We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Health Care Fraud Legal Defense Team Serving Houston and the Surrounding Area

The Oberheiden Law Group is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our attorneys are the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and education from the country’s leading schools such as Harvard Law School and Yale Law School. Our attorneys routinely serve clients in Houston as well as throughout Texas State.

If you’re facing an accusation of health care fraud in Houston, Texas or the surrounding area, you should call the Oberheiden Law Group, PLLC immediately. We are a Texas law firm that provides health care fraud defense. We also have extensive legal experience in OIG and grand jury subpoenas, Medicare and Tricare audits, fraud allegation defense, internal investigations, compliance programs, qui tam defense, protection of assets, criminal defense, and in jury trials. Our Health Care Fraud Defense Team includes lawyers with extensive and impressive backgrounds, including a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office, several former health care fraud prosecutors, elite former lead prosecutors of the Medicare Fraud Strike Force, and accomplished lawyers with leading education from the best law schools in the United States.

Dr. Nick Oberheiden is a Harvard-trained lawyer and negotiator. Dr. Oberheiden provides legal assistance to clients in Houston and throughout Texas. Dr. Oberheiden is a health care fraud defense attorney, and he is the managing partner of the Oberheiden Law Group.

Lynette Byrd is a former federal health care fraud prosecutor who brings her insight and experience to the Oberheiden Law Group’s clients. Prior to joining Oberheiden, Ms. Byrd prosecuted False Claims Act violations, Stark Law violations, Anti-Kickback violations, and health care fraud on behalf of the federal government.

You have legal options. Call the Oberheiden Law Group now and ask to speak with a member of our Health Care Fraud Defense Team. Initial consultations are free and confidential.

Houston, Texas Is Monitored for an Increase in Health Care Fraud Violations

Houston, Texas is one of nine locations in the nation that is closely monitored for an increase in health care fraud violations. The area is monitored by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is an exclusive team of prosecutors and investigators made up of members of several federal agencies including those from the Department of Justice, Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation. This list isn’t all-inclusive. Other federal prosecutors and investigators working for other federal agencies can be involved in the Medicare Fraud Strike Force.

Houston, Texas and its surrounding areas are so closely watched because of the large number of residents who rely on a federal health care program. This increases the number of claims filed with federal health care programs for reimbursement. In areas where more claims are filed, the federal government pays closer attention to watch for an increase in health care fraud. In fact, the Department of Justice released a statement in 2016 that it had investigated more than 300 cases of health care fraud. Close to 80 of those cases were on individual health care practitioners. The other cases on a health care entity or business. The Department of Justice reported that it recovered more than $900 million in fraudulently paid out claims.

The Definition of Health Care Fraud

Health care fraud can be defined as an attempt to receive reimbursement from a federal government health care program for medical services or equipment. Federal health care programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It includes at least one of the following elements:

  • Violation of the Anti-Kickback Statute – Federal health care law prohibits receiving money or other valuables in exchange for patient referrals. Any person (including doctors, marketing professionals, and business owners) may be prosecuted for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
  • Violation of Stark Law – This is also referred to as the Self-Referral Law. It prohibits doctors from referring patients to certain health care service entities if the doctor or a member of the doctor’s immediate family has an ownership or investment interest in it, or if there is some compensation arrangement. There are statutory exceptions to this law.
  • Violation of the False Claims Act – If you submit a claim to a federal health care program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an investigation into your billing practices under the criminal provisions of this act.
  • Prescription Fraud – The federal government watches health care practices that prescribe an unusually high number of narcotics. If you’re suspected of running a “pill mill,” you may be investigated for insurance fraud and for violating DEA dispensing rules.
  • Billing Fraud – One of the most common instances of billing fraud is when claims are upcoded. Upcoding means that the next higher code is used when the federal government is billed. The federal government also investigates phantom billing (billing for services that were not provided), ghost patients (billing for patients who don’t exist), and billing for services or equipment that aren’t medically necessary.
  • Certification Errors – The federal government pays close attention to the home health care and hospice industry. One of the most common allegations includes fraudulent certifications for care.

The Oberheiden Law Group has a track record of successful representations and in helping our clients avoid criminal charges. If you or your health care practice or your business are being investigated for health care fraud in Houston, Texas, contact the Oberheiden Law Group now. Our initial consultations are confidential and free of charge.

What Are the Penalties of Health Care Fraud?

Health care fraud is extremely serious. An allegation could be civil or criminal. Both include severe penalties. Civil penalties include repayment of claims, non-payment of future claims, and you may be excluded from federal health care programs. You may also face your state disciplinary board and lose your license or hospital privileges.

Criminal penalties can include fines in the hundreds of thousands of dollars, a criminal record, or even federal prison time.

Federal prison time can be sentenced as:

  • Up to 10 years for each count of health care fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
  • Life sentence if the health care fraud resulted in the death of a patient.

