Irving Healthcare Fraud Defense Lawyer
Irving Healthcare Defense Team Lead
Contact NickFederal agents and investigators have recently shown an increased interest in prosecuting Texas healthcare providers, especially those in and around the Irving area. If federal authorities contacted you about an investigation into your practice, our Texas healthcare fraud defense lawyers can help. Call 888-680-1745 now.
Medical providers who bill Medicare, Medicaid, Tri-Care and other federally funded health programs are subject to strict oversight. Federal investigators with the Health and Human Services – Office of the Inspector General (OIG), Drug Enforcement Administration (DEA), the Centers for Medicare and Medicaid (CMS) and the Department of Justice have broad authority to initiate civil and criminal cases against all healthcare professionals. These cases carry significant consequences, including recoupments, program exclusions, civil and criminal fines, and even lengthy federal prison sentences.
At Oberheiden, P.C., our dedicated team of Irving healthcare fraud defense lawyers is highly experienced in defending the rights of medical practitioners. We maintain an active, nationwide practice, drawing from the most talented pool of prodigious and veteran healthcare fraud defense attorneys. In fact, many of our senior attorneys prosecuted healthcare fraud cases on behalf of the government before joining Oberheiden, P.C. This provides us with a rare insight into how federal investigators and prosecutors view healthcare fraud allegations, how they build their case, and how to best defend against the allegations.
What Constitutes Healthcare Fraud?
This type of fraud covers a wide range of offenses, most of which relate to a provider’s interaction with one or more federally funded healthcare programs, such as Medicare, Medicaid or Tri-Care. Insurance fraud is also a significant aspect of healthcare fraud cases, involving both healthcare providers and patients facing allegations of false claims. While the term “fraud” typically brings to mind an intentional scheme to deprive, the government does not necessarily need to prove an intent to defraud unless it is pursuing criminal liability. In most healthcare fraud cases, the government merely needs to show that the error was intentionally made, not that it was made with the objective of engaging in fraud, or for illegal financial gain.
Given the lax requirements of a healthcare fraud case, many honest, hard-working providers who made a few inadvertent errors end up at the center of a healthcare fraud investigation. At Oberheiden, P.C., our respected Irving healthcare fraud defense attorneys advise providers accused of engaging in all types of fraudulent activity that can be classified as a federal crime under statutes like the False Claims Act and 18 USC 1347, and:
False and Fraudulent Claims
The False Claims Act prohibits the submission of any “false or fraudulent” claims to Medicare, Medicaid or any other federally funded program. While an intentional violation of the False Claims Act can result in criminal liability, inadvertent violations can still put you at risk of significant civil liability. Depending on the nature and severity of the allegations, the fines can reach the hundreds of thousands of dollars—or even higher. Those found in violation of the False Claims Act may also face program exclusion, meaning they can no longer receive reimbursement from Medicare or Medicaid. At Oberheiden, P.C., our Irving federal healthcare fraud defense lawyers have successfully represented hundreds of clients facing civil and criminal charges under the False Claims Act.
Illegal Referrals
Referrals are an important and legitimate part of the healthcare industry. However, federal law imposes strict laws governing these relationships. For example, the Stark Law, the Anti-Kickback Statute, and the Eliminating Kickbacks in Recovery Act all limit the situations in which physicians can refer patients. The Stark Law is a civil statute that precludes a provider from referring a patient to another practice in which the referring provider has an economic interest. The Anti-Kickback Statute is a criminal statute that prevents any party from paying or receiving anything of value when referring a patient whose medical bills are paid by Medicare or any other federally funded program. And the Eliminating Kickbacks in Recovery Act makes it illegal to profit from the referral of patients who are suffering from addiction. While the Stark Law imposes only civil liability, the Anti-Kickback Statute and the Eliminating Kickbacks in Recovery Act can both result in criminal sanctions in addition to civil liability under the False Claims Act.
Billing and Coding Errors
The federal government keeps a watchful eye on all providers who bill Medicare, Medicaid or any other federally funded program. Even unintentional errors can raise the brow of the federal government, triggering a burdensome and invasive investigation. At Oberheiden, P.C., an Irving healthcare fraud defense lawyer can intervene early on in the federal legal system before the government completes its investigation. Often, we are able to convince the government of the inadvertent nature of the errors that would otherwise form the basis of a prosecution.
