Laredo, Texas Medicare Fraud Defense Lawyers

Headquartered in Texas, Oberheiden, P.C. is a Texas law firm with specialized Laredo, Texas Medicare fraud defense attorneys who represent clients in Medicare fraud investigations and prosecutions. We work with healthcare companies and their executives and employees in civil and criminal fraud cases. We work with healthcare companies and their executives and employees in civil and criminal fraud cases.

Our Healthcare Fraud Defense Group is headed by senior attorney Dr. Nick Oberheiden. A nationally recognized healthcare fraud defense attorney, Dr. Nick Oberheiden is the founder and managing partner of Oberheiden, P.C.

Understanding Medicare Fraud

Medicare Fraud in Laredo, Texas

Submitting false or fictitious claims to the Centers for Medicare & Medicaid Services (CMS) is commonly referred to as Medicare fraud. Medicare fraud can be both a civil and criminal offense. It can involve violations of several federal statutes, including:

• False Claims Act;
• Anti-Kickback Statute;
• Physician Self-Referral Laws (Stark Law);
• Social Security Act; and
• U.S. Criminal Code;

In March 2007, to combat the rising cost of Medicare fraud, an elite task force to prosecute healthcare providers in Laredo, Texas came to be. Known as the Healthcare Fraud Prevention and Enforcement Action Team (HEAT), teams work in nine areas around the country. Texas is one of only three states with two HEAT teams devoted to targeting local providers. The government’s focus means healthcare providers in Laredo must avoid making mistakes to draw the attention of federal agents.

In addition, the federal government has set up multi-agency teams called the Medicare Fraud Strike Force to use data analytics to identify potential fraud in the medical community. With these elaborate methods of investigation, you must have a Laredo, Texas Medicare fraud defense lawyer from Oberheiden, P.C. to make sure your interests are heard.

Common Forms of Medicare Fraud

HEAT and other federal authorities most often prosecute companies and individuals suspected of:

• Phantom billing (billing for services never performed);
• Providing and billing for medically unnecessary services, supplies, and equipment;
• Billing for supplies and equipment never purchased;
• Obtaining certifications for medically unnecessary services and supplies (a common allegation in home health and hospice fraud investigations);
• Double-billing and submitting false patient records;
• Upcoding, unbundling, and other forms of coding fraud; and
• Entering into illegal kickback schemes with other providers.

Since federal authorities use data analysis to identify potential fraud, they often pursue providers filing numerous claims. These practices are fully compliant with the law, but raise suspicion from the government. This leaves innocent providers in Laredo, Texas too often made to defend themselves against fraud allegations.

The Penalties for Medicare Fraud

Even unwarranted investigations can expose healthcare providers to severe penalties. Providers doing nothing wrong, or those assuming they must have done something wrong and accept responsibility, can end up facing recoupment requests, non-payment of future claims, fines of up to $11,000 per false claim, treble damages, paying government attorneys’ fees, criminal fines, and even incarceration in federal prison. Penalties include:

• Up to 10 years in prison for each count of Medicare fraud;
• Up to 20 years in prison for Medicare fraud resulting in serious bodily injury; or
• A life sentence for Medicare fraud resulting in a patient’s death.
• Criminal penalties such as substantial fines and imprisonment.

Being found civilly or criminally liable for Medicare fraud can also result in exclusion from future participation in federal healthcare programs. In addition, medical professionals often face licensing actions and loss of hospital privileges.

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)

Proven Defense Strategies for Laredo, Texas Medicare Fraud Investigations

While each Medicare investigation presents its own challenges, Oberheiden, P.C. employs a unique defense approach, developing strategic defenses tailored to the individual circumstances of each Medicare fraud case. Each Laredo, Texas Medicare fraud defense lawyer has the required skills to develop a defense for the best outcome for each client. We find the following four defense strategies produce favorable results for our clients:

1. Early Intervention with Investigating Bodies

When facing federal investigation, it is crucial to engage a defense team as soon as possible. Contacting the prosecutor’s office immediately can reduce the risk of criminal prosecution. At Oberheiden, P.C., our former federal prosecutors and experienced defense lawyers have open channels to government agencies. We can quickly get answers to these questions to build your defense:

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

The government has already invested time and resources in building their case by the time you know about the investigation. To level the playing field, you need to hire a Laredo, Texas Medicare fraud defense attorney as soon as possible.

