San Antonio, Texas Healthcare Fraud Defense Attorneys

The Oberheiden, P.C. is a healthcare law defense firm with experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our team features talented attorneys with years of relevant experience and education from the country’s top schools such as Harvard and Yale Law Schools. Our attorneys routinely serve clients in San Antonio as well as throughout Texas.

If you’re facing an accusation of healthcare fraud in San Antonio, Texas or the surrounding area, you should call Oberheiden, P.C. today. We are a Texas law firm that provides healthcare fraud defense. We also 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. He provides legal assistance to clients in San Antonio and throughout Texas. Dr. Oberheiden is a healthcare fraud defense attorney and is the managing partner of Oberheiden, P.C.

San Antonio, Texas Faces Scrutiny by the Medicare Fraud Strike Force

Although the entire nation is observed for healthcare fraud, San Antonio, Texas is directly monitored by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is an exclusive team of prosecutors and investigators made of members of several federal agencies.

San Antonio, Texas and its surrounding areas are overseen because of the number of citizens who receive benefits from a federal healthcare program. The increase in the number of federal healthcare recipients increases the number of claims filed through CMS for payment. In areas like San Antonio where more claims are filed, the government is more vigilant. 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

Healthcare Fraud: What Is It?

Healthcare fraud is an attempt to falsely or fraudulently receive payment from a federal government healthcare program for medical services or equipment. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. Fraud includes at least one of the following elements:/p>

• 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. has a history of helping clients avoid criminal prosecution when facing allegations of healthcare fraud. If you, your healthcare practice, or your business are being investigated for healthcare fraud in San Antonio, Texas, contact Oberheiden, P.C. today. Initial consultations are free of charge and confidential.

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)

Civil and Criminal Penalties of Healthcare Fraud

Healthcare fraud can destroy your career. If charged, you could receive civil or criminal penalties. Civil penalties include repayment of claims, non-payment of future claims, and you may be excluded from federal healthcare programs. You may also face your state disciplinary board and lose your license or hospital privileges.

Criminal penalties can include fines in the hundreds of thousands of dollars, a criminal record, or even federal prison time.

Federal prison time can be sentenced as:

• 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

Often, we’re asked about the worst-case scenario for healthcare fraud for providers, entities, and businesses in San Antonio, Texas. Whether or not you’ll face criminal charges or a prison sentence depends on several factors. These are: the severity of injury suffered by a patient, whether the prosecutor sees an advantage in pursuing criminal charges, and the reason why the federal government launched the case. If you’re under investigation for healthcare fraud, contact Oberheiden, P.C. Your initial call is confidential and free.

Are You at Risk of Criminal Prosecution?

Healthcare fraud cases can be either civil or criminal. With early intervention and compelling defense strategies, Oberheiden, P.C. has an excellent reputation for helping clients avoid criminal charges. Call us today if you’re under investigation for healthcare fraud in San Antonio, Texas, or the surrounding area. Let us begin our process to develop your custom defense strategies.

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. Oberheiden, P.C. 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. These include OIG subpoenas, and how the inquiry or allegations are made. Expect criminal charges 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 whether you are facing criminal or civil charges, call Oberheiden, P.C. today. We represent providers, entire healthcare systems, and other related businesses. We provide exceptional defense services for those under investigation by the federal government for healthcare fraud.

Frequently Asked Questions

Strategic Healthcare Fraud Defenses for San Antonio, Texas Clients

Oberheiden, P.C. is a Texas firm providing healthcare fraud defense to clients in San Antonio, Texas and the surrounding areas. Several members of our Healthcare Fraud Defense team have prior experience as healthcare auditors and as healthcare fraud prosecutors with the Department of Justice. Our clients gain valuable insight for their healthcare fraud defense cases.

The main objective for our clients is to help them reduce the prospect of criminal charges. Our experience has taught us that the best way we can help our clients is to quickly contact federal authorities. We get answers to important questions, and stop the government from having unlimited time to investigate you. We work to protect your freedom and your career. We typically get answers to these most important questions within a few hours:

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

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 mistakes to prove you had criminal intent. Oberheiden, P.C. knows this most often happens as the result of a management 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 errors are a result of human or organizational fault 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.

Although these issues should be corrected, they should not lead to a criminal conviction.

Using strategic healthcare fraud defenses. 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. In the context of Stark Law, we’ve been able to use exceptions to either ease or entirely resolve a healthcare fraud case.

Protecting your reputation as a professional. We 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 instances to correct misinformation about our clients. Call our San Antonio, Texas healthcare fraud defense attorneys today to learn more about your legal options. The call is confidential and there is no charge for your initial call.

Oberheiden, P.C. provides legal advocacy for clients throughout the United States who face allegations of healthcare fraud. Call us now to learn more about how we can help. The initial call is free and confidential.

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

Oberheiden P.C.
21750 Hardy Oak Blvd Suite 102-189
San Antonio, TX 78258
210-942-0986