McAllen Medicare Fraud Attorneys

Oberheiden, P.C.’s Healthcare Fraud Defense Group represents clients in Medicare and other federal program fraud investigations in McAllen, TX Texas and nationwide. The Healthcare Fraud Defense Group is managed by Dr. Nick Oberheiden. Dr. Oberheiden is an aggressive Medicare fraud defense attorney with noted experience in assisting physicians, executives, hospitals, and other healthcare service providers against Medicare fraud allegations.

This page is intended as a resource for individuals and healthcare providers facing fraud investigations in McAllen, TX. Here you will find answers to the following questions:

• What is Medicare fraud?
• What are the civil and criminal penalties for Medicare fraud?
• What defenses are available in a Medicare fraud prosecution?
• What type of lawyer should you choose for a Medicare Fraud Investigation?
• What distinguishes Oberheiden, P.C.?

Medicare Fraud in McAllen, Texas

Healthcare service providers and businesses in McAllen, Texas are finding themselves at high risk for fraud investigations. Program fraud has long been a priority for many federal agencies. As of September 30, 2022, there have been 2,688 criminal actions and 3,483 indictments nationally as reported by the Healthcare Fraud Prevention and Enforcement Action Team (HEAT).

HEAT is a coordinated effort of the Department of Justice, the Department of Health and Human Services, the Office of Inspector General, the Federal Bureau of Investigation, and other federal agencies. HEAT uses data analysis and other tools to identify healthcare providers suspected of fraud. The method sadly leads to many innocent providers in McAllen, Texas facing investigation.

What is Medicare Fraud?

Medicare fraud is a federal offense involving false reimbursement claims submitted to the federal Medicare program. Many healthcare providers in McAllen, Texas rely heavily on Medicare reimbursements. Due to extreme complexities in the Medicare system, it is easy for providers to make mistakes. There are also providers who choose to exploit the system for illegal financial gain. This combination has led to major federal law enforcement efforts, such as HEAT, targeting healthcare providers with a high volume of Medicare reimbursement claims.

Medicare fraud violates a number of federal laws. These include:

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

Medicare fraud has many forms, but all involve illegally collecting funds from the federal government. Some of the most common forms of Medicare fraud are the following:

• Phantom billing – billing for services that were never performed;
• Providing and billing for medically unnecessary services, supplies, and equipment;
• Billing for supplies and equipment that were not actually purchased;
• Obtaining fraudulent certifications for services and supplies that are not medically necessary (a common allegation in home health and hospice fraud investigations);
• Double-billing;
• Upcoding;
• Unbundling; and
• Offering and accepting kickbacks

If HEAT’s data analysis or another form of investigation suggests a hint of health care fraud, providers of healthcare services and products in McAllen, Texas can face potential civil or criminal liability. The penalties can be extreme.

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)

What are the Civil and Criminal Penalties for Medicare Fraud?

Targets of alleged Medicare fraud investigations are exposed to substantial penalties. Huge financial liabilities and incarceration are possible. Financial penalties include recoupment requests, non-payment of future government claims, civil fines of up to $11,000 per false claim, exclusion from federal healthcare programs, treble damages, attorney fees, and criminal fines. The potential prison sentences for Medicare fraud include:

• Up to 10 years in prison for each count of Medicare fraud;
• Up to 20 years in prison for fraud resulting in serious bodily injury; and
• A life sentence for fraud resulting in a patient’s death.

Medical professionals can face licensing actions and loss of hospital privileges, as well.

What Defenses are Available in a Medicare Fraud Prosecution?

While each case presents its own set of details, our McAllen Medicare fraud attorneys pursues four specific defense strategies for our clients because these strategies have proven so successful;

• Early intervention with investigating bodies;
• Arguing lack of evidence to support criminal charges;
• Arguing lack of criminal intent; and
• Asserting the appropriate healthcare law defenses.

