Texas Healthcare Fraud Defense Attorneys
440 Louisiana St #200
Houston, TX 77002
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. On our team are talented attorneys with years of relevant experience and education from the country’s leading schools such as Harvard and Yale Law Schools. Our attorneys serve clients across Texas and surrounding areas.
Healthcare fraud allegations in Texas are extremely serious. If you are facing an investigation for alleged healthcare fraud, call Oberheiden, P.C. We are a Texas firm offering healthcare fraud defense. We 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 federal clients throughout Texas. Dr. Oberheiden is a healthcare fraud attorney and is the managing partner of Oberheiden, P.C.
If you want to find out more about the legal options related to your case, call Oberheiden, P.C. immediately and ask to speak with a member of our Healthcare Fraud Defense Team. Initial consultations are free of charge and confidential.
Texas Is Closely Watched for Healthcare Fraud
Texas is one of nine areas in the nation heavily monitored for healthcare fraud by the federal Medicare Fraud Strike Force. The Medicare Fraud Strike Force is an elite team comprised of select prosecutors and investigators.
Texas receives such attention because a large number of its citizens rely on a federal healthcare program. This increases the number of claims filed with the federal government for payment. The government aggressively monitors, investigates, and prosecutes allegations 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)
Healthcare Fraud Basics
Healthcare fraud is an attempt to receive payment from a federal healthcare program for medical equipment or services from an incorrect or misleading claim. Federal healthcare programs include Tricare, Medicare, Medicaid, and federal workers’ compensation. Healthcare fraud relates to at least one of the following laws:
- Anti-Kickback Statute – Federal healthcare 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.
- Prescription Fraud – Prescribing a high volume of narcotics is closely watched by the federal government. If you’re suspected of operating a “pill mill,” you may face allegations of 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 record of helping clients avoid criminal charges. If you or your healthcare practice or business are under investigation for health care fraud, call our Texas healthcare fraud defense attorneys now. Initial calls are free and confidential.
What Are the Penalties of Healthcare Fraud?
Healthcare fraud allegations may result in civil or criminal charges and penalties. Civil penalties may include civil repayment and non-payment of future claims, and you may be excluded from federal healthcare programs. Criminal penalties may include criminal prosecution, federal prison time, and fines that cost you hundreds and thousands of dollars. If found guilty of criminal healthcare fraud, you may receive a prison sentence of:
- 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
Clients ask us about worst case scenarios for healthcare fraud allegations in Texas. Criminal prosecution can depend on many factors. The severity of the injury received by a patient, if the prosecutor has interest in pursuing criminal charges, and the reason the case began, are a few. If you’re being investigated for healthcare fraud in Texas, you should call Oberheiden, P.C. today to speak to an experienced Texas healthcare fraud attorney from our firm to learn about your options. Initial consultations are confidential and free of charge.
Signs of Criminal Healthcare Fraud
Healthcare fraud cases can be either civil or criminal. With early intervention and compelling defense strategies, Oberheiden, P.C. helps clients avoid criminal charges. Call us today if you’re being investigated for healthcare fraud in Texas. We can begin the process of developing your custom defense strategy right away.
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 including OIG subpoenas, and the manner in which the inquiry or allegations are made. Expect criminal prosecution 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 the charges you may face, call Oberheiden, P.C. now. We provide counsel for providers, entire healthcare systems, and other related healthcare businesses. If you need help determining whether you’re facing civil or criminal charges, contact Oberheiden, P.C. now. We represent individual providers, entire healthcare systems, and other related businesses. We provide healthcare defense services to individuals, businesses, and entities in Texas that are under investigation by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, the Drug Enforcement Administration, the Office of Inspector General, Medicare Fraud Control Unit, state law enforcement, or the Internal Revenue Service.
Healthcare Fraud Defenses
Oberheiden, P.C. is a Texas law firm serving healthcare fraud defense clients in the State of Texas. We’ve handled more than 2,000 healthcare fraud-related matters and tried more than 200 cases in court. Many of our lawyers have experience as healthcare auditors and as former healthcare fraud prosecutors with the Department of Justice. Our Texas clients receive valuable insight for their healthcare fraud defense cases.
Legal advocacy with the federal government. Our main goal is to help our clients avoid criminal indictment. We know that the best way in which we can advocate for our clients is to quickly contact the federal government. This immediate contact limits the amount of time the federal government has to pursue its case against you. We work to protect your career and your freedom. We can get answers to some important questions typically within a few hours after you retain us. Here are a few initial questions we will ask on your behalf:
- What is the investigation about?
- What is the purpose of it?
- How long will the investigation take?
- What is the most likely outcome?
Mistakes should not be held to criminal standards. 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 errors 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 company error and not criminal intent. Some factors leading to such mistakes are:
- Unqualified staff,
- 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 criminal liability.
Healthcare fraud defense. Oberheiden, P.C. developed strategic healthcare fraud defenses for each case. Many of our cases were successful because of statutory loopholes and exceptions. For instance, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either mitigate or entirely resolve a healthcare fraud case.
Defending your reputation. We are committed to doing more than providing healthcare fraud defenses. We are also committed to defending your image. Allegations of healthcare fraud can be extremely damaging. Many of our clients are concerned about how these allegations may affect their future. The media has a lot of power. Your reputation could be destroyed by rumors spread by the media. Our attorneys routinely address concerns about slander, and book news spots and other opportunities to correct misinformation about our clients.
