Rio Grande City Healthcare Attorneys

Rio Grande City, Texas healthcare providers, entities, and businesses have a high risk of being investigated for healthcare fraud by the federal government. Oberheiden, P.C. has extensive experience in:

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

Our Healthcare Fraud Defense Team includes members of the State Bar of Texas, a former Chief Healthcare Fraud Coordinator for the U.S. Attorney’s Office, medical malpractice attorney, personal injury attorney, several former healthcare fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. We offer our services to clients in Rio Grande City as well as throughout Texas.

If you’re in Rio Grande City, Texas and you’re under investigation by the federal government for healthcare fraud, call Oberheiden, P.C. Ask to speak with a member of our Healthcare Fraud Defense Team. The initial call with our Rio Grande City healthcare lawyer is confidential and free.

Rio Grande City, Texas Is Intently Monitored for Healthcare Fraud

Rio Grande City, Texas is one of nine areas in the nation intently monitored by the federal government for healthcare fraud. The Medicare Fraud Strike Force is a team of federal health law prosecutors and investigators from several federal agencies. They monitor, investigate, and prosecute healthcare fraud.

Rio Grande City, Texas is intently monitored because of the large number of people covered by federal healthcare programs. This causes the filing of more claims for payment from the federal government. An increase in the number of claims makes the government believe that there is a higher likelihood of healthcare fraud. 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 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

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 Is Federal Healthcare Fraud?

Federal healthcare fraud is defined as an attempt to receive payment from a federal government healthcare program for medical services or equipment from incorrect or misleading claims. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It incorporates at least one of the following elements:

• The Anti-Kickback Statute. Federal law restricts the exchange of money or other valuables for patient referrals. Anyone may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
• 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.
• False Claims Act. If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an inquiry into your billing practices under the criminal provisions of the Act.
• Prescription Fraud. Prescribing a high volume of narcotics is closely monitored by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA 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.

Oberheiden, P.C. helps clients avoid criminal charges that may result from a healthcare fraud allegation. If you’re being investigated in Rio Grande City, Texas, call us right away. The call is free and confidential.

The Civil and Criminal Penalties of Federal Healthcare Fraud

Healthcare fraud allegations in Rio Grande City, Texas and the surrounding area can lead to civil or criminal charges. Civil penalties may include the repayment of reimbursed claims, non-payment of future claims, and possible exclusion from federal healthcare programs. You could also be called before the state licensing board. You could lose your professional license or your hospital privileges during litigation.

Criminal penalties are extremely serious. You could be forced to pay heavy fines and you may be sentenced to time in federal prison:

• 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

Healthcare providers, businesses, and entities in Rio Grande City, Texas have one pressing question. What is the worst-case scenario for healthcare fraud allegations? The answer is criminal charges and a federal prison sentence. If you will be charged criminally or receive a prison sentence depends on several factors. The injuries suffered by the affected patients, whether the prosecutor sees an advantage in pursuing criminal charges, and why the investigation began are some of these factors.

Determining If the Investigation Is Criminal

Healthcare fraud investigations can be civil or criminal. They often start off as civil and then become criminal. This is why you should contact Oberheiden, P.C. as soon as you can after discovering that you’re being investigated.

Being contacted by a prosecutor is not an indicator determining the investigation against you is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal prosecutor alone as an indicator. Rather, signs of a criminal investigation may include:

• Search warrants,
• Seizure warrants,
• Arrest warrants,
• Target letters,
• Contact from a federal criminal prosecutor,
• Involvement from the IRS, or
• Receipt of a grand jury subpoena.

Healthcare Fraud Defenses

Oberheiden, P.C. is a healthcare fraud defense law firm offering services in Rio Grande City, Texas and the surrounding area. Several of our attorneys have previous experience as healthcare auditors and fraud prosecutors with the Department of Justice. We provide this remarkable insight directly to our clients.

Immediate legal advocacy. The main priority of our firm is to help clients avoid criminal charges. We’ve learned from experience that the most effective way to do this is to promptly contact the federal government on behalf of our clients. This provides less uninterrupted time for the federal government to conduct their investigation against you or your business. Once retained, we contact the federal government. Within hours, we can usually get answers to these important questions:

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

Proving lack of criminal intent. 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.

Choosing strategic legal defenses for each case. Our Rio Grande healthcare lawyers review each case to determine the right legal defenses. This may include researching and using applicable statutory loopholes and exceptions. For instance, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either lessen or entirely resolve a healthcare fraud case.

Defending your professional reputation. Allegations of healthcare fraud in South Texas can damage your professional reputation. Oberheiden, P.C. will help protect your reputation both inside of and outside of the courtroom. Our Rio Grande City healthcare attorneys will correct misinformation presented to the public by the media about our clients. We also address slanderous comments.

If you’re being investigated for healthcare fraud in Rio Grande City, Texas or the surrounding areas, call Oberheiden, P.C. right away and speak to a healthcare fraud attorney for a confidential and free consultation.

We are available every day of the year. Call, complete our contact form, or email us directly.