McAllen Healthcare Fraud Attorneys

Attorney Nick Oberheiden
McAllen Healthcare Defense Team Lead envelope icon

Oberheiden, P.C. is a healthcare law defense firm. Among our McAllen healthcare fraud defense team are talented attorneys with years of relevant experience and education from the country’s best schools such as Harvard and Yale Law Schools. Our attorneys serve clients in Texas, as well as surrounding areas. Our McAllen healthcare fraud attorneys have experience in the areas of:

Regulatory compliance,
Corporate structuring,
Litigation,
Government investigations, and
Criminal defense.

Allegations of healthcare fraud in McAllen, Texas are extremely serious matters. If you’re investigated for healthcare fraud by the Department of Health and Human Services, call Oberheiden, P.C. We are a Texas firm specializing in healthcare fraud defense. Our McAllen healthcare fraud attorneys have extensive legal experience in:

OIG and grand jury subpoenas,
Medicare and Tricare audits,
Fraud allegation defense,
Internal investigations,
Compliance programs,
Qui tam defense,
Protection of assets,
Criminal defense, and
Jury trials.

Dr. Nick Oberheiden is a Harvard-trained lawyer and negotiator. Dr. Oberheiden provides legal assistance to clients in McAllen and throughout Texas. Dr. Oberheiden is a healthcare fraud attorney and is the managing partner of Oberheiden, P.C.

If you want to learn more about your legal options, contact Oberheiden, P.C. now and ask to speak with a member of our Healthcare Fraud Defense Team. Initial calls are confidential and free of charge.

McAllen, Texas Is Closely Monitored for Healthcare Fraud

McAllen, Texas is monitored by the Medicare Fraud Strike Force and the Medicaid Fraud Control Unit because of the large number of citizens in the area who rely on federal healthcare programs. The number of beneficiaries in the healthcare industry means more claims filed with the federal government for payment. The large number of claims is a trigger for the federal government that fraud may be happening. 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 healthcare fraud 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)

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)

Basics of Healthcare Fraud

Healthcare fraud is an attempt to receive payment from a federal healthcare program for medical equipment or services for an incorrect or misleading claim. Federal healthcare programs include Tricare, Medicare, Medicaid, and federal workers’ compensation. Healthcare fraud involves at least one of the following laws:

A Violation of the Anti-Kickback Statute – Federal healthcare law restricts the exchange of money or other valuables for patient referrals. Anyone can face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
A Violation of 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.
Prescription Fraud – Prescribing a high volume of narcotics is closely watched by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating the Drug Enforcement Administration 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.

McAllen healthcare fraud defense lawyers at Oberheiden, P.C. have a history of success helping clients avoid civil or criminal liability. If you, your healthcare practice, or your business are under investigation for False Claims Act violations or alleged healthcare fraud in McAllen, Texas, call us today. Initial calls are free and confidential.

The Penalties of Healthcare Fraud

Healthcare fraud is extremely serious and can result in civil or criminal penalties. Civil penalties may include repayment of claims, non-payment of future claims, and exclusion from federal healthcare programs entirely. You could be called before the state disciplinary board, lose your license, and/or lose your hospital privileges.

Criminal penalties can include fines that cost you hundreds of thousands of dollars, criminal indictment, or a prison term 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

Clients ask us about worst-case scenarios for healthcare fraud in McAllen. Criminal prosecution can depend on many factors. The severity of the injury received by a patient, if the prosecutor has interest in pursuing criminal charges, and the reason the investigation began, are a few. If you’re being investigated for healthcare fraud in McAllen, you should call Oberheiden, P.C. today to speak to an experienced McAllen healthcare fraud lawyer from our firm to learn about your options. Initial consultations are confidential and free of charge.

McAllen, Texas Healthcare Fraud Defense Attorneys

What Are the Signs of a Criminal Investigation?

Healthcare fraud charges can be civil or criminal in nature. Oberheiden, P.C. utilizes early intervention and a strategic defense to help our McAllen clients. If you are being investigated, contact us promptly.

It’s not always easy to know if you are facing civil or criminal charges. The U.S. Attorney’s Office and other federal agencies have both a civil and a criminal division. So, being contacted by a federal prosecutor doesn’t always mean a criminal charge is imminent. However, civil cases can become criminal in nature. Our McAllen healthcare fraud lawyers can help by contacting federal prosecutors on your behalf. If you’re contacted by a federal prosecutor, call us right away.

Determining charges depends on the legal reading of many factors including OIG subpoenas, and the manner in which the inquiry or allegations are made. Expect criminal prosecution if you receive a(n):

search warrant,
seizure warrant,
arrest warrant,
target letter,
IRS involvement,
grand jury subpoena, or
there is involvement of a federal criminal prosecutor.

If you have questions about the charges you may face, call Oberheiden, P.C. now. We provide counsel for providers, entire healthcare systems, and other related healthcare businesses.

