Ohio Healthcare Fraud Attorneys

Attorney Nick Oberheiden
Ohio Healthcare Defense
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Ohio meeting location – by appointment only: We do NOT accept mail or service at this location.
175 South 3rd Street
Suite 200
Columbus, OH 43215
888-680-1745

Oberheiden, P.C. is a healthcare law defense firm with experience in Ohio Healthcare Fraud Defense and in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our team are talented Ohio healthcare fraud attorneys with years of experience and education from the country’s best schools such as Harvard and Yale Law Schools. Our attorneys serve clients who provide healthcare and medical services in the state of Ohio as well as surrounding areas.

Health care providers, entities, or businesses in Ohio facing an allegation of healthcare fraud should call Oberheiden, P.C. immediately. Speak to an experienced healthcare fraud defense attorney. We have 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.

If you’re being investigated for healthcare fraud, call now to speak with our Ohio Healthcare Fraud Defense Lawyer. Initial consultations are free and confidential.

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)

Ohio Is Directly Monitored by the Medicare Fraud Strike Force

The Medicare Fraud Strike Forces exist in fifteen areas in the nation with large populations dependent on a federal healthcare program. The Medicare Fraud Strike Force is an exclusive team of prosecutors and investigators from multiple federal agencies.

Since Ohio has a large population that depends on federal healthcare programs, medical providers file more claims for payment. The government pays close attention to claims filed to ensure they are legitimate. The Medicare Fraud Strike Force monitors, investigates, and prosecutes confirmed healthcare fraud. Ohio’s Medicaid Fraud Control Unit recovered more than $19 million in fines and restitution in 2022. Fraud is a huge cost to the federal government each year.

Defining Healthcare Fraud

Federal health care fraud occurs when one or more false claims are filed for payment from federal healthcare programs like Medicaid, Medicare, Tricare, or federal workers’ compensation. It includes a violation of at least one of the following:

The Anti-Kickback Statute. Any individual is subject to prosecution for violating the Anti-Kickback statute. Offering or providing payment or other valuables in exchange for patient referrals is strictly enforced under the Statute.
Stark Law. Stark Law prohibits doctors from referring patients to specific healthcare service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest. Compensation arrangements also fall within this law. Note, however, that there are statutory exceptions.
False Claims Act. If you submit a claim to any federal healthcare program, you are required to abide by the False Claims Act. If an inaccurate claim is submitted to the federal government, they will likely launch a criminal inquiry into your billing practices.
Prescription Fraud. The federal government pays attention to providers who write an unusually high number of narcotic prescriptions. If suspected of running a “pill mill,” you are at high risk of investigation for insurance fraud and violating DEA dispensing rules.
Billing Fraud. The federal government is forceful about investigating the upcoding of claims. Upcoding means that the next higher and more expensive code is used for a service when filing the claim. The federal government is also highly active in investigating phantom billing (billing for services not provided), billing for patients who do not exist (ghost patients), and billing for equipment or services not medically necessary.
Certification Errors. The home healthcare and hospice industry are areas the federal government closely monitors. The most common accusations include fraudulent certification for home healthcare and hospice care.

Oberheiden, P.C. is proud of its success helping clients avoid criminal charges in healthcare and Medicaid fraud cases. If you or your medical practice, clinic, entity, or business are under investigation or accused of committing health care fraud in Ohio, call Oberheiden, P.C. now to speak to an Ohio Medicaid fraud lawyer. The initial consultation is free and confidential.

Healthcare Fraud Has Civil and Criminal Penalties

Healthcare fraud is a serious offense. It can lead to civil or criminal charges resulting in significant penalties. Civil penalties for health care fraud charges include repayment of claims and non-payment of future claims. You may be entirely excluded from federal healthcare programs if convicted of having committed health care fraud. You could be called before the Ohio Medical Board, lose your license, or lose your hospital privileges. Criminal penalties are also grave. They include criminal charges, fines in the hundreds of thousands of dollars, and a federal prison sentence of:

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 resulting in death

One of the most common questions our Ohio healthcare fraud attorneys get in initial meetings with Ohio clients is what the worst-case scenario may be. Criminal charges or a prison sentence are the most serious, but these depend on several factors. The severity of the injury suffered by a patient, the prosecutor’s interest in a criminal conviction, and the reason for the investigation are all considered.

Oberheiden, P.C. is prepared to defend Ohio clients against healthcare fraud. Our experience as former healthcare prosecutors, with our background as defense attorneys, provides a unique insight that benefits our clients. Call us now if you’re under investigation for alleged health care fraud in Ohio. Initial consultations are free and confidential.

Is It a Criminal Matter?

Healthcare fraud investigations can be civil or criminal. Oberheiden, P.C. has a reputation for helping clients avoid criminal charges. We do this by early contact with the federal government. Call us as soon as you’re contacted about a healthcare fraud investigation. We can quickly begin to act on your behalf.

Contact from a federal prosecutor isn’t a sure sign you’re facing criminal charges. All federal agencies with prosecutors have both civil and criminal divisions. Whether the investigation is criminal in nature depends on a legal view of many elements. Criminal prosecution may be indicated by:

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

For questions about whether you’re under a civil or criminal investigation, call Oberheiden, P.C. We provide our healthcare defense services to individuals, businesses, and entities in and around Ohio under investigation by any number of federal agencies.