2. Arguing Lack of Evidence

To convict you for Medicare fraud, the government must prove beyond a reasonable doubt that you committed an illegal act with criminal intent. This means the government must have enough proof to convince a jury you acted in a fraudulent scheme. We will challenge the government’s argument on all available grounds. We will strive to show that any evidence the government may have is not enough to convict you for Medicare fraud.

3. Arguing Lack of Criminal Intent

A key element of the government’s case is establishing criminal intent. Intentional Medicare fraud is rare. Establishing intent can be a highly subjective matter. In our experience, most incidents prompting an investigation do not involve intentional conduct. Generally, it is honest organizational and human errors. Such errors do not rise to the level of criminal conduct. If you or your company have made mistakes, we will focus on showing exactly that. Mistakes are not proof of criminal intent.

4. Asserting Appropriate Healthcare Law Defenses

The fourth strategy we deploy involves identifying all viable healthcare law defenses. Depending on the facts of your case, you may have several available. For example, in one recent Medicare fraud case, the government alleged that our client fraudulently certified a patient for home healthcare services. We argued successfully that a recognized delegation exception made our client’s action compliant with the law. In another case, we used a safe harbor exception to convince the government to stop pursuing our client. These are just two examples of the many defenses potentially available.

Choosing the Right Healthcare Fraud Defense Lawyer

There is too much to lose if you or your organization are under investigation for Medicare fraud. Thus, it is vital to choose a Lareo, Texas Medicare fraud defense lawyer with the skills and experience to help you avoid prosecution. How do you make the right choice?

The Right Choice: A Team of Laredo, Texas Healthcare Fraud Defense Lawyers.

You need experienced lawyers with the necessary blend of Medicare knowledge and a strong record in healthcare fraud defense. They know how to assess the complex healthcare and billing issues involved in Medicare fraud cases. They have the skills required to represent clients in negotiations with federal prosecutors.

To know if an attorney has the knowledge and experience to represent you, we recommend asking the following questions:

• How many Medicare Fraud cases have you handled in your career?
• How many of your healthcare fraud cases resulted in neither civil nor criminal charges or won dismissals for your clients?
• How many healthcare fraud cases have you tried in court?

About Oberheiden, P.C.

Our attorneys have handled hundreds of healthcare proceedings and conducted several criminal trials across the nation. Many of our attorneys come from senior positions within the Department of Justice for Northern Texas. They benefit from a collective experience in Medicare and other healthcare fraud investigations. Our team approach to Medicare fraud defense in Laredo, Texas means you will also benefit from this experience.

Each Laredo, Texas Medicare fraud defense attorney focuses on helping medical service providers and other entities in the industry with the following:

• Healthcare fraud defense;
• Compliance programs and their implementation;
• Internal investigations;
• Qui tam defense;
• Asset protection;
• Licensure & disciplinary proceedings; and
• Jury trials.

What distinguishes Oberheiden, P.C. from other law firms? It’s our broad experience within the area of healthcare fraud defense. Our clients range from individual providers to entire healthcare systems. We have exceptional experience representing clients under investigation by the following:

• Department of Justice;
• Department of Defense;
• Federal Bureau of Investigation;
• Drug Enforcement Administration;
• Office of Inspector General;
• Medicaid Fraud Control Unit;
• Internal Revenue Service;
• Laredo and Texas law enforcement, and other state and federal agencies.

We are available every day of the year, to discuss your case. You can call us directly or complete our contact form to request a free consultation.