Texas Medicare Fraud Attorneys

Headquartered in Dallas, TX, Oberheiden, P.C., is a team of experienced defense attorneys and former federal prosecutors led by attorney Dr Nick Oberheiden who brings extensive experience to representing healthcare providers, executives, and others who may be the subject of health care fraud investigations. If you are facing a federal inquiry or if you have already been charged, contact us today. We offer free case reviews and defense strategy consultations.

Are You Facing a Medicare Fraud Investigation in Texas?

Medicare fraud cases commonly focus on perceived false billing issues. Each year, government programs pay billions of dollars in false claims. As a result, federal program fraud has become an area closely monitored by the federal government. Medicare fraud involves a number of federal statutes:

• False Claims Act,
• Anti-Kickback Statute,
• Physician Self-Referral Laws (Stark Law),
• Social Security Act, and
• U.S. Criminal Code.

The key to any investigation are allegations the provider improperly received money from a federal healthcare program.

Texas is home to many retirees and has one of the largest populations of Medicare recipients nationwide. The volume of services billed to Medicare in Texas, makes the state a focus of government efforts to curb fraud. Texas is one of fifteen areas within the United States that is more than just closely watched. It has a team of healthcare fraud specialists who focus solely on medical professionals, facilities, and businesses.

Texas is one of only two states with two Medicare Fraud Strike Force teams. The teams investigate and prosecute healthcare providers suspected of Medicare fraud. The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) is a federal task force made of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies. HEAT aggressively pursues healthcare providers suspected of fraud on a statewide basis. Oberheiden, P.C. has extensive knowledge of defending against violations alleged by HEAT and healthcare fraud charges.

Common Forms of Medicare Fraud

Medicare fraud involves submitting false claims for payment from Medicare or other government healthcare programs. While healthcare providers treating Medicare patients are entitled to payment for qualifying services, some providers abuse the system. This has led to increased diligence by the government. Fraud inquiries often focus on practices like:

• Billing for services never performed (so-called “phantom billing”);
• Billing for services that were medically unnecessary;
• Billing for supplies and equipment that were never ordered;
• Billing for supplies and equipment that were medically unnecessary;
• Obtaining certification for medically unnecessary services (common in Home Health and Hospice Fraud Investigations);
• Obtaining certification for medically unnecessary supplies (including Durable Medical Equipment (DME));
• Double billing, upcoding, or unbundling services;
• Overutilization of services and equipment; and
• Offering or accepting kickbacks.

The Department of Justice centers its efforts on individuals as well as companies. No one in the Texas healthcare industry is immune from prosecution for Medicare fraud. Possible targets include:

• Physicians,
• Executives,
• Nurses,
• Home healthcare centers,
• Hospice care centers,
• Nursing homes,
• Registered care facilities,
• Hospitals,
• Pharmacies,
• Toxicology labs,
• Medical devices companies,
• Physician syndications,
• DNA testing centers, and
• Cancer treatment centers.

The Risks of a Medicare Fraud Investigation

If you are the target of healthcare fraud investigations, the potential outcome can be severe. If found civilly liable or criminally responsible for fraud, penalties could end in a judgment for repayment of false claims, non-payment of future claims, civil fines up to $11,000 per false claim, exclusion from federal healthcare programs, treble damages, attorney fees, and criminal fines. You can also face years in prison:

• Medicare fraud: Up to 10 years in prison per count; for instance. This means that a conviction of five counts of fraud could equal 50 years in prison.;
• Medicare fraud resulting in serious bodily injury: Up to 20 years in prison per count; or
• Medicare fraud resulting in death: Life imprisonment.

In addition to civil and criminal penalties, healthcare providers can face loss of professional licensure and hospital privileges.

Limiting the Risks: Choosing the Right Defense Lawyer

The risks of a Medicare fraud conviction in Texas make it critical to hire a qualified defense team. To give yourself the best chance of obtaining a favorable outcome, you must have experience on your side.

