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 Legal Defense for San Antonio and the Surrounding Areas in Texas

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 best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in San Antonio as well as throughout Texas State.

Health care providers, businesses, facilities, executives, and lawyers in San Antonio, Texas have a powerful legal advocate on their side for Medicare fraud defense. The Oberheiden Law Group, PLLC provides Medicare fraud defense for San Antonio, Texas and the surrounding areas. Dr. Nick Oberheiden, managing principal partner, is a Harvard-trained negotiator and defense attorney providing legal assistance to clients in Garland, Dallas, Mesquite, Richardson, McKinney, and their surrounding areas.

Lynette Byrd is a former federal health care fraud prosecutor and 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.

Defining Medicare Fraud

Medicare fraud violates federal law. It involves the submission of a false claim to a government health care program. It doesn’t just include Medicare. It also includes Medicaid, Tricare, and federal workers’ compensation. If you’re charged with Medicare fraud, you’ve violated at least one of the following statutes:

  • Violation of the False Claims Act
  • Violation of the Anti-Kickback Statute
  • Violation of the Physician Self-Referral Law (Stark Law)
  • Violation of U.S. Criminal law
  • Violation of Social Security Act

Medicare fraud investigations can involve a single person or an entire organization who is accused of filing at least one false claim with a federal health care program in order to receive an illegal payment from the program.

San Antonio, Texas actually has a higher average of these investigations than the majority of the United States. San Antonio is one of nine areas in the United States that is more closely watched by the federal government for Medicare fraud. This happens because San Antonio has a large number of individuals who are enrolled in a federal health care program. There are more federal health care claims filed in the area. The area is monitored by the Medicare Fraud Strike Force.

The Medicare Fraud Strike Force is responsible for monitoring, investigating, and prosecuting instances of Medicare fraud. This team is a combination of investigators and prosecutors from various federal agencies including Department of Health and Human Services, the Office of Inspector General, the DOJ, DOD, FBI, IRS, and other agencies. However, other federal agencies can also be involved with the Medicare Fraud Strike Force. If you’ve been contacted and told that you’re being investigated for Medicare fraud, call the Oberheiden Law Group immediately. Initial consultations are free of charge and totally confidential.

How Do Most Medicare Fraud Investigations Start in San Antonio?

We are often asked what the most common trigger is for Medicare fraud investigations in San Antonio. The answer to that question is billing problems. It could be inappropriate billing practices or fraudulent reimbursement requests including excessive, false, or unauthorized charges. The federal government refers to this as billing fraud. The most common types of billing problems in San Antonio that trigger Medicare fraud investigations include:

  • Billing for medically unnecessary services
  • Billing for unordered medical equipment
  • Phantom billing (billing for services that were never referred)
  • Billing for unordered services
  • Billing for medically unnecessary services or equipment
  • Certification for medically unnecessary supplies, equipment, or services
  • Double billing
  • Upcoding
  • Inflating charges
  • Overuse of equipment
  • Overuse of services
  • Providing or accepting kickbacks

The second most common question we are asked about San Antonio Medicare fraud investigations is who is most likely to be investigated. San Antonio practitioners, including nurses, ARNPs, physician assistants, and doctors are most commonly investigated. Health care service providers, registered care facilities, nursing homes, hospitals, clinics, pharmacies, labs, medical device company, cancer treatment centers, and DNA centers are also common targets of Medicare fraud investigations.

Penalties for Medicare Fraud

Medicare fraud is an incredibly serious allegation and can have both civil and criminal penalties that affect your life.

Civil penalties may include one or more of the following:

  • Recoupment requests
  • Treble damages
  • Non-payment of future claims
  • Fines up to $11,000 per false claim
  • Exclusion from federal health care programs
  • Attorney fees

Criminal penalties can occur on their own or you may face them along with civil penalties. They may include one or more of the following:

  • Criminal charges
  • Hundreds of thousands of dollars in fines
  • 10 years in federal prison for each count of Medicare fraud for which you are convicted
  • 20 years in federal prison for each count of Medicare fraud that caused serious bodily injury to the patient
  • Life sentence for Medicare fraud if it results in the death of the patient

You Must Choose the Right San Antonio Defense Lawyer

Choosing the right San Antonio defense lawyer is imperative to your case. The defense attorney needs the right skills and experience to face the federal government. Do not choose any lawyer who does not have the right experience. Your case and your life are just too important.

The most common instinct by people and businesses facing an allegation of Medicare fraud is to hire a health care attorney. However, Medicare fraud is often not the only charge. Serious federal criminal charges such as tax evasion, money laundering, wire fraud, and mail fraud are often included. Health care attorneys may understand the laws related to health care, but most will not have the experience that you need to deal with federal criminal charges. They may not have the necessary negotiating experience to help you face the federal government or to assist you in the development of a vital and strategic defense if your case goes to trial.

