Duval County, Texas Healthcare Fraud Defense Attorneys
Duval County Healthcare Defense Team Lead
Contact Nick440 Louisiana St #200
Houston, TX 77002
713-597-3388
Individual healthcare providers, entities, and businesses in Duval County, Texas face a high risk of investigation for healthcare fraud. Oberheiden, P.C. has substantive experience in:
- Healthcare fraud defense,
- Medicare and Tricare audits,
- Protection of assets,
- Compliance programs,
- Jury trials,
- Fraud allegation defense,
- Qui tam defense,
- OIG and grand jury subpoenas,
- Criminal defense, and
- Internal investigations.
Our Healthcare Fraud Defense Team includes a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, several former healthcare fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. Our attorneys help clients in Duval County as well as the rest of Texas.
If you’re in Duval County, Texas and you’re under investigation for healthcare fraud, call Oberheiden, P.C. to speak with a member of our Healthcare Fraud Defense Team. Initial calls are free and confidential.
Duval County, Texas Is Constantly Observed for Healthcare Fraud
Duval County, Texas is one of nine regions in the nation that is closely monitored for healthcare fraud by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is a federal team of investigators and prosecutors from several federal agencies.
Duval County, Texas and the surrounding areas face constant monitoring because of the number of people who receive federal healthcare program benefits. This means that there are more claims filed with the federal government healthcare program for payment. Since there are more claims filed, the federal government believes that more healthcare fraud also occurs. In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year. OIG, HHS
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
Lynette S. Byrd
Former DOJ Trial Attorney
Partner
Brian J. Kuester
Former U.S. Attorney
Hon. Kevin McCarthy
55th Speaker, U.S. House of Representatives (ret.)
Government Consultant
Mike Pompeo
Of Counsel
Former U.S. Secretary of State
John W. Sellers
Former Senior DOJ Trial Attorney
Linda Julin McNamara
Federal Appeals Attorney
Nicholas B. Johnson
Former Prosecutor
Roger Bach
Former Special Agent (DOJ)
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Ray Yuen
Former Supervisory Special Agent (FBI)
The Basics of Healthcare Fraud
It’s important to understand what constitutes healthcare fraud. Healthcare fraud is defined as an attempt to receive payment from a federal government healthcare program for medical services or equipment from incorrect or misleading claims. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It is a violation of at least one of the following:
- The Anti-Kickback Statute. Federal law restricts the exchange of money or other valuables for patient referrals. Anyone may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
- Stark Law. Stark Law is more commonly known as the Self-Referral Law. It bars physicians from referring patients to certain healthcare entities if the physician or an immediate family member has an ownership or investment interest in the entity. Or, if there is a compensation arrangement between the providers. There are statutory exceptions to this law.
- False Claims Act. If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an inquiry into your billing practices under the criminal provisions of the Act.
- Prescription Fraud. Prescribing a high volume of narcotics is closely monitored by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA dispensing rules.
- Billing Fraud. One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates:
- Allegations of phantom billing (services not provided),
- Ghost patients (patients who do not exist), and
- Billing for medically unnecessary services or equipment.
- Certification Errors. The federal government pays close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.
Oberheiden, P.C. has a history of success in helping our clients avoid criminal charges. That’s our main priority. If you’re being investigated in Duval County, Texas for healthcare fraud, call us. Initial calls are free and confidential.
What Are the Civil and Criminal Penalties of Healthcare Fraud?
Healthcare fraud in Duval County, Texas can cause you to be the recipient of civil or criminal penalties. In civil court, you could be ordered to repay the amount of the federal claims, you may lose payment for future claims, and you could be barred from future participation in federal healthcare programs.
If you face criminal charges, you could end up with a criminal record, huge fines, or even a federal prison sentence of:
- Up to 10 years for each count of healthcare fraud
- Up to 20 years for each count of fraud that resulted in serious bodily injury
- Life sentence if the healthcare fraud resulted in death
Often, we’re asked about the worst-case scenario for healthcare fraud for providers, entities, and businesses in Duval County, Texas. Whether you’ll face criminal charges or a prison sentence depends on several factors. These are: the severity of injury suffered by a patient, if the prosecutor sees an advantage in pursuing criminal charges, and the reason the federal government began the case. If you’re under investigation for healthcare fraud, contact Oberheiden, P.C. Your initial call is confidential and free.
Oberheiden, P.C. is ready to help Duval County, Texas healthcare clients based on our background as former federal prosecutors and healthcare fraud defense attorneys. If you’re contacted and told you’re under investigation for healthcare fraud, call us today. Learn more about your legal options and how we can help. Initial consultations are confidential and free of charge.
Signs That the Investigation Against You Is Criminal
Healthcare fraud investigations in Duval County can be civil or criminal. Investigations can start as civil and then become criminal as the investigation progresses. Being contacted by a prosecutor does not mean the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor as an indicator. Rather, signs of a criminal case may include:
- Search warrants,
- Seizure warrants,
- Arrest warrants,
- Target letters,
- Contact from a federal criminal prosecutor,
- Involvement from the IRS, or
- Receipt of a grand jury subpoena.
