San Antonio Medicare Fraud Attorneys

Oberheiden, P.C. is a healthcare law defense firm with experience in regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our attorneys have expertise in all aspects of healthcare law defense and education from the country’s best schools such as Harvard Law School and Yale Law School. Our San Antonio Medicare fraud attorneys serve clients in San Antonio as well as throughout Texas.

Healthcare providers, and companies in San Antonio have a powerful advocate on their side for Medicare fraud defense. Dr. Nick Oberheiden, managing principal partner, is a Harvard-trained negotiator and defense attorney providing counsel to clients in Garland, Dallas, Mesquite, Richardson, McKinney, and surrounding areas.

Defining Medicare Fraud

Medicare fraud violates federal law. It is the submission of a fraudulent claims to a government healthcare program. It doesn’t just include Medicare. It also includes Medicaid, Tricare, and federal workers’ compensation. If you’re charged with health care fraud, you’ve violated at least one of the following statutes:

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

San Antonio is one of fifteen areas closely watched by the federal government for Medicare fraud. Because San Antonio has a high number of individuals enrolled in federal healthcare programs, there are more claims filed in the area. A high number of claims always draws attention from the government.

The Medicare Fraud Strike Force is responsible for monitoring, investigating, and prosecuting Medicare fraud. Each team is a combination of investigators and prosecutors from various federal agencies. If you’ve been told that you’re being investigated for insurance fraud, call Oberheiden, P.C. immediately. 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)

How Do Most Medicare Fraud Investigations Start in San Antonio?

We are often asked what the most common trigger is for Medicare fraud investigations. The answer to that question is billing problems. It could be improper billing or fraudulent payment requests including excessive, false, or unauthorized charges. The federal government refers to this as billing fraud. The most common types of billing problems in San Antonio include:

• Billing for medically unnecessary services
• Billing for unordered medical equipment
• Phantom billing (billing for services never referred)
• Billing for unordered services
• Billing for medically unnecessary services or equipment
• Certification for medically unnecessary supplies, equipment, or services
• Double billing
• Upcoding
• Inflating charges
• Overuse of equipment
• Overuse of services
• Providing or accepting kickbacks

The second most common question is who is most likely to be investigated. San Antonio practitioners, including nurses, ARNPs, physician assistants, and doctors are most commonly investigated. Healthcare service providers, care facilities, nursing homes, hospitals, clinics, pharmacies, labs, device companies, cancer centers, and DNA centers are also common targets of Medicare fraud investigations.

Penalties for Medicare Fraud

Medicare fraud is a very serious allegation and carries both civil and criminal penalties.

Civil penalties may include one or more of the following:

• Recoupment requests
• Treble damages
• Non-payment of future claims
• Fines up to $11,000 per false claim
• Exclusion from federal healthcare programs
• Attorney fees

Criminal penalties can occur on their own or with civil penalties. They may include one or more of the following:

• Criminal charges
• Hundreds of thousands of dollars in fines
• 10 years in federal prison for each Medicare fraud conviction
• 20 years in federal prison for each count of Medicare fraud causing serious bodily injury to the patient
• Life sentence for Medicare fraud resulting in the death of the patient

You Must Choose the Right San Antonio Medicare Fraud Lawyer

Choosing the right San Antonio Medicare fraud lawyer is imperative to your case. Your attorney needs the right skills and experience to face the federal government. Do not choose a lawyer without expertise in these matters. Your business and future are too important to settle for less.

Those facing allegations of Medicare fraud first think to hire a healthcare attorney. However, Medicare fraud is not the only charge possible. Criminal charges such as tax evasion, money laundering, wire fraud, and mail fraud are often included. Healthcare attorneys may understand the laws related to healthcare, but most will not have the experience needed for criminal charges. They may not have the negotiating experience to help you face the federal government or to help you build a defense if your healthcare fraud case goes to trial.

