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former federal prosecutors


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Oberheiden Attorneys

Defense Attorneys Fighting False Claims Act Charges in Laredo and all of Texas

The Oberheiden & McMurrey, LLP 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 best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in Laredo as well as throughout Texas.

The False Claims Act imposes severe civil and criminal penalties for health care service providers and other companies that receive federal reimbursements through Medicare, Medicaid, Tricare, and other federal benefit programs. If you are facing a False Claims Act investigation or a “qui tam” lawsuit, you need to be smart about protecting your assets and, in some cases, your freedom. Headquartered in Texas, our nationally recognized Health Care Fraud Defense Group provides aggressive representation for clients facing allegations of False Claims Act violations in Laredo, TX and throughout the United States.

Oberheiden & McMurrey, LLP’s Health Care Fraud Defense Group is led by a team of senior attorneys: (i) Dr. Nick Oberheiden, the firm’s founder and a leading health care fraud defense attorney and (iii) Lynette Byrd, a seasoned former Assistant United States Attorney with broad experience on both sides of federal fraud investigations. The attorneys in our Health Care Fraud Defense Group take an aggressive, experienced-based approach to False Claims Act cases that focuses on effectively using their combined experience to help clients avoid civil and criminal liability.

This page is intended as a resource for individuals and companies facing allegations of submitting false and fraudulent claims in Laredo, TX. Here you will find:

  • An Introduction to the False Claims Act
  • What It Means to “Knowingly” Submit a False or Fraudulent Claim
  • An Overview of Potential Penalties Under the False Claims Act
  • An Overview of the “Qui Tam” Litigation Process
  • Three Key Components of a Strategic False Claims Act Defense

Laredo Health Care Companies Are Facing Strict Enforcement Under the False Claims Act

In recent years, Laredo has seen a number of high-profile Medicare fraud stings involving the federal government’s Medicare Fraud Strike Force and other state and federal law enforcement authorities. This included a sting that was, until recently, the largest national Medicare fraud takedown in history.

Due to the large number of federal program beneficiaries in Texas, cities throughout the state – including Laredo – have long been key targets in the government’s fight against violations of the False Claims Act. In fact, Texas is one of only two states nationwide that hosts two of the government’s nine elite Health Care Fraud Prevention and Enforcement Action Team (HEAT) task forces. These task forces are comprised of prosecutors from 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, and are focused on targeting local providers suspected of violating the False Claims Act.

1. Introduction to the False Claims Act

The False Claims Act is a federal statute that prohibits “knowingly” submitting or causing the submission of false and fraudulent compensation claims under federal government contracts and federal benefit programs (including Medicare, Medicaid, and Tricare).

2. What It Means to “Knowingly” Submit a False or Fraudulent Claim

While the False Claims Act applies this “knowingly” standard when imposing civil liability (note that you can face criminal penalties for “intentional” violations), more fraudulent claims can get you in serious trouble than you might think. This is because it is enough if you “should have known” that the claim was unlawful in order to meet the “knowingly” standard. As a result, you do not actually have to know that a claim is false or fraudulent in order to violate the False Claims Act. Some examples of False Claims Act violations include:

  • Mistakenly using an old (“false”) billing code
  • Double-billing for services, supplies, medication, or use of equipment
  • Unbundling and upcoding reimbursable services
  • Billing for services that were not provided or that were not medically necessary
  • Billing for supplies, medication, or equipment that were not purchased or that were not medically necessary

3. Overview of Potential Penalties Under the False Claims Act

As noted above, the False Claims Act contemplates both civil and criminal penalties for the submission of false and fraudulent claims. These penalties include:

  • Civil Penalties – Three times the government’s actual losses plus fines of up to $11,000 per false claim.
  • Criminal Penalties (18 U.S.C. § 287) – Up to five years of federal imprisonment and fines of up to $250,000 (for individuals) or $500,000 (for companies) per false claim.

4. Overview of the “Qui Tam” Litigation Process

While HEAT is aggressively pursuing health care companies in Laredo suspected of federal program fraud, the government is not alone in its enforcement efforts under the False Claims Act. Under the False Claims Act’s “qui tam” provision, private citizens (referred to as “relators”) can file lawsuits on behalf of the United States government based upon allegations of submission of false or fraudulent claims (see 31 U.S.C. § 3729). Unfortunately, while qui tam does have legitimate purposes in some circumstances, it is often used maliciously by competitors and disgruntled ex-employees.

