We are a team of
former federal prosecutors


Most of our cases have ended in
No Criminal Charges

Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense Attorneys for McAllen, Texas

The Oberheiden Law Group, PLLC’s Health Care Fraud Defense Group focuses on representing clients in Medicare and other federal program fraud investigation in McAllen, Texas and nationwide. The Health Care Fraud Defense Group is managed by Dr. Nick Oberheiden, an aggressive Medicare fraud defense attorney with decades of experience to assist physicians, executives, hospitals, and other health care service providers against allegations of Medicare fraud.

This page is intended as a resource for individuals and health care companies facing Medicare fraud investigations in McAllen, TX. Here, you will find answers to the following questions:

  • What is Medicare fraud?
  • What are the civil and criminal penalties for Medicare fraud?
  • What defenses are available in a Medicare fraud prosecution?
  • What type of lawyer should you choose for a Medicare fraud Investigation?
  • What distinguishes The Oberheiden Law Group, PLLC?

Medicare Fraud in McAllen, Texas

Health care service providers and businesses in McAllen, Texas are finding themselves at high risk for becoming the subjects of federal Medicare investigations. Federal program fraud has long been a priority for many federal agencies. Recently, the Department of Justice announced that it intends to prosecute both companies and individuals. In 2016, the DOJ investigated more than 300 total cases. In addition, Texas is one of only seven U.S. states in which the federal government has deployed teams from a special task force to monitor, investigate, and prosecute those suspected of Medicare fraud.

This special task force is known as the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a coordinated effort of the Department of Justice, the Department of Health and Human Services, the Office of Inspector General, the Federal Bureau of Investigation, and also involves other federal agencies. HEAT uses data analysis and other tools to identify health care providers suspected of fraud – a method which unfortunately is leading to many innocent providers in McAllen, Texas facing invasive and disruptive investigations.

What is Medicare Fraud?

Medicare fraud is a federal offense that involves submitting false or fictitious reimbursement claims under the federal Medicare program. Many health care service providers in McAllen, Texas rely heavily upon Medicare reimbursements when providing services, supplies, and equipment to patients. However, due to extreme complexities in the Medicare system, it is easy for providers to make mistakes and some providers have unfortunately chosen to exploit the system for illegal financial gain. This combination has led to major federal law enforcement efforts, such as HEAT, specifically targeting health care providers that submit a high volume of Medicare reimbursement claims.

Medicare fraud violates a number of federal laws. These 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.

Medicare fraud can take many forms, though all forms involve illegally collecting funds from the federal government. Some of the most common forms of Medicare fraud include the following:

  • Phantom billing – billing for services that were never performed;
  • Providing and billing for medically unnecessary services, supplies, and equipment;
  • 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;
  • Upcoding;
  • Unbundling; and
  • Offering and accepting kickbacks

If HEAT’s data analysis or another form of investigation suggests any possible form of Medicare fraud, 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 other health care service providers in McAllen, Texas can all face potential civil and criminal liability. The penalties can be extreme.

What are the Civil and Criminal Penalties for Medicare Fraud?

Targets of Medicare fraud investigations are exposed to substantial penalties, including huge financial liabilities and possible incarceration. The potential financial penalties include recoupment requests, non-payment of future government claims, civil fines of up to $11,000 per false claim, exclusion from federal health care programs, treble damages, attorney fees, and criminal fines. The potential prison sentences for Medicare fraud include:

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

Medical professionals can face licensing actions and loss of hospital privileges, as well.

What Defenses are Available in a Medicare Fraud Prosecution?

While each case presents its own unique set of circumstances, The Oberheiden Law Group, PLLC begins by pursuing four specific defense strategies on behalf of our clients because these four strategies have shown to be successful time and time again:

  • Early intervention with investigating bodies;
  • Arguing lack of evidence to support criminal charges;
  • Arguing lack of criminal intent; and
  • Asserting the appropriate health care law defenses.

1. Early Intervention with Investigating Bodies

In our experience, early intervention with the investigating bodies is key. Hiring a McAllen health care fraud defense lawyer to begin working with the prosecutor’s office as early as possible can significantly reduce the chances of your case turning into a criminal matter. At The Oberheiden Law Group, PLLC, our former federal prosecutors have open lines of communication with the government, and can immediately initiate a dialogue with our government contacts. Within the first hours of our engagement, we will seek answers to the most pressing questions for building your defense strategy:

  • What is the investigation about?
  • What prompted it?
  • Is the case civil or criminal?
  • What agencies are involved in the investigation?
  • Who else is under investigation?
  • How can the investigation be resolved?