Billing Medicare or Medicaid for Unnecessary Supplies, Services or Equipment
Providers can only bill Medicare and Medicaid for supplies, services or equipment that are medically necessary. However, what makes something medically necessary? It’s up to the federal government. This often results in the government second-guessing providers, who may face liability based on a subjective interpretation of what is a medical necessity.
Prescription Drug Fraud
Given the ongoing opioid epidemic, federal agents with the Drug Enforcement Administration and the Department of Justice have recently come down hard on providers who prescribe, dispense, or administer opioid medications. The federal laws governing controlled substances are exceptionally complex, and a small misstep in compliance can result in significant civil or criminal liability.
Falsifying Patient Records
The federal government often raises allegations that a provider falsified patient records or test results to buttress its claim that a provider engaged in intentional billing and coding violations. A federal prosecutor plays a crucial role in proving these allegations, as they must demonstrate that the false claims were submitted knowingly and intentionally. If these accusations are not addressed immediately, it can result in a minor pattern of errors turning into something much larger and more serious.
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)
Oberheiden P.C. Handles All Types of Healthcare Fraud Cases
As a premier Irving healthcare fraud defense law firm, we represent individual and organizational clients in a wide range of fraud actions. While the federal government has many tools to enforce healthcare fraud laws, in recent years, we’ve come to see that federal prosecutors most often bring the following types of cases.
False Claims Act
The False Claims Act is perhaps the leading healthcare fraud statute in the United States. The False Claims Act makes it illegal to submit any “false or fraudulent” claim for reimbursement to Medicare, Medicaid, or any other federally funded program. A violation of the False Claims Act can bring civil or criminal liability. However, to establish civil liability, the government does not need to prove that a provider had any intent to defraud the government. Thus, many well-intentioned and honest providers find themselves at the center of a healthcare fraud violation based on innocent mistakes
Stark Law
The Stark Law is a civil liability statute the prohibits physician self-referrals. More specifically, the Stark Law makes it illegal for a doctor to refer a patient to another practice when the referring doctor shares an economic interest in the practice receiving the referral. The Stark Law is somewhat narrow in scope in that it only applies to physicians and their “related entities” and does not apply outside the context of Medicare and Medicaid referrals.
Anti-Kickback Statute
The Anti-Kickback Statute is similar to the Stark Law in that it limits the situations in which healthcare providers can pay or receive referrals. However, unlike the Stark Law, the Anti-Kickback Statute applies to all providers, giving it a much broader reach. The Anti-Kickback Statute prohibits the payment or receipt of anything of value for a referral of a patient whose medical expenses are being paid by a federally funded program. The Anti-Kickback Statute is a criminal law, which carries a penalty of five years in prison and a fine of up to $25,000. In addition, any provider who violates the Anti-Kickback Statute may be excluded from participating in Medicare or Medicaid in the future.
Controlled Substances Act
The Controlled Substances Act applies to all providers who prescribe, administer, dispense prescription medication. The DEA is the primary agency that investigates these claims, often with help from the Department of Justice. Given the ongoing opioid epidemic, in recent years, federal authorities have taken a particular interest in investigating doctors, pharmacies, hospitals, recovery centers, pain management clinics and hospice centers.
Healthcare Fraud Statute
While many healthcare fraud allegations involve conduct targeting federally funded programs, the Healthcare Fraud Statute applies more broadly to all public and private payors. The Healthcare Fraud Statute carried some of the most severe criminal penalties, up to 20 years in prison per offense in some cases.
What Makes Oberheiden, P.C. Different?
If you find yourself at the center of a healthcare fraud investigation, it is imperative that you consult with a skilled attorney as soon as possible. To be sure, there are many Irving federal healthcare fraud defense lawyers out there, and most of them will be able to competently handle your case. However, when your profession and freedom are on the line, you deserve more than mere competence.
At Oberheiden, P.C., we’ve assembled a team of highly skilled Irving healthcare fraud defense lawyers. Our lawyers have risen to the top of their field through years of dedication to their craft. Many of our lawyers spent years learning the intricacies of these complex cases while working as prosecutors or investigators with the federal government. When you bring Oberheiden, P.C. onto your team, you are getting more than a lawyer; you are getting a team of advocates who bring a diverse range of skills and knowledge to the table.
Given the seriousness of healthcare fraud investigations, your choice of attorney is critical. At Oberheiden, P.C, we offer the following:
Unrivaled Experience
At Oberheiden, P.C., we are highly experienced with handling complex healthcare fraud cases from both the defense and government side. This gives us a valuable perspective on the best way to situate your case for a successful resolution.
