
• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
  Result: No civil or criminal liability.
• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.
• Defense of healthcare management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
  Result: No civil or criminal liability.
• Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

Our Missouri Healthcare Fraud Defense Lawyers are available every day of the year. You can call us directly or complete our online contact form.