Often, we’re asked about the worst-case scenario for health care fraud in Houston, Texas. Facing criminal charges or a prison sentence will depend on several factors, including the severity of an injury suffered by a patient, whether the prosecutor is interested in pursuing criminal charges, and the reason why the federal government initiated the investigation. If you’re being investigated for health care fraud, contact the Oberheiden Law Group. Initial consultations are free of charge and confidential.

Is Your Health Care Fraud Investigation Criminal?

Health care fraud can be civil or criminal. Early intervention and strategic defenses can help prevent a civil investigation from turning criminal. Call the Oberheiden Law Group right away if you’re being investigated.

At the beginning of a health care fraud investigation, you may not know if the investigation is civil or criminal in nature. All federal agencies with prosecutors, including the U.S. Attorney’s Office, has a civil and a criminal division. Being contacted by a federal prosecutor is not enough to determine if the investigation against you is civil or criminal. A civil investigation can quickly turn into a criminal investigation. We can assist you by contacting the federal government on your behalf.

Determining the nature of your charges can depend on the legal interpretation of many things, such as OIG subpoenas, the manner in which the inquiry is made or in the way in which the allegations are made, and other indicators of criminal prosecution. Criminal prosecution may be imminent if you receive a search warrant, seizure warrant, arrest warrant, target letter, IRS involvement, grand jury subpoena, or if there is the involvement of a federal criminal prosecutor.

If you have questions about whether you’re facing criminal or civil charges, contact the Oberheiden Law Group immediately. We provide legal advocacy for individual practitioners, entire health care systems, and other related health care businesses. If you are a health care provider, business, or entity in Houston, Texas or the surrounding areas and you’re being investigated by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, Drug Enforcement Administration, Office of Inspector General, Medicare Fraud Control unit, Houston or Texas state law enforcement, or the IRS, contact us now.

Health Care Fraud Defense

The Oberheiden Law Group is a Texas law firm providing health care fraud defense to clients in Houston, Texas and the surrounding areas. Many of our attorneys have previous experience as health care auditors and as health care fraud prosecutors with the Department of Justice. Our clients gain valuable insight for their health care fraud defense cases.

Immediate legal advocacy. Our main objective for each Houston, Texas client is to help them avoid criminal charges. Experience has taught us that the best way to advocate for our clients against the possibility of criminal prosecution is to immediately contact the federal government. This gets answers to important questions, and also stops the government from having much uninterrupted time to investigate you. We work to protect your freedom and your career. Usually, we get answers to the most important questions within just 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 Constitutional standards. The U.S. Constitution has a high standard of proof that requires the federal government to prove beyond a reasonable doubt that you committed a crime. It must also prove that you acted with criminal intent. In cases where criminal charges may be brought, we test these standards. The federal government will often try to use billing inaccuracies to prove that you acted with criminal intent. The Oberheiden Law Group has learned from experience that mistakes happen by our clients. Those mistakes should not equate to being treated like a criminal. We have provided successful legal defense for clients across the United States by proving that the inaccuracies are a result of human or organizational error, and were not a result of criminal intent. We’ve noted that the use of unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the constantly changing laws and rules that are involved in health care are the most common errors that cause these investigations. Although these issues should be corrected, they should not lead to criminal liability.

The use of strategic health care fraud defense. The Oberheiden Law Group has substantial experience in developing strategic defenses. Many of our cases were successful because of statutory loopholes and exceptions. For instance, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either mitigate or entirely resolve a health care fraud case.

Defending your professional reputation. The Oberheiden Law Group is committed to more than health care fraud defense. We’re also fully committed to defending your professional reputation. Allegations of health care fraud can be extremely damaging. Many of our clients are concerned about how these allegations may affect their future. The media has a lot of power. Your reputation could be destroyed by rumors spread by the media. Our attorneys routinely address concerns about slander, and book news spots and other opportunities to correct misinformation about our clients.

The Oberheiden Law Group has helped clients across the country who were accused of health care fraud. Call us today to learn more about your legal options. The call is confidential and there is no charge.

Our Track Record

The commitment of the Oberheiden Law Group is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former health care prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home health care entities, and many other health care organizations against any form of alleged health care fraud. Here are some recent examples of our case outcomes.

  • Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Health Care 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.
  • Representation of a Health Care Marketing Group Against an Investigation by the Office of Inspector General for Alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation of Health Care Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
    Result: No civil or criminal liability.

Health Care Fraud Defense Lawyers Serving Houston, Texas
Nick OberheidenNick Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. In addition to his health care defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Clients greatly benefit from Ms. Byrd’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she regularly argues federal matters for her clients.

We are available every day of the year. You can call us directly or complete our contact form or by emailing us directly.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
 
Serving: Westbury, Chinatown, Sharpstown, Braeburn, Missouri City and ALL of Houston!
Zip Codes: 77096, 77074, and 77071 – and ALL of Houston!
www.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. The Oberheiden Law Group PLLC is a Texas PLLC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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