When providers and businesses find out that they may be facing criminal charges, they often default to seeking out a San Antonio criminal defense attorney. Yet, most criminal defense attorneys don’t have the proper experience needed when it comes to federal criminal matters. They also likely do not have the required knowledge of billing, coding, and medical utilization rules.

San Antonio area health care providers, facilities, and businesses should seek the services of a health care fraud defense attorney. As you’re doing your research, look for the following four key traits:

  1. A proven track record of success in Medicare fraud cases
  2. Industry experience
  3. Intimate understanding with health care laws and their exceptions
  4. Litigation and trial experience

After you’ve located a health care fraud defense attorney, you need to ask the following three questions to really get a good idea of their experience with Medicare fraud:

  1. How many Medicare fraud cases have you handled during your career in law?
  2. How many of those cases resulted in no civil or criminal charges, or in dismissals for your clients?
  3. How many Medicare fraud cases did you try in court?

Necessary Defense Strategies for Medicare Fraud

A good defense strategy is necessary to fight the allegations of Medicare fraud. The Oberheiden Law Group, PLLC has three guiding principles that we use to help our San Antonio clients. Although each Medicare fraud case is different and has its own set of facts that led up the allegations, these three principles continue to help our clients nationwide.

Early contact with the federal government. The more time that the federal government has to investigate you without an interruption, the more likely it is that you may face criminal charges. Early contact with the federal government is one of the keys to minimizing the risk. Once retained, we contact the federal investigating bodies to get answers to questions such as:

  • What prompted the investigation?
  • What is the case about?
  • Is the matter civil or criminal?
  • Which federal agencies are involved in the investigation?
  • What is the ultimate goal of the investigation?
  • How can the matter be resolved?

The Oberheiden Law Group works hard to get answers to these questions. We can usually do so within the first few hours after we begin working on your behalf.

Lack of evidence. The federal government must present evidence that proves that you committed a crime. This proof must meet an incredibly high standard known as ‘beyond a reasonable doubt.’ We test the evidence in each Medicare fraud case. We’ve seen the following results regularly on behalf of our clients:

  • Dismissal of case
  • No criminal charges
  • Clients maintain their professional license
  • Civil fine without a criminal plea
  • Reduction of a felony to a misdemeanor
  • No prison sentence

Lack of criminal intent. In addition to proving that you committed a crime, the federal government must also prove that you acted with criminal intent. Throughout our years of experience in Medicare fraud, we’ve learned that San Antonio has very few legitimate instances of it. These allegations usually start because someone made a mistake and not because someone set out with an intention to break the law. Common mistakes include:

  • The use of unqualified staff
  • Inadequate supervision of staff
  • Delegation or outsourcing to entities who are not qualified
  • Business errors
  • Human errors
  • Oversight
  • Employees who are overwhelmed by their job duties
  • No Medicare compliance program
  • Inability to keep up with the quickly changing health care laws and rules

Even though most Medicare fraud cases start because of a mistake, there are many providers and, businesses, and facilities who are accused and just accept the consequences although they did not set out to break the law. They accept the reality of the harsh criminal and civil penalties for making an honest mistake.

Our Health Care Fraud Defense Team has a single goal: To show the federal investigators and prosecutors that our clients made a mistake. While the mistake may certainly need to be addressed and corrected, honest mistakes that lack criminal intent should not be treated as crimes.

The use of strategic and applicable defenses. The Oberheiden Law Group takes the time to examine and analyze each case to determine strategic and applicable defenses on behalf of our clients. This is a necessity since each case has a different set of extenuating facts. In a recent Medicare fraud case, the government alleged fraudulent certification for home health care services by our client. We were able to prove to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant within the law. In another Medicare fraud case, we refused to admit liability. We were able to prove to prosecutors that our client acted within a safe harbor exception.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides strategic defense and legal advocacy for San Antonio health care practitioners, facilities, and related businesses. This includes business owners, attorneys, executives, individual providers, hospitals, pharmacies, labs, and other health care entities that are investigated for illegal kickbacks and fraudulent billing. We also assist with allegations of medically unnecessary services or equipment, services not rendered, or unlawful joint ventures. We provide assistance to our San Antonio clients with:

  • Health care fraud defense
  • Compliance program creation and implementation
  • Internal investigations
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

The Oberheiden Law Group provides representation to individuals and businesses in San Antonio who are being investigated by the DOJ, DOD, FBI, DEA, OIG, Medicare Fraud Control Unit, San Antonio or Texas state law enforcement, and the IRS.

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.

Medicare Fraud Defense Attorneys Serving San Antonio, Texas

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, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. He is most known for stopping federal investigations before criminal charges can be filed. 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 San Antonio, 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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