The Ability to Immediately Intervene
Once you realize you are under investigation for healthcare fraud, it is essential to take immediate action. Why sit back and allow the government to continue with an uninterrupted investigation? At Oberheiden, P.C, we will reach out to federal investigators on your behalf early in the process in hopes of resolving the case efficiently and without the formal filing of charges.
A Precise Focus
When you face federal healthcare fraud charges, you don’t want to put your future in the hands of a jack-of-all-trades; you want a lawyer with a laser-like focus on healthcare fraud issues. At Oberheiden, P.C., we dedicate our practice to the representation of healthcare providers and others in the healthcare industry.
Custom-Tailored Solutions
No two Irving healthcare fraud cases are identical, and there is no universal formula to reach a successful resolution in every case. At Oberheiden, P.C., our vast experience gives us the tools necessary to develop personalized strategies based on your specific situation.
Seasoned Litigators
In the vast majority of cases, a pre-trial resolution is the goal, whether it be convincing the prosecution to withdraw the case or offer a favorable plea agreement. However, some cases must go to trial. At Oberheiden, P.C., we’ve tried many federal healthcare fraud cases, so you will never feel compelled to accept any plea agreement because you will know that we are ready to take the case to trial.
Frequently Asked Questions
What is a whistleblower claim?
A whistleblower lawsuit is a type of Irving healthcare fraud claim brought under the qui tam provision of the False Claims Act. The qui tam provision allows private citizens—often former employees, patients, or business partners—to report allegations of healthcare fraud to the U.S. government in hopes of securing a percentage of any amount recovered. When a whistleblower brings evidence of possible fraud to the government’s attention, the government will conduct its own investigation into the allegations. The government may decide to intervene, which means it will take over prosecuting the case. However, even if the government determines it won’t intervene, the whistleblower can decide to proceed at their own expense. While allegations made by a whistleblower raise some intuitive concerns given their financial interest in the case, these allegations must be addressed early on to avoid an even more burdensome federal investigation. If you recently learned that a whistleblower claimed you engaged in any fraudulent activity, reach out to an Irving healthcare fraud defense lawyer as soon as possible.
Will I face criminal charges if I am under investigation for healthcare fraud?
While many healthcare fraud investigations are civil in nature, some also carry the possibility of criminal liability. There are several criminal healthcare fraud statutes, such as the False Claims Act and the Anti-Kickback Statute. For example, a violation of the Anti-Kickback Statute is a federal felony punishable by up to 5 years in federal prison and a fine of up to $25,000 for each violation. Additionally, charges under the False Claims Act can be either civil or criminal, depending on whether the government believes there was any intent to engage in fraud. However, when you first learn you are under investigation for healthcare fraud, it is not always clear whether you are facing civil or criminal charges. You cannot be sure what you are looking at until you reach out to an Irving healthcare fraud defense attorney.
What can an Irving healthcare fraud defense attorney do to help me?
If you are a healthcare provider and recently discovered you are under investigation or being audited by a federal agency, it is essential to contact an Irving federal healthcare fraud defense immediately. At Oberheiden, P.C., our first step in any healthcare fraud case is to determine whether there is any possibility of criminal exposure. If so, we will take immediate action to take it off the table. While civil violations are still very serious, criminal cases carry the possibility of jail time, so those are always our first priority. Our experienced Irving healthcare fraud defense lawyers will also communicate with federal investigators on your behalf. We do this to learn more about the allegations so we can better defend against them. From here, Oberheiden, P.C. will conduct our own investigation, looking for weaknesses in the government’s case. For example, often, investigators get hung up on a few billing inconsistencies that don’t necessarily evidence a wide-ranging fraud scheme. To learn more about how to develop an effective defense strategy to the charges you face, contact the Irving healthcare fraud defense lawyers at Oberheiden, P.C. today.
Contact Oberheiden. P.C. to Schedule a Free Consultation with an Experienced Irving Healthcare Fraud Defense Attorney
If you recently learned that you are under investigation for healthcare fraud, contact an Irving healthcare fraud defense attorney at Oberheiden, P.C. You can reach our Irving healthcare fraud defense lawyers at 888-680-1745 or reach us online through our contact form. If a member of our team is not available immediately, we will respond to your inquiry as soon as possible.
