Midland / Odessa False Claims Act Attorneys

Oberheiden, P.C. is a healthcare law defense firm with expertise in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Many of our attorneys are graduates of some of the finest colleges such as Harvard Law School and Yale Law School. Our attorneys serve clients in Midland/Odessa as well as throughout Texas.

Oberheiden, P.C.’s nationally recognized Healthcare Fraud Defense Group is composed of senior attorneys. The firm is led by Dr. Nick Oberheiden who offers mastery in defending against False Claims Act allegations in the Midland/Odessa area.

False Claims Act Enforcement in Midland/Odessa, TX

Texas is one of only two states where there are two locations of the Healthcare Fraud Prevention and Enforcement Action Team (HEAT). This fact shows the federal agencies’ focus on targeting healthcare companies in Texas. HEAT, the Department of Health and Human Services, and the Medicare Fraud Strike Force investigate and prosecute healthcare providers suspected of False Claims Act violations. The government can seek both civil and criminal penalties.

What Providers in Midland and Odessa Need to Know about the False Claims Act

The False Claims Act: An Overview

The False Claims Act is a federal law applying to persons and businesses with United States government contracts. Such contracts allow payments from the federal government under federal healthcare programs like Medicare, Medicaid, and Tricare. The False Claims Act imposes civil liability and criminal penalties for those who “knowingly” submit or cause the submission of false or fraudulent claims.

To “knowingly” file 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 obsolete (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 staying current on the latest codes.

Civil and Criminal Penalties Under the False Claims Act

The potential penalties for violating the False Claims Act are severe. If you are under investigation or named in a qui tam complaint (see below), you must take it seriously.

Civil Liability

In a civil case, defendants can face triple damages and fines up to $11,000 per claim for knowingly submitting or causing submission of a false or fraudulent claim.

Criminal Liability (18 U.S.C. § 287)

Healthcare providers who purposely present false claims can face criminal penalties. Criminal penalties under the False Claims Act include up to five years of federal imprisonment and fines:

• Felony False Claims Act Violations: $250,000 for individuals or $500,000 for companies
• Misdemeanor False Claims Act Violations: $100,000 for individuals or $200,000 for companies

As with civil fines, these criminal fines apply for each individual fraudulent claim.

Qui Tam Litigation Under the False Claims Act

Across the country, most False Claims Act cases are initiated by former employees or competitors, not by the government. This holds true in Midland and Odessa as well.

Citizens with information about fraudulent billing can file a qui tam lawsuit. The action seeks to recover monies on behalf of the United States government. All it takes to initiate a qui tam action is an accusation of illegally receiving payment by submitting a false or fraudulent claim (see 31 U.S.C. § 3729). In Midland and Odessa, the following is how a qui tam lawsuit functions:

1. A Private Citizen Files a Qui Tam Complaint

A private citizen, referred to as a relator, files a complaint with the U.S. District Court in Midland, TX stating an individual or company violated the False Claims Act. To protect relators’ identity, all qui tam complaints are under seal. Copies of the complaint are available to the judge and select government officials, but not to defendants. If requested by the relator, the complaint remains sealed until the government has time to investigate.

2. The Government Investigates the Relator’s Allegations

The government reviews all qui tam complaints. If a relator’s claims are groundless, the complaint gets rejected. Federal prosecutors may choose to investigate if evidence appears to support a violation. Investigations in qui tam cases are typically done by subpoena. Requests for corporate, financial, billing, business, and communications records are typical.

3. Will the Government Intervene?

The government reviews records and negotiates with the defendant’s attorneys to make a decision. The government’s prosecutors will either intervene or let the relator pursue the qui tam action alone. If the government intervenes, prosecutors typically include violations of additional laws. The most common are the Anti-Kickback Statute, the Truth in Negotiation Act, and other federal anti-fraud laws.

4. Case Settlement Negotiations Continue

While investigating and deciding whether to intervene, prosecutors continue to negotiate with the defendant’s attorneys. Many cases will be resolved during the investigative process and before any charges get filed. However, the qui tam process moves slowly, and a favorable settlement can take several months or longer.

5. The Case Closes and the Relator Gets Paid (if Successful)

If the case does not settle, the defendant can face significant fines and fees. The burden can be as much as three times the government’s losses, and fines of up to $11,000 per claim. In many cases, this adds up to hundreds of thousands or even millions of dollars. The relator can receive 15-25 percent of the amount collected if the government intervenes, and 25-30 percent if the relator proceeds alone.

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)

Three Components of a Successful Defense Strategy for False Claims Act Investigations

Our years of experience successfully defending clients in False Claims Act cases have allowed us to develop a proven strategy for defending healthcare providers. This strategy has three key parts:

• Avoid Criminal Charges. In every False Claims Act case, the first priority is ensuring that our client avoids criminal charges.
• Avoid Government Intervention. We take action as soon as possible to aggressively refute the relator’s claims and credibility. We work to convince prosecutors the allegations do not justify the expense of government time and resources.
• Negotiate a Favorable Settlement. If liability appears likely, we try to negotiate our clients’ repayments and fines down to a fraction of the government’s demands.

Put Experience On Your Side

Located in Texas, the experienced defense attorneys and former federal prosecutors in our Healthcare Fraud Defense Group have successfully defended many professionals and businesses in Midland and Odessa. We offer healthcare industry insights that few law firms match. With our team approach, clients benefit from our attorneys’ collective experience in False Claims Act proceedings. This information may constitute attorney advertising in some jurisdictions. All information on this website has been prepared for informational purposes only and does not constitute legal advice.

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