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Oberheiden Attorneys

Medicare Fraud Defense in Houston, Texas

The Oberheiden & McMurrey, LLP, PLLC is a Texas health care fraud defense law firm with a team of experienced health care fraud defense attorneys and former federal prosecutors. The firm’s Health Care Fraud Defense Group is headed by senior attorney Dr. Nick Oberheiden, who brings extensive experience to defending clients in Medicare fraud investigations throughout the greater Houston, Texas area.

This page is intended as a resource for individuals and health care companies facing Medicare fraud investigations in Houston, Texas. The information presented here will help you understand:

  • What constitutes Medicare fraud;
  • The potential penalties in Medicare fraud prosecutions;
  • How a lawyer can help with your Medicare fraud investigation;
  • How to choose the best lawyer to represent you; and
  • What distinguishes Oberheiden & McMurrey, LLP.

Medicare Fraud Enforcement in Houston, Texas

Texas is one of nine areas in the country in which the federal government closely watches for Medicare fraud. In Texas, the federal government relies on the elite task force known as Health Care Fraud Prevention and Enforcement Action Team (HEAT). Medicare fraud costs taxpayers millions of dollars per year, and HEAT, along with other members of the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies, is tasked with combating Medicare fraud in areas of the country where health care providers submit a high volume of Medicare reimbursement claims. In 2016, the Department of Justice states that they investigated more than 200 cases with a combined claims total of more than $900 million.

This means that health care practitioners and businesses in Houston, Texas need to be particularly vigilant when it comes to avoiding coding errors and other billing mistakes that the government may interpret as signs of Medicare fraud. However, even if you are able to avoid making these types of mistakes, you could still face a federal investigation. HEAT relies on data analysis as one of its primary tools for identifying potential sources of fraud, and this unfortunately is leading many innocent providers in the Houston, Texas area to face unwarranted investigations.

Medicare Fraud: An Overview

The practice of submitting false or fictitious reimbursement claims to the Centers for Medicare & Medicaid Services (CMS) is what is commonly referred to as Medicare fraud. Many health care service providers rely on CMS reimbursements in providing services, supplies, and equipment to Medicare beneficiaries. Countless Houston patients would be unable to receive the care that they need if it weren’t for the availability of Medicare benefits. However, the Medicare system is extremely complex. As a result, providers are able to defraud the system to the tune of billions of dollars per year. This has led HEAT and other federal authorities to vigorously pursue almost any provider suspected of fraud.

“Medicare fraud” is a broad term that can include violations of numerous federal laws. These laws include:

  • The False Claims Act;
  • The Anti-Kickback Statute;
  • The Physician Self-Referral Law (Stark Law);
  • The Social Security Act; and
  • The U.S. Criminal Code.

Some of the most common forms of Medicare fraud include the following:

  • Providing and billing for medically unnecessary services;
  • Providing and billing for medically unnecessary supplies, and equipment;
  • Phantom billing – billing for services that were never performed;
  • Billing for supplies and equipment that were not actually purchased;
  • Obtaining fraudulent certifications for services and supplies that are not medically necessary (a common allegation in home health and hospice fraud investigations);
  • Double-billing and falsifying patient records;
  • Upcoding and unbundling; and
  • Offering and accepting kickbacks.

The Department of Justice has recently announced that it intends to hold both individuals and companies accountable for Medicare fraud. This means that executives, physicians, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, and others can all face potential civil liability and criminal prosecution as the result of a Medicare fraud investigation.

Potential Penalties for Medicare Fraud

Medicare fraud investigations can be civil or criminal in nature. Determining the nature of your investigation is critical to understanding the possible ramifications. Depending on the nature of your investigation, the potential penalties may include recoupment requests, non-payment of future claims, civil fines of up to $ 11,000 per false claim, exclusion from future participation in federal health care programs, treble damages, government attorneys’ fees, criminal fines, and long-term imprisonment. The federal prison sentences for Medicare fraud are as follows:

  • Up to 10 years for each count of Medicare fraud;
  • Up to 20 years for fraudulent schemes resulting in serious bodily injury; and
  • A life sentence if for fraudulent schemes that result in a patient’s death.

Physicians and other medical professionals can face state disciplinary action (including license revocation) and loss of hospital privileges, as well.