1. Early Intervention with Investigating Bodies

In our experience, early intervention is key. Hiring experienced McAllen Medicare fraud attorneys to begin working with the prosecutor’s office as early as possible can greatly reduce the chances of your case becoming a criminal one. At Oberheiden, P.C., our former federal prosecutors have open lines of communication with the government. This allows us to immediately begin a dialogue with our government contacts. Within the first hours of our engagement, we seek answers to the most pressing questions for building your defense:

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

2. Arguing Lack of Evidence to Support Criminal Charges

To gain a conviction for Medicare fraud, the government must prove beyond a reasonable doubt that you committed an illegal act, and that you did it with criminal intent. This means that the government must have substantial evidence of your involvement in a fraudulent scheme. Our McAllen Medicare fraud lawyers will challenge the government’s evidence on all sides. We will argue that any evidence they may have is not enough to support a criminal charge or conviction.

3. Arguing Lack of Criminal Intent

In our experience, intentional Medicare fraud in McAllen, Texas is extremely rare. We see as both defense lawyers and federal prosecutors that most events prompting federal fraud investigations involve honest errors – not criminal intent. These errors are often the result of non-criminal issues such as:

• Unqualified staff;
• Inadequate supervision;
• Delegation problems;
• Outsourcing to independent third parties;
• Organizational mistakes;
• Human errors resulting from oversights and overwhelming workload; and
• Lack of an up-to-date compliance program due to frquently changing Medicare rules.

Regrettably, too many business owners simply accept guilt and penalties they do not deserve. Oberheiden, P.C. can help avoid such mistakes. Our McAllen Medicare fraud lawyers will work to convince the government you lacked the malicious intent required for criminal charges.

4. Asserting the Appropriate Healthcare Law Defenses

During our case assessment, we can often identify a number of viable healthcare law defenses to help our clients avoid civil and criminal liability. In a recent Medicare fraud case, the government alleged our client fraudulently certified a patient for home healthcare services. We successfully argued that a recognized delegation exception applied. The exception rendered our client’s certification fully compliant with the law. In another case, we refused to admit liability. We convinced prosecutors that our client’s conduct was protected under a safe harbor exception. These are just two examples of the countless healthcare law and other defenses that may be available.

What Type of Lawyer Should You Choose for a Medicare Fraud Investigation?

In light of potential penalties and the unique details of Medicare fraud investigations, it is essential to have an experienced legal team on your side. Yet, there remains one more pressing question. What type of lawyer will have the right experience for your case?

Our healthcare fraud defense lawyers are expert not only in federal healthcare laws, but in criminal laws and procedures in federal prosecutions.

To gauge the experience of a healthcare fraud defense lawyer, ask the following questions:

• How many Medicare fraud cases have you managed during your career?
• How many of cases resulted in neither civil nor criminal charges?
• How many dismissals of charges have you gained for your clients?
• How many healthcare fraud cases have you tried in court?

What Distinguishes Oberheiden, P.C.?

The attorneys of Oberheiden, P.C. have managed hundreds of healthcare proceedings and conducted more than 200 criminal trials nationwide. Several of our attorneys have prior experience as senior prosecutors in the Department of Justice, and all have substantial experience successfully defending clients accused of Medicare fraud. As a result, the four key factors that distinguish us from other law firms serving clients in McAllen, Texas are:

• Proven record for healthcare fraud defense;
• Industry knowledge;
• Deep familiarity with federal healthcare and criminal laws;
• Litigation & trial experience.

Unlike most other firms, we have significant experience in the area of healthcare fraud defense. Our defense team represents these as well as other professionals in the healthcare industry:

• Business owners;
• Healthcare executives;
• Lawyers;
• Healthcare providers;
• Hospitals;
• Pharmacies; and
• Labs.

The following agencies conduct most fraud investigations and our firm has worked with them all:

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

We are available to discuss your case. You can call us directly or complete our contact form to request a free consultation.