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 Legal Team Serving all of Texas

3131 McKinney Ave #600
Dallas, TX 75204
800-810-0259
(Meeting location by appointment only)

The Oberheiden Law Group, PLLC is a team of experienced defense attorneys and former federal prosecutors and is headquartered in Dallas, TX. Our Health Care Fraud Defense Group is headed by Texas attorney Dr. Nick Oberheiden who brings extensive experience to representing health care providers, executives, and others who may be the subject of Medicare fraud investigations. If you are facing a federal investigation or if you have already been charged with Medicare fraud in Texas, we encourage you to contact us immediately for a free case evaluation and defense strategy consultation.

Are You Facing a Medicare Fraud Investigation in Texas?

Medicare fraud investigations, like fraud investigations involving Medicaid, Tricare, and federal workers’ compensation, typically focus on perceived false and fictitious billing practices. Each year, these government programs pay billions of dollars in false claims. As a result, federal program fraud (including Medicare fraud) has become an area watched by the federal government. Medicare fraud involves a number of federal statutes, including the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Laws (Stark Law), the Social Security Act, and the U.S. Criminal Code; and, while fraud can take many forms, the key component of any Medicare fraud investigation is an allegation that the health care provider has illegally received money from this well-known federal health care program.

Texas is home to many retirees and has one of the largest numbers of Medicare beneficiaries nationwide. As a result, Texas is a major target of the federal government’s crackdown on suspected Medicare fraud. Due to the sheer volume of health care services billed to Medicare in Texas on a daily basis, the state has become a focal point of the government’s efforts to curb widespread instances of fraud. Texas is one of nine areas within the United States that is more than just closely watched. It has a team of Medicare fraud investigators that focus exclusively on health care professionals, facilities, and businesses.

In fact, Texas is one of only two states nationwide with two Medicare Fraud Strike Force task forces deployed specifically to investigate and prosecute health care providers suspected of Medicare fraud. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is a coordinated federal task force comprised of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies. The HEAT task force is aggressively pursuing health care providers suspected of Medicare fraud on a statewide basis. The Oberheiden Law Group has extensive knowledge of how to defend violations investigated by HEAT.

Common Forms of Medicare Fraud

Medicare fraud involves the submission of false or fictitious claims for reimbursement within the federal Medicare or other government health care program. While health care service providers that treat Medicare beneficiaries are entitled to seek payment for qualifying services, supplies, and equipment from the government, in some cases providers have been known to abuse the system. This has led to an increased diligence on behalf of the government to prevent Medicare fraud. Specifically, Medicare fraud investigations will often focus on practices such as:

  • Billing for services never performed (so-called “phantom billing”);
  • Billing for services that were medically unnecessary;
  • Billing for supplies and equipment that were never ordered;
  • Billing for supplies and equipment that were medically unnecessary;
  • Obtaining certification for medically unnecessary services (common in Home Health and Hospice Fraud Investigations);
  • Obtaining certification for medically unnecessary supplies (including Durable Medical Equipment (DME));
  • Double billing, upcoding, or unbundling services;
  • Overutilization of services and equipment; and
  • Offering or accepting kickbacks.

A recent announcement from the Department of Justice stated that the agency is focusing its investigative efforts on individuals as well as companies. No one working in the Texas health care industry is immune from prosecution for Medicare fraud. As a result, physicians, executives, 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 Texas are all potentially at risk for being investigated and prosecuted for Medicare fraud.

The Risks of a Medicare Fraud Investigation

If you are a Texas health care professional or organization being targeted in a Medicare fraud investigation, the potential consequences can be severe. Being found civilly liable or criminally responsible could result in a judgment for repayment of false claims, non-payment of future claims, civil fines of up to $11,000 per false claim, exclusion from federal health care programs, treble damages, attorney fees, and criminal fines. You can also face long-term imprisonment:

  • Medicare fraud: Up to 10 years in prison per count; for instance, if you are found guilty of five counts, you could face up to 50 years in prison;
  • Medicare fraud resulting in serious bodily injury: Up to 20 years in prison per count; or
  • Medicare fraud resulting in death: Life imprisonment.

In addition to civil and criminal penalties, physicians and other health care providers charged with Medicare fraud in Texas will often face the loss of their professional license and the loss of their hospital privileges.

Mitigating the Risks: Choosing the Right Defense Lawyer

In light of the severe risks of a Medicare fraud conviction in Texas, it is critical to hire a qualified defense team as soon as you find out that you are under investigation. To give yourself the best chance of obtaining a favorable outcome (ideally, no civil or criminal liability), the best thing that you can do is to put experience on your side.

Why You Don’t Just Want a “health care” or “Criminal” Lawyer

Medicare fraud cases are extremely complex in terms of both the general health care law aspects and the unique Medicare-specific issues involved. In addition, many Medicare fraud cases also involve allegations of mail fraud, wire fraud, tax evasion, money laundering, and other serious federal offenses – exposing targets to the possibility of spending decades behind bars. Most criminal lawyers lack the health care knowledge necessary to effectively defend Medicare fraud claims. Most health care lawyers lack the experience and training needed to negotiate with prosecutors and challenge their clients’ federal charges in court.