Here is an overview of the qui tam litigation process for claims filed in Laredo, TX:

  • The Complaint. The litigation begins with the relator filing a complaint in the U.S. District Court for the Southern District of Texas. To protect the relator’s anonymity, the complaint is filed “under seal” and only made available to the assigned judge and select government officials.
  • Initial Case Review. The government will conduct an initial case review to determine whether the relator’s allegations are substantiated. If they are not, the government will not get involved. However, if the allegations appear to support a possible violation, government attorneys – with assistance from the FBI and other agencies – will open an investigation. This generally involves serving the defendant(s) with subpoenas requesting any corporate, financial, billing, or other records that may contain evidence of a violation of the False Claims Act.
  • Government Intervention. Based on the results of this investigation and initial negotiations with the defense attorneys involved in the case, the government’s attorneys will either (i) intervene in the litigation, or (ii) drop out and let the relator pursue the case without government support. If they intervene (subject to approval by the DOJ headquarters in Washington D.C.), in most cases, they will amend the initial complaint to add causes of action under a variety of other anti-fraud statutes (such as the Anti-Kickback Statute and the Truth in Negotiation Act) as well.
  • Settlement Negotiations Continue. During these initial stages, the prosecutors and defense lawyers will continue their settlement negotiations. However, depending on scope of the alleged fraud, it will likely take several months or longer before any settlement is reached.
  • Resolution and Relator Compensation. If the case results in a finding of civil liability, as noted above, the defendant(s) can face penalties of three times the government’s losses plus civil fines of $11,000 per false claim. If the government intervenes, the relator will receive up to 25 percent of the amount recovered (this can increase to 30 percent if the relator pursued the case independently).

5. Three Key Components of a Strategic False Claims Act Defense

In False Claims Act investigations, our Health Care Fraud Defense Group deploys a proven strategy that involves three key components:

  1. Keeping the Case Civil. Our first priority is to keep our clients’ cases civil. This keeps a prison sentence and criminal fines off of the table.
  1. Preventing Government Intervention. In qui tam cases, we want to prevent government intervention. To do this, we will conduct our own investigation in order to expose the flaws in the relator’s complaint and destroy the relator’s credibility.
  1. Negotiating a Favorable Settlement. If the evidence supports possible civil liability, we will seek to negotiate a minimal settlement that allows our client to remain in business.

If you are facing accusations or a federal investigation under the False Claims Act, the time to act is now. You do not want to delay and risk facing criminal charges. At Oberheiden & McMurrey, LLP, we have successfully defended physicians, practice owners, physician-owned entities, toxicology laboratories, medical device companies, pharmacies, service management organizations, health care marketing companies, hospitals, and other individuals and entities in federal cases in Laredo and across the United States. Our Health Care Fraud Defense Group is prepared to act quickly to protect you, so request your free case evaluation now.

Our Track Record

  • False Claims Act Investigation (Pharmacy)
    Result: No Liability.
  • False Claims Act Investigation (Pharmacy)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Physician)
    Result: No Liability.
  • False Claims Act Investigation (Physician)
    Result: No Liability.
  • False Claims Act Investigation (DME Company)
    Result: No Liability.
  • False Claims Act Investigation (MSO)
    Result: No Liability.
  • False Claims Act Investigation (MSO)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Device Company)
    Result: No Liability.
  • False Claims Act Investigation (Health Care Service Provider)
    Result: No Liability.

False Claims Act Defense Attorneys Serving Laredo, TX

Nick OberheidenDr. Nick Oberheiden serves as managing principal of Oberheiden & McMurrey, LLP and has extensive experience in Qui Tam, False Claims Act, Medicare Fraud and other civil and criminal matters involving federal agencies including, but not limited to, the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL). Dr. Oberheiden trained in negotiation at Harvard Law School and received his Juris Doctor from the University of California, Los Angeles. He also holds a Ph.D. in law.

Lynette ByrdLynette S. Byrd is also a former federal prosecutor, having served as Assistant United States Attorney (AUSA) in the Northern District of Texas prior to joining Oberheiden & McMurrey, LLP. Clients benefit greatly from Ms. Byrd’s government experience and her deep knowledge of the False Claims Act and the other federal laws impacting the health care industry. As a prosecutor, she was involved in what was, at the time, one of the largest health care fraud cases in North Texas.

We are available to discuss your case. Call us directly or complete our contact form to schedule your free, confidential case evaluation today.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving Laredo, Texas and Surrounding Areas
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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