When a healthcare provider and businesses learn they may be facing criminal charges, they often look for a criminal defense attorney. Yet, most criminal defense attorneys lack the proper experience needed when it comes to healthcare fraud. They also likely do not have the required knowledge of billing, coding, and medical utilization rules.

San Antonio area healthcare providers, facilities, and businesses should seek the services of a healthcare fraud defense attorney. You should look for the following four key traits:

• A proven record of success in health care fraud cases

• Industry experience
• Understanding of healthcare laws and exceptions
• Litigation and trial experience

After locating a San Antonio healthcare fraud attorney, ask the following questions to get an idea of their experience with Medicare or Medicaid fraud:

• How many Medicare fraud cases have you handled in your career?
• How many of those cases resulted in neither civil nor criminal charges, or in dismissals?
• How many Medicare fraud cases have you tried in court?

Necessary Defense Strategies for Medicare Fraud

A good defense strategy is necessary to fight the allegations of Medicare fraud. Oberheiden, P.C. has three guiding principles that we use to help our San Antonio clients. Although each Medicare fraud case is different and has its own set of facts, these three principles continue to help our clients nationwide.

Early contact with the federal government. The more time the federal government has to investigate you, the more likely you may face criminal charges. Early contact with the federal government is one of the keys to minimizing the risk. Once retained, we contact the federal investigating bodies to get answers to questions such as:

• What prompted the investigation?
• What is the case about?
• Is the matter civil or criminal?
• Which federal agencies are involved in the investigation?
• What is the ultimate goal of the investigation?
• How can the matter be resolved?

Oberheiden, P.C. works to get answers to these questions. We can usually do so within the first few hours of working on your behalf.

Lack of evidence. The federal government must present evidence that proves you committed a crime. This proof must meet a high standard known as ‘beyond a reasonable doubt.’ We test the evidence in each Medicare fraud case. We’ve seen the following results on behalf of our clients:

• Dismissal of case
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reduction of a felony to a misdemeanor
• No prison sentence

Lack of criminal intent. In addition to proving you committed a crime, the federal government must also prove that you acted with criminal intent. Throughout our years of experience in Medicare fraud, we’ve learned that San Antonio has very few legitimate instances of criminal intent. These allegations tend to begin when you make a mistake and not because you set out intending to break the law. Common mistakes include:

• The use of unqualified staff
• Inadequate supervision of staff
• Delegation or outsourcing to entities who are not qualified
• Business errors
• Human errors
• Oversight
• Staff who are overwhelmed by their job duties
• No Medicare compliance program
• Inability to keep up with the quickly changing healthcare laws and rules

Even though most Medicare fraud cases are the result of a mistake, there are many providers, businesses, and facilities accused that decide to accept the consequences although they did not set out to break the law. Sadly, they accept the reality of harsh criminal and civil penalties for making an honest mistake.

Our Healthcare Fraud Defense Team has a single goal. We seek to show federal investigators and federal prosecutors that our clients made a mistake. The mistake may certainly need correction, but honest mistakes lacking criminal intent should not be treated as crimes.

The use of strategic and applicable defenses. Oberheiden, P.C. takes time to analyze each case in determining a strategic defense for our clients. In a recent Medicare fraud case, the government alleged fraudulent certification for home healthcare services. We proved to the government that our client was protected by a recognized delegation exception rendering the certification within the law. In another Medicare fraud case, we refused to admit liability. Instead, we proved that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. provides strategic defense counsel for San Antonio healthcare practitioners, facilities, and related businesses. We also assist with allegations of medically unnecessary services or equipment, services not rendered, or unlawful joint ventures. Our firm provides assistance to San Antonio clients in:

• Healthcare fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

Oberheiden, P.C. provides representation to individuals and businesses in San Antonio who are being investigated by the DOJ, DOD, FBI, DEA, OIG, Medicare Fraud Control Unit, San Antonio or Texas state law enforcement, and the IRS.

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