Put an Experienced Team of Health Care Fraud Defense Lawyers on Your Side

If you are facing a Medicare fraud investigation, you need to retain an experienced health care fraud defense lawyer in Texas.

At The Oberheiden Law Group, PLLC, our team of health care fraud defense lawyers brings decades of experience to help clients fight their federal charges. Our lawyers offer:

  • A proven track record;
  • Industry knowledge;
  • Deep familiarity with federal health care and criminal laws;
  • Litigation & trial experience; and
  • Experience settling claims with the federal government.

Unlike other defense firms, at The Oberheiden Law Group, PLLC we truly take a team approach to defending our clients. When you retain us, you can feel confident knowing that you have a team of senior defense attorneys and former federal prosecutors who are pooling their resources and using aggressive, proven defense tactics to help you avoid facing charges in court.

Aggressive, Proven Defense Tactics for Medicare Fraud Investigations

At The Oberheiden Law Group, PLLC we have handled hundreds of health care proceedings and conducted trials in nationwide, including in Texas. Based on our attorneys’ collective experience, we have identified a number of proven defense strategies for helping our clients avoid criminal convictions and civil liability. These strategies include:

Early Intervention During the Investigation

Early intervention in federal investigations is extremely important. This limits the time that the federal government has to build their case against you when you don’t have legal representation. When clients get us involved early, we are able to open the lines of communication through our government contacts and quickly get answers to important questions. We can find out what the case is about, what prompted the investigation, whether the investigation is civil or criminal, which agencies are involved, and who is under investigation. We can usually get these answers within a couple of days. This is important because answers to those questions help put our clients at ease and helps us formulate a strategic and custom defense.

Arguing a Lack of Federal Evidence in Texas

In order to convict you of Medicare fraud, the government must meet two extremely high standards. They must prove that you are guilty beyond a reasonable doubt. They must also prove that you acted with criminal intent. In Medicare fraud cases, we seek to challenge the government’s evidence as insufficient to support criminal charges. By demonstrating that the government lacks the necessary evidence to convict you in a criminal case, we can seek results including:

  • Dismissal;
  • Dropping criminal charges;
  • Maintaining your professional license;
  • Civil fines without a criminal plea;
  • Misdemeanor charges instead of felony charges; and
  • No prison sentence.

Establishing the Lack of Criminal Intent in Texas

Intentional Medicare fraud in Texas is rare. In fact, most incidents that prompt Medicare fraud investigations actually involve simple business or human errors. These mistakes occur because health care providers are focused on caring for their patients. The most common mistakes include:

  • The use of unqualified staff;
  • Lack of supervision;
  • Improper delegation;
  • Outsourcing;
  • Structural deficits;
  • Organizational errors;
  • Human error;
  • Oversight;
  • Lack of a compliance program to prevent errors; and
  • Constantly changing health care rules and laws.

However, while these may be issues that should ultimately be addressed, they do not amount to criminal intent. When you choose The Oberheiden Law Group, we will seek to use the facts of your case to argue that any errors that may have occurred do not rise to the level of establishing criminal intent or liability.

Asserting Specific Defenses Under Applicable Health Care Laws

The fourth strategy that we use is to identify any defenses that may be available under applicable health care laws. For example, in one recent Medicare fraud case, the government alleged that our client provided fraudulent certification for the need of health care services. In our response, we successfully argued that a recognized delegation exception protected our client. In another Medicare fraud case, we refused to admit liability and ultimately convinced the prosecutors that our client was protected by a safe harbor within the statute.

About The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides representation of Texas business owners, health care executives, lawyers, health care providers, hospitals, pharmacies, laboratories, and other entities in the health care industry in all types of health care fraud investigations. This includes cases involving allegations or suspicion of illegal kickbacks, fraudulent billing practices, rendering medically unnecessary services, and engaging in unlawful joint ventures involving referring physicians and ancillary-income businesses.

We have experience in Medicare fraud investigations involving the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, Drug Enforcement Administration, the Office of Inspector General, the Medicaid Fraud Control Unit, Texas enforcement, the Internal Revenue Service, and other state and federal agencies. Regardless of the allegations or the involved investigating body in your case, we have most likely handled similar allegations as defense attorneys, prosecutors, or both.

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.

Texas Defense Attorneys

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has provided successful defense and representation of health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, political corruption allegations, government investigations, and in media campaigns, including 60 Minutes. Dr. Oberheiden is best known for minimizing the risk of federal charges by bringing a halt to federal investigations. In addition to his health care defense practice, Dr. Oberheiden assists 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). She prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States during her time with the Department of Justice. Ms. Byrd has immense experience with health care law enforcement, and regularly handles federal matters for her clients.

We are available every day of the year, 24 hours a day. 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 the State of 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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