Why You Don’t Want Just a “healthcare” or “Criminal” Lawyer

Medicare fraud cases are complex due to the healthcare law aspects and the unique Medicare issues involved. Cases can include allegations of mail fraud, wire fraud, tax evasion, money laundering, and other federal offenses. These crimes carry the risk of spending decades behind bars. Most criminal lawyers lack the healthcare knowledge needed to defend Medicare fraud claims. Most healthcare lawyers lack the experience and training to negotiate with prosecutors and challenge federal charges in court. You need a lawyer who can do both.

Put an Experienced Team of Healthcare Fraud Defense Lawyers on Your Side

If you are facing a healthcare fraud investigation in Texas, you need an experienced Texas Medicare fraud lawyer.

At Oberheiden, P.C., our Texas Medicare fraud lawyers team is highly experienced in helping clients fight federal charges offering:

• A proven track record;
• Industry knowledge;
• In-depth knowledge of federal healthcare and criminal laws;
• Litigation & trial experience; and
• Experience settling claims with the federal government.

At Oberheiden, P.C. we have handled hundreds of healthcare proceedings and conducted trials nationwide, including in Texas. We use a number of strategies to help our clients avoid criminal convictions and civil liability. These strategies include:

Aggressive, Proven Defense Tactics for Medicare Fraud Investigations

At Oberheiden, P.C., our Texas Medicare fraud attorneys have handled hundreds of healthcare proceedings and conducted trials nationwide. Based on our attorneys’ collective experience, we have identified a number of proven defense strategies for helping our clients avoid criminal convictions and civil liability. These strategies include:

Early Intervention During the Investigation

Early intervention in federal investigations is extremely important. The less time the government has to build its case, the better the potential outcome for you. Getting involved early allows us to open lines of communication through our government contacts. Plus, we can more quickly get answers to these important questions:

• What is the case about?
• What prompted the investigation?
• Is the investigation civil or criminal?
• What agencies are involved? and
• Who is under investigation?

We can usually get these answers within a couple of days. Answers to these questions help put you at ease and help us formulate a strategic defense.

Arguing a Lack of Federal Evidence in Texas

In order to convict you of Medicare fraud, the government must meet two standards. They must prove guilt beyond a reasonable doubt. They must also prove that you acted with criminal intent. In health insurance fraud cases, we challenge the government’s evidence as insufficient to support criminal charges. If the government lacks the evidence to convict you in a criminal case, we can seek results including:

• Dismissal,
• Dropping criminal charges,
• Maintaining your professional license,
• Civil fines without a criminal plea;,/li>
• Misdemeanor charges instead of felony charges, and
• No prison sentence.

Establishing the Lack of Criminal Intent in Texas

Intentional Medicare fraud in Texas is rare. Most incidents prompting Medicare fraud investigations involve simple business or human errors. These mistakes can occur because healthcare providers focus on caring for their patients. The most common mistakes include:

• The use of unqualified staff;
• Lack of supervision;
• Improper delegation;
• Outsourcing;
• Structural deficits;
• Organizational errors;
• Human error;
• Oversight;
• Lack of a compliance program to prevent errors; and
• Constantly changing healthcare rules and laws.

While these are issues to be addressed, they do not rise to criminal intent. When you choose Oberheiden, P.C., we work to use the facts of your case to argue that any errors made do not establish criminal intent or liability.

Asserting Specific Defenses Under Applicable Healthcare Laws

The fourth strategy we use is identifying any defenses available under applicable healthcare laws. For example, in a recent case, the government alleged our client falsely certified healthcare services. We successfully argued that a recognized delegation exception protected our client. In another case, we refused to admit liability. We then convinced prosecutors our client was protected by a safe harbor within the statute.

About Oberheiden, P.C.

Oberheiden, P.C. provides counsel for a variety of entities in the healthcare industry. We have experience in all types of healthcare fraud probes. Our team assists in cases involving illegal kickbacks, fraudulent billing practices, medically unnecessary services, and unlawful joint ventures.

We have experience in Medicare fraud investigations involving the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, the Drug Enforcement Administration, the Office of Inspector General, the Medicaid Fraud Control Unit, Texas enforcement, the Internal Revenue Service, and other state and federal agencies. No matter the allegations or agency in your case, we have likely managed similar charges as defense attorneys and/or prosecutors.

We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form to request a free consultation.

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