McAllen False Claims Act Attorneys

Oberheiden, P.C. is a healthcare law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Several of our talented attorneys have graduated from the country’s best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in McAllen as well as throughout Texas.

Under the federal False Claims Act, healthcare service providers and companies can face civil or criminal liability. Government investigations and private citizen-initiated “qui tam” lawsuits account for much of this. If you are facing an investigation or a qui tam complaint, you must take your situation seriously. Our nationally recognized Healthcare Fraud Defense Group brings real-world expertise to defending clients in McAllen, TX and nationwide.

Experienced Representation for False Claims Act Defense in McAllen, TX

Experienced Representation for False Claims Act Defense in McAllen, TX
Due to a history of high volumes of Medicare claims, McAllen remains a focus of the federal government’s enforcement efforts under the False Claims Act.

High levels of fraud in McAllen and other cities throughout the state forced the government to place two task forces from its elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT) in Texas. Texas is one of only two states nationwide with two HEAT task forces. There are only nine of these task forces nationwide. Like the Department of Health and Human Services, HEAT aggressively investigates and prosecutes providers in McAllen suspected of fraud involving Medicare and other federal benefit programs.

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)

About The False Claims Act: Violations and Penalties

What Constitutes a Violation of the False Claims Act?

The False Claims Act makes it illegal to submit false and fraudulent claims for payment to the United States government. The Act applies in two primary scenarios. 1) When a person or business contracts with the federal government for goods or services. 2) When a person or business receives compensation under federal healthcare benefit programs like Medicare, Medicaid, or Tricare.

It is a violation of the False Claims Act to “knowingly” submit or cause the submission of false or fraudulent claims for payment. But, the word “knowingly” is misleading. To “knowingly” submit a false or fraudulent claim, you do not have to know that it was false or fraudulent. The False Claims Act attributes knowledge when a party should have known that a claim for payment violates the law. For instance, using an outdated (false) code after a change in Medicare billing rules can trigger the False Claims Act. This is based on a lack of due diligence in being current on the latest codes.

Other examples of potential False Claims Act violations include:

• Double-billing, unbundling and upcoding reimbursable services and supplies
• Billing for medically unnecessary services, supplies, equipment, or medications
• Billing for services, supplies, equipment, or medications that were not actually provided

What are the Penalties for Violating the False Claims Act?

Providers in McAllen, TX can face civil and criminal penalties under the False Claims Act. These penalties include:

• Civil Penalties – Three times the government’s actual losses (“treble damages”) and fines of up to $11,000 per false claim.
• Criminal Penalties (18 U.S.C. § 287) – Up to five years of federal imprisonment and fines of up to $250,000 (for individuals) or $500,000 (for companies) per false claim.

To seek criminal penalties, the government must prove beyond a reasonable doubt that you intentionally submitted a false or fraudulent claim.

Have You Been Accused of Fraud in a “Qui Tam” Complaint?

If you have been accused of violating the False Claims Act, there is a good chance the accusations came from a former employee or a competitor. While HEAT and other federal authorities initiate many False Claims Act investigations in McAllen, many investigations arise from qui tam complaints.

Under the False Claims Act, private citizens can file qui tam lawsuits on behalf of the federal government. This can occur when they believe they have information about a possible billing violation. An allegation of false or fraudulent claims (see 31 U.S.C. § 3729) is all that is needed to start an inquiry. Qui tam litigation can be highly disruptive. Claimants, called relators, receive some of the government’s financial recovery. Therefore, qui tam actions are a problem for healthcare providers in McAllen and across the country.

What happens in a qui tam lawsuit?

• The Complaint. The relator files a complaint in the U.S. District Court for the Southern District of Texas claiming an individual or company has violated the False Claims Act. Qui tam complaints are filed under seal. They are only available to the judge and select government officials in order to protect the relator’s identity.
• Initial Assessment. With receipt of the complaint, the government conducts an initial assessment to decide if it should investigate. If the complaint lacks enough evidence, the government will not intervene. However, if it seems legitimate, the government issues subpoenas for records that may provide evidence of violations.
• Government Intervention. Based on the investigation, the government can either intervene and prosecute healthcare fraud cases, or allow the relator to proceed alone. If the government intervenes, it may include other violations under the Anti-Kickback Statute, the Truth in Negotiation Act, and other federal laws.
• Settlement Negotiations. At the same time, prosecutors negotiate with the defendant’s attorneys regarding possible settlement. The sooner you hire a McAllen False Claims Act attorney, the better your chances of securing a settlement. A good attorney may help avoid liability entirely. All this can take place before the government decides to investigate or press charges.
• Liability and Relator Compensation. If a settlement isn’t reached, providers can face hundreds of thousands or even millions of dollars in penalties from an alleged Medicare fraud or alleged False Claims Act violation. The government can seek triple damages plus civil fines of $11,000 per false claim. The relator can collect up to 25 percent of the recovered amount if the government intervened. Up to 30 percent may be awarded if the relator pursued the case alone.

Three Stages of a Successful False Claims Act Defense

Prior experience as federal prosecutors and defense attorneys in such cases gives our attorneys proven strategies for fending off federal actions. In these instances, there is a fine line between human error and liability. Convincing the government not to seek penalties requires skilled advocacy. Based on our attorneys’ skill, we developed a three-stage approach to defend clients in False Claims Act cases in McAllen, TX:

• Avoid Criminal Charges
  Our first priority is always to avoid criminal charges. As former federal prosecutors in charge of false claims cases, our experience is profound. Plus, our practice focuses on healthcare fraud defense allowing us to take charge at once. We quickly determine if our clients’ cases are civil or criminal in nature. If necessary, our McAllen False Claims Act attorney negotiates with prosecutors to keep criminal penalties off of the table.
• Prevent Government Intervention
  Qui tam cases often involve groundless claims made by ex-employees or competitors with dishonest agendas. We aggressively confront these individuals. We challenge their alleged evidence, and seek to destroy their credibility. By doing so, we can often convince the government not to intervene.
• Negotiate a Favorable Civil Settlement
  When possible, our McAllen False Claims Act lawyers seek an outcome with no civil or criminal judgment. If civil liability looks certain, we try to lower fines and penalties to a fraction of the government’s demand.

Put Experience on Your Side. Choose Oberheiden, P.C..

When facing the possibility of criminal penalties, you must have experienced representation. Our Healthcare Fraud Defense Group attorneys have successfully defended healthcare providers and entities in federal cases nationwide. Put experience on your side for your McAllen, TX False Claims Act investigation. Contact Oberheiden, P.C. for a free case assessment with our McAllen False Claims Act lawyer today.

We are available to discuss your case. Call us directly or complete our contact form to schedule your free, confidential case evaluation today.