2. Arguing Lack of Evidence to Support Criminal Charges

In order to convict you for Medicare fraud, the government must prove beyond a reasonable doubt that you committed an illegal act, and that you did it with criminal intent. This means that the government must have substantial evidence of your involvement in a fraudulent scheme. We will challenge the government’s evidence on all available grounds, and argue that any evidence that the government may have against you is not enough to support a criminal charge or conviction.

3. Arguing Lack of Criminal Intent

In our experience, intentional Medicare fraud in McAllen, Texas is extremely rare. In fact, what we have observed over decades of experience as both defense lawyers and federal prosecutors is that most incidents that prompt these federal fraud investigations involve honest organizational and human errors – not criminal intent. These errors are often the result of non-criminal issues such as:

  • Having an unqualified staff member;
  • Inadequate supervision;
  • Delegation problems;
  • Outsourcing to independent third parties;
  • Organizational mistakes;
  • Human errors resulting from oversights and being overwhelmed; and
  • Lack of an up-to-date compliance program due to the constantly-changing Medicare rules.

Unfortunately, too many business owners simply assume that they are liable and accept penalties that they do not deserve. The Oberheiden Law Group can help you avoid this critical mistake and demonstrate to the government that you lacked the malicious mindset required for criminal charges.

4. Asserting the Appropriate Health Care Law Defenses

During our case assessment, we can often identify a number of viable health care law defenses to help our clients avoid civil and criminal liability. For example, in a recent Medicare fraud case, the government alleged that our client fraudulently certified a patient for home health care services. We were able to successfully argue that a recognized delegation exception applied, rendering our client’s certification fully compliant with the law. In another Medicare fraud case, we refused to admit liability and convinced the prosecutors that our client’s conduct was protected under an applicable safe harbor exception. These are just two examples of the countless health care law and other defenses that may be available.

What Type of Lawyer Should You Choose for a Medicare Fraud Investigation?

In light of the potential penalties and the unique complexities involved in Medicare fraud investigations, it is absolutely essential to have an experienced attorney (or, preferably, an experienced legal team) on your side. Yet, there is still one more pressing question. What type of lawyer will have the right experience for your case?

When defending against a Medicare fraud investigation, ideally you will have a team of experienced health care fraud defense lawyers on your side. Health care fraud defense lawyers are knowledgeable not only about federal health care laws, but about the criminal laws and procedures involved in federal prosecutions.

To find out if an attorney is an experienced health care fraud defense lawyer, you will want to ask the following questions:

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

What Distinguishes The Oberheiden Law Group, PLLC?

The attorneys of the Oberheiden Law Group, PLLC have collectively handled hundreds of health care proceedings and conducted more than 200 criminal trials nationwide. Several of our attorneys have prior experience as senior prosecutors in the Department of Justice, and all of our health care fraud defense lawyers have substantial experience successfully defending clients suspected and accused of Medicare fraud. As a result, the four key factors that distinguish us from other law firms serving clients in McAllen, Texas are:

  • Proven track record for health care fraud defense;
  • Our industry knowledge;
  • Our deep familiarity with federal health care and criminal laws;
  • Our litigation & trial experience.

Unlike most other firms, we have broad experience specifically within the area of health care fraud defense. Our defense team regularly represents business owners, health care executives, lawyers, health care providers, hospitals, pharmacies, laboratories, and other entities in the health care industry that find themselves under federal scrutiny. This includes investigations involving the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, the Drug Enforcement Administration, the Office of Inspector General, the Medicaid Fraud Control Unit, McAllen and Texas law enforcement, the Internal Revenue Service, and other state and federal agencies.

If you are facing a Medicare fraud investigation in McAllen, Texas you can trust our experience as former federal prosecutors and as health care fraud defense attorneys in complex investigations nationwide to help you present the strongest possible defense.

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.

McAllen, Texas Health Care Fraud Defense Attorneys

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, charges of political corruption, government investigations, and during media campaigns, including 60 Minutes. Dr. Oberheiden is best known and respected for his ability to stop federal investigations before criminal charges can be filed. In addition to his health care defense practice, Dr. Oberheiden provides assistance with 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 the Oberheiden Law Group 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). Clients greatly benefit from Ms. Byrd’s former experience from working with the Department of Justice. She prosecuted health care fraud, Anti-Kickback violations, False Claims Act investigations, and Stark violations on behalf of the United States. Her immense experience with health care law enforcement is extremely beneficial for her clients in federal court.

We are available to discuss your case. You can call us directly or complete our contact form to request a free consultation.

800-810-0259
Including Weekends
Oberheiden Law Group, PLLC
Serving McAllen, 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. 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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