Oberheiden, P.C. has helped clients across the country who were accused of healthcare fraud. Call us today to learn more about your legal options. The call is confidential, and there is no charge.
Frequently Asked Questions
What is the Anti-Kickback Statute?
The Anti-Kickback Statute (AKS) is the federal government’s attempt to limit the situations in which medical providers can receive a referral fee for referring a patient whose medical expenses are being paid by a federally funded program. Essentially, if a patient is on Medicare or Medicaid, the general rule is that no referral arrangements involving medical professionals are permitted. This includes non-cash referrals, such as hotel stays or lavish meals. The AKS is codified in 42 U.S.C. §1320a–7b, and provides for both criminal liability as well as civil liability under the False Claims Act. The criminal consequences of an AKS violation include a prison term of up to five years and a fine of up to $25,000 per violation. If you are under investigation for a violation of the Anti-Kickback Statute, protect yourself by contacting a Texas federal healthcare fraud attorney as soon as possible.
What is a qui tam lawsuit?
A qui tam lawsuit is a type of civil claim brought against a healthcare provider. A qui tam lawsuit is started by a whistleblower, or “relator” as they are also referred to. A relator may be anyone with knowledge of a healthcare provider’s business. Included are:
- Former employees,
- Current or former patients,
- Current or former business partners, or
- Any other party with evidence they believe shows the provider is defrauding the government.
When a relator brings evidence to the federal government, there is a legal obligation to conduct a formal inquiry. They then decide whether to intervene in the case. Even if the government chooses not to intervene, the relator can proceed with the case on their own. Relators may recover significant compensation if the case ends in a finding of liability for the provider. It can be up to 30 percent of the amount recovered. If someone provides evidence about you or your practice to the federal government, it is imperative to speak to a Texas federal healthcare fraud defense attorney. You need to minimize the chances of federal involvement and a drawn-out trial.
Are healthcare fraud charges criminal or civil?
Federal healthcare fraud charges can be either civil or criminal in nature, depending on the nature of the alleged violation. For example, the Stark Law, which prohibits physician self-referrals, is solely a civil statute. The Anti-Kickback Statute, however, imposes criminal penalties and can also result in civil liability under the False Claims Act. A violation of either statute can carry separate civil charges under the False Claims Act. If you are at the center of a healthcare fraud investigation, your primary concern should be removing the possibility of criminal liability. Then you can focus on developing a strong defense strategy to address the pending civil charges.
Which providers are most at risk for a healthcare fraud investigation?
The federal government oversees all healthcare providers, and no type of provider is immune from healthcare fraud charges. Typically, the more volume a practice handles, and the more successful it is, the higher the chances of incurring federal scrutiny. If you own or operate any of the following practices, it is important you reach out to a Texas healthcare fraud defense lawyer the moment you learn of an investigation:
- Drug rehabilitation facilities;
- DNA testing facilities;
- Toxicologists and toxicology laboratories;
- Healthcare marketing agencies;
- Home healthcare agencies;
- Hospice providers;
- Outpatient surgical centers; and
- Mobile healthcare clinics.
I am accused of healthcare fraud. What now?
You probably already know that healthcare fraud is a serious allegation, how serious exactly, is what you and a healthcare fraud lawyer at Oberheiden, P.C. should discuss. In general, the sooner clients contact us and the sooner we can address potential problems with the prosecutors, the better the chances to end the investigation quickly.
Should I talk to federal investigators about my healthcare fraud case?
Absolutely not. While it is tempting to clear things up by speaking to investigators, talking to them yourself is not advisable. You are under no obligation to speak with investigators or answer their questions. They may tell you it will “look bad” if you refuse to cooperate, but it is best not to talk to them until you have consulted an attorney. When federal agents come to the subject of an investigation with questions, it is usually because they suspect wrongdoing, but need additional information to file charges. When you talk to an investigator about a healthcare fraud case, you risk harming your own interests. To better understand why, put yourselves in the position of the investigator. If a physician provides you with an answer that appears to help their case, you may assume that it’s a self-serving answer and choose not to believe it. On the other hand, if that same physician made an incriminating statement, you’d almost certainly believe it to be true. In either case, there is very little chance of helping the course of the investigation. The better approach is to reach out to one of the skilled federal healthcare fraud lawyers at Oberheiden, P.C., and allow us to handle all communication with investigators and prosecutors.
What should I look for in a Texas federal healthcare fraud defense attorney?
While there are many considerations when hiring a Texas federal healthcare fraud defense attorney, finding a lawyer with specific experience handling healthcare fraud claims is crucial. Healthcare fraud claims are exceedingly complex and require not only a knowledge of the controlling laws, but also the healthcare industry as a whole. These are not cases that should be handled by any attorney, even one with years of experience litigating other types of federal cases. If you are under investigation for healthcare fraud, you want an attorney who has represented hundreds of other clients that were in a similar situation. Some Texas federal healthcare fraud defense law firms even have former federal prosecutors and investigators on their staff, which gives these firms a unique insight into how the government builds its cases.
Whether you are under healthcare fraud investigations involving Medicare, Tricare, or Medicaid fraud, or you are already facing healthcare fraud charges, you need the experienced legal representation of our Texas healthcare fraud defense lawyers. We are available every day of the year. You can call us directly or complete our contact form, or email us directly.
Serving the State of Texas and Surrounding Areas