Frequently Asked Questions
What is a whistleblower?
A whistleblower provides evidence of healthcare fraud to the federal government. Often in the hopes of obtaining a financial reward. Whistleblowers can be current or former employees, business associates, patients, customers, or anyone else who comes across information they believe shows a violation of federal law. All whistleblower claims are brought under the False Claims Act. However, the alleged violation can be based on any federal healthcare fraud statute. When a whistleblower contacts federal investigators, the government determines if it will intervene in the case. If it does, federal prosecutors will formally take over the case. If the government chooses not to intervene, the whistleblower is permitted to pursue the case alone. Whistleblowers who successfully bring a case, either on their own or after the government intervenes, are entitled to a percentage of the amount recovered. This raises some suspicion about the information whistleblowers provide. These suspect accusations should still be taken very seriously. Any healthcare provider facing a violation of the False Claims Act should speak to a Duval County, Texas federal healthcare fraud defense attorney as soon as possible.
What is the difference between Medicare fraud and Medicare abuse?
Under federal law, both Medicare fraud and Medicare abuse are illegal. However, the difference between the two is quite subtle. Medicare fraud usually involves a healthcare provider submitting a false or fraudulent claim for payment or participating in an illegal kickback scheme. Medicare abuse refers to billing Medicare for unnecessary or unjustified costs. For example, billing for unneeded services or charging for excessive supplies. Depending on the type of violation, both Medicare fraud and abuse can result in civil or criminal penalties. If under investigation for Medicare fraud or abuse, contact a dedicated Texas federal healthcare fraud defense attorney today. You can learn more about your options and how to effectively defend against allegations.
Should I speak with federal investigators about an investigation?
Absolutely not. It is very important to first speak to a Duval County federal healthcare fraud defense attorney. One problem in speaking to federal investigators is you can’t be sure if they are being upfront with you regarding the case. It is easy to provide incomplete or misleading information, which could shift the focus onto you. Rather than risk speaking with investigators on your own, it is in your best interest to discuss the situation with an experienced Texas federal healthcare fraud defense attorney. An attorney can help you decide on the most effective next steps.
Healthcare Fraud Defenses in Duval County, Texas
Oberheiden, P.C. is a healthcare fraud defense firm. We develop personalized strategies for our Duval County clients. We’ve defended hundreds of people. Several of our healthcare fraud attorneys have experience as former healthcare auditors and healthcare fraud prosecutors with both the Department of Justice and the Medicare Fraud Strike Force. We use this experience to develop strategic defenses for each of our clients.
Getting answers to important questions. The main priority of our firm is to help our clients avoid criminal charges. Once retained, we promptly contact the federal prosecutor. This lessens the time that the federal government has to investigate you without interruption. This is important. If the federal government has too much time to investigate you, you could face criminal charges. Our goal is to get answers to these most important questions within hours:
- What is the investigation about?
- What is the purpose of it?
- How long will the investigation take?
- What is the most likely outcome?
No criminal intent. The federal government must prove that you committed a crime and that you acted with criminal intent. They must present evidence that meets a high legal standard. Often, the federal government will try to use billing inaccuracies to prove that you committed a crime. We’ve found that billing errors usually don’t occur because someone acted with criminal intent to defraud the government. They happen because of a mistake. Mistakes should certainly be corrected, but they should not lead to criminal conviction. The most common errors that cause problems include:
- Hiring unqualified workers,
- Delegation errors,
- Outsourcing errors,
- Lack of oversight,
- Insufficient supervision, and
- Frequently changing laws and rules in healthcare billing.
Using legal defenses for each case. The healthcare fraud defense attorneys at Oberheiden, P.C. examine the facts in each case to develop the right defenses for each client. Often, this includes the use of statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a healthcare fraud case.
Protecting your professional reputation. Allegations of healthcare fraud can damage your professional reputation. Oberheiden, P.C. will help protect your reputation both inside and outside the courtroom. Our attorneys will correct misinformation presented to the public by the media about our clients. We also address slanderous comments.
If you’re being investigated for healthcare fraud in Duval County, Texas, call Oberheiden, P.C. now. The first call is free and confidential.
Our Track Record
The commitment of Oberheiden, P.C. is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced healthcare fraud defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. Here are some recent examples of our case outcomes.
- Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
Result: No civil or criminal liability.
- Representation of a Healthcare 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.
- Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud.
Result: No civil or criminal liability.
- Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
Result: No civil or criminal liability.
- Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
Result: No civil or criminal liability.
We are available every day of the year. Call, complete our contact form, or email us directly.
Including Weekends
Oberheiden, P.C.
Serving Duval County, Texas and Surrounding Areas
www.federal-lawyer.com
