Texas 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 Texas and surrounding areas.

Based in Texas, the Oberheiden, P.C.’s nationally recognized Healthcare Fraud Defense Group is comprised of senior attorneys. Led by firm founder Dr. Nick Oberheiden, our firm offers noted legal experience and government and industry insights for healthcare providers facing False Claims Act allegations throughout Texas.

Texas: A Key Battleground for False Claims Act Enforcement

Texas is a key battleground in the federal government’s fight against suspected False Claims Act violations. The violations involve Medicare, Medicaid, and Tricare as well as other federal benefit programs. Texas has a high number of federal program beneficiaries. This results in a high number of claims submitted. Large numbers of claims tend to get the attention of government auditors.

In fact, Texas is one of only two states where two teams from the Healthcare Fraud Prevention and Enforcement Action Team (HEAT) operate. This is significant given only nine HEAT teams are deployed across the United States. HEAT targets healthcare providers submitting claims to the Centers for Medicare and Medicaid Services (CMS). Attention focuses heavily on claim volume when investigating Medicare, Tricare, and Medicaid fraud. Sadly, the approach leaves many innocent providers in Texas facing unwarranted investigations.

The False Claims Act: An Overview

The federal False Claims Act is a federal law designed to protect taxpayers. It applies to individuals and businesses with government contracts. Those receiving compensation from the federal government from healthcare benefit programs are included. The Act imposes both civil and criminal penalties for those who “knowingly” submit or cause the submission of false or fraudulent claims.

However, the word “knowingly” is misleading. To “knowingly” submit a false or fraudulent claim, you do not have to know that it was false or fraudulent. The False Claims Acts 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 being current on the latest codes. Other common allegations in False Claims Act cases include actions like:

• Billing for services, supplies, equipment, or medications that were not actually provided or that were medically unnecessary
• Double-billing for services, supplies, equipment, and medications
• Unbundling and upcoding reimbursable services

The False Claims Act: Civil and Criminal Penalties

Violators of the False Claims Act can face both civil and criminal penalties. Penalties depend on the nature of the government’s investigation and the scope of the alleged fraud. Penalties are quite severe in most cases. The penalties for False Claims Act violations are as follows:

• Civil Penalties – In a civil case, individuals and companies can face treble damages (three times the government’s actual losses). Fines of up to $11,000 per false claim.
• Criminal Penalties (18 U.S.C. § 287) – Healthcare providers who intentionally present false claims can face up to five years of federal imprisonment. Fines can reach up to $250,000 for individuals and $500,000 for companies. As with civil fines, criminal fines apply on a per-claim basis.

What is a “Qui Tam” Lawsuit?

Across the country, most False Claims Act and Medicaid Fraud Prevention Act cases begin with a complaint from former employees or competitors, not by the government.

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). As a result, qui tam actions are an easy way to interfere with law-abiding companies’ operations./p>

Here is a brief overview of the qui tam process:

1. A Private Citizen Files a Qui Tam Complaint

A private citizen (referred to as a “relator”) files a complaint in the local federal district court. Allegations are that an individual or company submitted fraudulent claims to a federal benefits program. The qui tam complaint is filed under seal to protect the relator’s identity. Copies of the complaint are provided only to the assigned judge and select government officials. Qui tam complaints frequently remain under seal until the government investigates the allegations.

2. The Government Investigates the Relator’s Allegations

Next, the government conducts an initial assessment. It will decide if the relator’s allegations are baseless and should be ignored, or if they warrant a full investigation. The process typically involves federal prosecutors and agents from several federal agencies. The defendant will receive a subpoena to produce any records that may show evidence of violations.

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 anti-fraud laws.

4. Case Settlement Negotiations Continue

While investigating, 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. Settling can be a favorable option for defendants in qui tam lawsuits. To date, not a single client has been forced to cease its operations or close its business from a settlement we negotiated on their behalf.

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.

Three Tenets of a Successful False Claims Act Defense Strategy

Our experience successfully representing clients in False Claims Act cases has allowed us to develop a proven strategy for defense. The strategy has three key parts:

• Avoid Criminal Charges. In every False Claims Act case we handle, our first priority is to avoid 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 are not worth the expense of government time and resources.
• Negotiate a Favorable Settlement. If evidence supports a possible violation, we use our knowledge and experience to negotiate the liability to as little as possible.

Why Choose Oberheiden, P.C.?

When facing allegations under the False Claims Act, you need experience on your side. At Oberheiden, P.C., we have successfully defended a myriad of healthcare providers across Texas, and nationwide.

If you are serious about avoiding criminal charges and minimizing your liability, schedule a free consultation with our Healthcare Fraud Defense Group today.

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

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