Frequently Asked Questions

What is a whistleblower lawsuit?

Under the False Claims Act, a private citizen who believes he/she has evidence of healthcare fraud can bring a lawsuit against the practice or provider accused of fraud. Anyone from former employees to patients to other providers can be a whistleblower. When a whistleblower brings a healthcare fraud case, they usually first approach federal investigators. This checks for the government’s interest in the case. The decision to intervene depends on the severity of the allegations and the whistleblower’s evidence. If federal investigators decide not to intervene, the whistleblower can still move forward on his/her own. If a whistleblower’s case ends in a finding of fraud, they can receive up to 30 percent of any amount recovered. Given the financial incentives involved, allegations raised by a whistleblower are suspect. However, these cases are still taken very seriously by the federal government.

What is the False Claims Act?

The False Claims Act is a federal law focusing on the prevention of overcharging federal programs. The False Claims Act bars providers and medical supply makers from submitting false, or fraudulent claims for patient services or supplies. The False Claims Act can impose civil penalties on anyone who knowingly submits, or causes submission of a false or fraudulent claim. Depending on the offense, a violation of the Act may result in civil or criminal liability. Even if you believe there is no factual basis for them, these charges are very serious. There is no specific intent required to violate the False Claims Act, meaning a simple error can still be a violation. Contact a McAllen, Texas federal healthcare fraud defense attorney to learn more about the False Claims Act.

Which federal government agencies investigate healthcare fraud claims?

For the most part, healthcare fraud is overseen by the Federal Bureau of Investigation (FBI). However, FBI agents often rely on cooperation from other federal agencies, such as:

The Centers for Medicare and Medicaid Services (CMS)
The Department of Defense (DOD)
The Department of Health and Human Services (HHS)
The Department of Justice (DOJ)
The Department of Labor (DOL)
The Drug Enforcement Administration (DEA)

The DEA or OIG may provide the FBI with information if it thinks a provider is involved in fraud. At that point, the FBI agents will work with the referring agency to build a case. In some instances, one of these government agencies will receive a tip from a whistleblower. The matter will then be referred to the FBI for investigation. If you are involved in a healthcare fraud investigation, you should speak to a McAllen federal healthcare fraud defense attorney. An expert attorney can find out more on the accusations and help you defend yourself.

The Use of Compelling and Strategic Healthcare Fraud Defenses

Oberheiden, P.C. is a Texas law firm serving healthcare fraud clients. Many of the lawyers on our team have experience as healthcare auditors and as former federal healthcare fraud prosecutors. This experience gives our McAllen clients valuable insight and legal defense for their healthcare fraud cases.

Immediate contact on your behalf. Our main goal is to help our clients avoid criminal indictment. We know the best way in which we can advocate for our clients is to quickly contact the federal government. This immediate contact limits the amount of time the federal government has to pursue its case against you. We work to protect your career and your freedom. We can get answers to some important questions typically within a few hours after you retain us. Here are a few initial questions we will ask on your behalf:

What is the investigation about?
What is the purpose of it?
How long will the investigation take?
What is the most likely outcome?

Mistakes shouldn’t be treated as crimes. The federal government must prove beyond a reasonable doubt that you committed a crime. They must also show that you acted with criminal intent. When criminal charges look certain, we test if the government will be able to meet Constitutional standards. The government will try to use billing inaccuracies to prove you had criminal intent. Oberheiden, P.C. knows this most often happens as the result of an organizational or human error. These mistakes should not be held to criminal standards. We have provided successful legal defense for clients across the United States by proving that inaccuracies are a result of human or organizational error and not criminal intent. Some factors leading to such mistakes are:

unqualified workers,
delegation errors,
outsourcing errors,
lack of oversight,
insufficient supervision, and
constantly changing laws and rules in healthcare billing.

Strategic healthcare fraud defense. Oberheiden, P.C. develops strategic healthcare fraud defenses for each client. Many of the cases we’ve successfully defended were won because of statutory loopholes and exceptions. For example, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either ease or entirely resolve a healthcare fraud case.

Protecting your professional reputation. Our McAllen healthcare fraud defense lawyers are committed to doing more than providing healthcare fraud defense. We are determined to defend your image. Allegations of healthcare fraud can be damaging. Many of our clients express concern about how these allegations will affect their career and future. The media has a lot of power and your reputation could be destroyed by their rumors. Our attorneys address instances of slander, and seek opportunities to correct misinformation about our clients. Call our McAllen healthcare fraud defense attorneys today to learn more about your legal options.

Oberheiden, P.C. provides legal advocacy to clients across the country who are accused of healthcare fraud. Call us now to learn about your options. Your initial call is confidential and free.

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 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. You can call or email our McAllen healthcare fraud lawyers directly, or complete our contact form.

888-680-1745
Including Weekends
Oberheiden, P.C.
Serving McAllen, 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. Oberheiden, P.C. is a Texas PC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.