How a Lawyer Can Help with Your Medicare Fraud Investigation

Our Health Care Fraud Defense Group employs three primary strategies for successfully defending clients in Houston, Texas involved in Medicare fraud investigations. While each case is unique, these strategies have proven to be the most effective for mitigating the consequences of an investigation and, ideally, avoiding civil or criminal charges:

1. Early Involvement with Investigating Bodies

In Medicare fraud investigations, early involvement with investigating bodies is critical. By the time you find out that you are under investigation, the government will have already invested substantial time and resources in building its case against you. To level the playing field, you need to retain an attorney as soon as possible. At Oberheiden & McMurrey, LLP, when a new client hires us, we immediately reach out to our government contacts to get answers to some key questions:

  • What is the case about?
  • What prompted the investigation?
  • Is the case civil or criminal?
  • Which agencies are involved?
  • Who else is under investigation?
  • What is the government’s ultimate goal?

Armed with this information, we can quickly develop and implement a defense strategy tailored to the unique circumstances of your investigation.

2. Attacking the Government’s Case

In a criminal Medicare fraud prosecution, the government must prove its case beyond a reasonable doubt. This is an extremely high standard, and one that requires the government’s attorneys to develop a substantial record filled with convincing evidence.

As a result, throughout our representation, we will center on exposing evidentiary holes in the government’s case. In particular, we will target two key areas: the government’s obligation to prove that you committed a criminal act and that you did so with criminal intent. Mistakes happen. They aren’t criminal, and they shouldn’t land you in federal prison.

3. Making Effective Use of Key Health Care Fraud Defenses in Houston, Texas

In addition to challenging the government’s evidence, we will also seek to assert all applicable health care fraud legal defenses that may be available given the circumstances involved in your case. As an example, in one of our recent Medicare fraud case, the prosecutors alleged that our client had fraudulently certified a patient’s need for home health care services. We were able to successfully argue that a delegation exception to the standard certification requirement rendered our client’s certification fully compliant with the law. In another Medicare fraud case, we used a safe harbor provision to help our client escape federal prosecution. These are just two examples of numerous defenses that may be available.

How to Choose the Best Lawyer to Represent You

When it comes to defending yourself in a Medicare fraud investigation, most health care lawyers and criminal lawyers do not have the knowledge and experience necessary to represent you effectively. So, who should you choose? The answer is a health care fraud defense lawyer.

The Right Choice: A Health Care Fraud Defense Lawyer in Houston, Texas

Health care fraud defense lawyers combine the knowledge and abilities of health care lawyers and criminal lawyers, and will typically be the best choice for your Medicare fraud investigation. When researching health care fraud defense lawyers in Houston, Texas you should use the following four criteria:

  • Proven track record of success;
  • Health care industry knowledge;
  • Profound familiarity with health care laws; and
  • Litigation & trial experience.

To learn more about the experience held by the attorney, you should ask the following three questions:

  • How many Medicare fraud cases have you handled during your career?
  • How many of the health care fraud cases that you have handled have resulted in no civil or criminal charges or dismissals for your clients?
  • How many health care fraud cases have you tried in court?

About Oberheiden & McMurrey, LLP

Oberheiden & McMurrey, LLP’s Health Care Fraud Defense Group includes former federal prosecutors and experienced defense lawyers who have handled hundreds of health care proceedings and conducted several criminal trials. Our defense lawyers regularly represent clients ranging from individual providers to entire medical systems in investigations involving:

  • The Department of Defense;
  • The Department of Justice;
  • The Drug Enforcement Administration;
  • The Federal Bureau of Investigation;
  • The Internal Revenue Service;
  • The Medicaid Fraud Control Unit;
  • The Office of Inspector General;
  • Houston and Texas law enforcement; and
  • Other state and federal agencies.

If you are facing a Medicare fraud investigation in Houston, Texas then we encourage you to contact us immediately for a free and confidential consultation and case evaluation.

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 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.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged health care fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of health care 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 health care 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.

Health Care Fraud Defense Attorneys in Houston, Texas

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has worked successfully to benefit health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, political corruption scandals, government investigations, and in media campaigns, including 60 Minutes. Dr. Oberheiden is best known for his ability to stop federal investigations before criminal charges are filed. In addition to his health care defense practice, Dr. Oberheiden is experienced with conducting internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad. Dr. Oberheiden is the managing principal of Oberheiden & McMurrey, LLP and he assists clients in Dallas, Garland, Mesquite, Richardson, McKinney and surrounding communities in federal health care investigations.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Ms. Byrd prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. She uses her immense experience with health care law enforcement to benefit her Houston, Texas clients.

We are available every day of the year to discuss your situation. You can call us directly or complete our contact form to request a free consultation.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
 
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. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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