Strategic Healthcare Fraud Defense Strategies for Ohio Clients

Ohio healthcare fraud lawyers from Oberheiden, P.C. provide legal counsel to those facing allegations of healthcare fraud. We’ve handled hundreds of trials and health care fraud cases. Several of our attorneys have previous experience as healthcare auditors and prosecutors working with the Department of Defense. This experience is an asset to our firm and our Ohio clients.

Immediate contact with federal investigators. Our objective in each case is to help our clients avoid criminal charges. Our experience and record prove contacting the government quickly is the best way to begin assisting clients. We usually get answers to the most important questions within a few hours after hire:

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 evidence. Federal prosecutors must meet high Constitutional standards to bring charges against you. They must prove beyond a reasonable doubt that you committed a crime and did so with criminal intent. In each case, we test this standard. Federal prosecutors may use billing inaccuracies as an example of criminal intent. However, we’ve learned that mistakes happen in instances of medical billing with no intent to break federal law. Mistakes do not and should not convict you of a crime. Our Ohio health care fraud lawyer has successfully defended clients by showing that human or organization oversight can result from billing errors. Such mistakes are not intended to defraud the government. These are some of the most likely causes of mistakes in billing:

Use of unqualified workers,
Delegation errors,
Outsourcing errors,
Lack of oversight,
Insufficient supervision, and
Frequently changing laws and rules.

While these mistakes should certainly be addressed and corrected, they should not lead to criminal charges.

Strategic healthcare fraud defenses. Oberheiden, P.C. reviews each case on its own merits to develop strategic legal defenses. This often includes locating applicable exceptions and statutory loopholes. Many of our cases have been successful based on these legal strategies. For example, Stark Law involves medical necessity certifications, and we’ve been able to point to exceptions that mitigate or entirely resolve a healthcare fraud matter.

Representation both in and out of the courtroom. Oberheiden, P.C. is committed to clients both in and out of the courtroom. Inaccurate reporting can ruin your career. Our clients are rightfully concerned about how these charges may affect their reputation. The media holds a lot of power. They use gossip and biased reporting that doesn’t tell the entire story. Our Ohio healthcare fraud lawyers address slander and will seek opportunities to correct misinformation about our clients.

If you’re under investigation for health care fraud, contact us at Oberheiden, P.C. now to learn how we can help. The call is free and confidential.

Frequently Asked Questions

What is the difference between the Anti-Kickback Statute and the Stark Law?

The Anti-kickback Statute and the Stark Law deal with physician referrals. The two laws have some important differences. The Anti-Kickback Statute prohibits paying or receiving referral fees for patients with federally funded healthcare programs. The Stark Law focuses on stopping self-referrals. These involve a physician’s referral to other health care providers where there is a shared economic interest. The Anti-Kickback Statute is a criminal law with maximum penalties of up to five years in prison and a fine of $25,000 per violation. The Stark Law is a civil statute, with a maximum penalty of up to $15,000 per violation. Anyone who violates either statute may be barred from participation in Medicare or Medicaid. If you are under investigation for violating the Anti-Kickback Statute or the Stark Law, speak to a dedicated Ohio health care fraud lawyer as soon as possible.

When are physician kickbacks not allowed?

Kickbacks and referral fees are common in the medical industry. However, there are several instances when a referral arrangement runs afoul of federal healthcare fraud laws. The Eliminating Kickback in Recovery Act forbids accepting or paying kickbacks for referrals to recovery homes, treatment facilities, or labs. The Anti-Kickback Statute prohibits giving or receiving anything of value by referring a patient covered by a federal program. Finally, the Stark Law places civil blame on medical providers who refer patients to a practice where they have a financial interest. While nothing prohibits referral arrangements, providers should speak with an Ohio healthcare fraud defense attorney to make sure a referral is legal.

What should I look for in an Ohio healthcare fraud lawyer?

When you look for an Ohio healthcare fraud defense lawyer to represent you in a complex case, experience should be your primary concern. For example, the Medicare guidelines regarding amino testing frequently change. These cases require in-depth knowledge of the current laws, the reasoning behind the laws, and where such laws may go in the future. Be aware, not all legal experience is equal. Don’t hire a healthcare fraud lawyer who boasts 50 years of experience, to learn that he/she spent 45 years as a lawyer in an unrelated field. Oberheiden, P.C., is a dedicated team of healthcare fraud lawyers who defend physicians and others in the medical industry. Several of our senior attorneys previously worked in high-ranking positions within the federal government. This provides us with a unique view into how the government sees health care fraud cases. We also know what may motivate prosecutors to drop charges.

When should I reach out to an Ohio federal healthcare fraud defense attorney?

In a healthcare fraud probe, the sooner you retain an attorney, the better your options to avoid the most serious consequences. An attorney’s early involvement can resolve mix-ups and prevent a client from making critical errors when speaking to investigators. In many cases, federal agents rely on statements made by a subject during the course of the inquiry. The last thing you want is to speak with investigators thinking you are helping your situation, but end up making matters worse. If you are under investigation for alleged health care fraud, you gain nothing by waiting to contact a lawyer. Seek out an experienced Ohio federal healthcare fraud defense lawyer today.

Speak with an Ohio Healthcare Fraud Lawyer Today

A health care fraud conviction can result in severe legal fall-out. If you are accused of committing health care fraud, under investigation or facing charges involving Medicare, Tricare, or Medicaid fraud, we encourage you to contact our Ohio healthcare fraud defense attorneys today. We are available every day of the year. You can call or email us directly, or complete our contact form.

888-680-1745
Including Weekends
Oberheiden, P.C.
Serving the State of Ohio and Surrounding Areas
Federal-Lawyer.com

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden, P.C. is a Texas PC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.