Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

Medicare Fraud Defense in Laredo, Texas

At the Oberheiden & McMurrey, LLP, a significant portion of our practice is devoted to representing Laredo, Texas clients in Medicare fraud investigations and prosecutions. Headquartered in Texas, we represent health care companies and their executives and employees in civil and criminal Medicare fraud cases in Laredo, Texas.

Our Health Care Fraud Defense Group is headed by senior attorney Dr. Nick Oberheiden. A nationally recognized health care fraud defense attorney, Dr. Nick Oberheiden is the founder and managing partner of Oberheiden & McMurrey, LLP.

Understanding Medicare Fraud

Medicare Fraud in Laredo, Texas

Medicare fraud is a broad term that refers to various billing practices and other acts that ultimately result in the receipt of wrongful payments from the Centers for Medicare and Medicaid Services (CMS). Medicare fraud can be charged as both a civil and criminal offense, and can potentially involve violations of a number of federal statutes. These statutes include:

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

To combat the rising cost of Medicare fraud, the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies have combined to form an elite task force specifically focused on prosecuting health care providers in Laredo, Texas suspected of defrauding CMS. This task force, known as the Health Care Fraud Prevention and Enforcement Action Team (HEAT), has teams deployed in nine areas around the country. Texas is one of only two states nationwide with two HEAT teams devoted to targeting local providers. As a result, health care practitioners, hospitals, hospices, home health care providers, pharmacies, medical equipment companies, and other health care entities in Laredo must be extremely diligent to avoid making mistakes that could draw the attention of the federal government.

Common Forms of Medicare Fraud

HEAT and other federal authorities most commonly prosecute companies and individuals suspected of the following types of practices – all of which constitute serious forms of Medicare fraud:

  • “Phantom billing” (billing for services that were never performed);
  • Providing and billing for medically unnecessary services, supplies, and equipment;
  • Billing for supplies and equipment that were never purchased;
  • Obtaining fraudulent certifications for medically unnecessary services and supplies (a common allegation in home health and hospice fraud investigations);
  • Double-billing and submitting false patient records;
  • Upcoding, unbundling, and other forms of coding fraud; and
  • Entering into illegal kickback arrangements with physicians or other providers.

However, since federal authorities use data analysis to identify potential targets of investigations, they often end up pursuing high-volume providers that maintain practices that are fully compliant with the law. This means that innocent physicians, executives, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, and other health care service providers in Laredo, Texas are increasingly being forced to defend against unwarranted investigations.

The Penalties for Medicare Fraud

Unfortunately, even unwarranted investigations can expose health care providers to severe penalties. Providers that do nothing wrong (or assume that they must have done something wrong and accept responsibility for something that they did not do) can end up facing recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, treble damages, paying government attorneys’ fees, criminal fines, and even incarceration in a federal prison. This includes:

  • Up to 10 years in prison for each count of Medicare fraud;
  • Up to 20 years in prison for Medicare fraud resulting in serious bodily injury (e.g., in cases involving counterfeit or excessive medication); or
  • A life sentence for Medicare fraud resulting in a patient’s death.

Being found civilly or criminally liable for Medicare fraud can also result in exclusion from future participation in federal health care programs. Medical professionals will often face licensing actions and loss of hospital privileges.

Proven Defense Strategies for Laredo, Texas Medicare Fraud Investigations

While each Medicare fraud investigation presents its own unique challenges, Oberheiden & McMurrey, LLP has found that the following four defense strategies consistently produce favorable results for our clients:

1. Early Intervention with Investigating Bodies

When facing any type of federal investigation, it is critical to engage a defense team as soon as possible. In Medicare fraud investigations in particular, making contact with the prosecutor’s office as early as possible can significantly reduce the risk of a criminal prosecution. At Oberheiden & McMurrey, LLP, our former federal prosecutors and experienced defense lawyers have open channels to the government, and we can immediately seek answers to the most pressing questions for building your defense:

  • What is the case about?
  • What prompted the investigation?
  • Is the case civil or criminal?
  • Which agencies are involved in this investigation?
  • Who else is under investigation?
  • How can the issue be resolved?

By the time when you find out that you are under investigation, the government will have already invested substantial time and resources in building its case against you. The sooner you take action, the sooner you can begin to level the playing field.

2. Arguing Lack of Evidence

In order to convict you for Medicare fraud, the government must prove beyond a reasonable doubt that you committed an illegal act with criminal intent. This means that the government must collect enough evidence to convince a jury that you were participating in a fraudulent scheme. When we take your case, we will challenge the government’s evidence (or lack thereof) on all available grounds, and argue that any evidence that the government may have against you is not enough to support a conviction for Medicare fraud.

3. Arguing Lack of Criminal Intent

As noted above, a key element of the government’s case is establishing criminal intent. However, intentional Medicare fraud is rare. Establishing criminal intent can be a highly subjective matter. In our experience as both defense lawyers and federal prosecutors, most incidents that prompt Medicare fraud investigations do not involve intentional conduct, but rather involve honest organizational and human errors that do not rise to the level of criminal conduct. If you or your company has made mistakes, we will center on demonstrating that they are exactly that – mistakes – and not evidence of criminal intent.

4. Asserting Appropriate Health Care Law Defenses

The fourth strategy that we deploy involves identifying all potentially viable health care law defenses. Depending on the facts of your case, you could have several potential defenses available. For example, in one recent Medicare fraud case, the government alleged that our client fraudulently certified a patient for home health care services. We argued successfully that a recognized delegation exception rendered our client’s certification fully compliant with the law. In another Medicare fraud case, we used a safe harbor exception to convince the government to stop pursuing our client. These are just two examples of the countless defenses that may be available.

Choosing the Right Health Care Fraud Defense Lawyer

With so much at stake, if you or your organization is under investigation for Medicare fraud, it is absolutely essential to choose a team of defense attorneys who have the skills and experience necessary to help you avoid prosecution. So, how do you make the right choice?

The Right Choice: A Team of Health Care Fraud Defense Lawyers.

Experienced health care fraud defense lawyers have the necessary blend of Medicare knowledge and a strong record in health care fraud defense. They know how to assess the complex health care and billing issues involved in Medicare investigations that happen in Laredo, Texas. They have the skills necessary to effectively represent clients in negotiations with federal health care fraud prosecutors.

To find out if an attorney has the knowledge and experience necessary to represent you effectively, we recommend asking the following three important questions:

  • How many Medicare Fraud cases have you handled so far in your career?
  • How many of the health care fraud cases that you handled resulted in no civil and no criminal charges or dismissals for your clients?
  • How many health care fraud cases have you tried in court?

About Oberheiden & McMurrey, LLP

At Oberheiden & McMurrey, LLP, our attorneys have handled hundreds of health care proceedings across and conducted more several criminal trials. Many of our attorneys in our Health Care Fraud Defense Group come from senior positions within the Department of Justice for Northern Texas. All of our attorneys benefit from decades of collective experience in Medicare and other health care fraud investigations. Our team approach to Medicare fraud investigations that occur in Laredo, Texas means that you benefit from all of this collective experience – not just the experience of a single attorney.

We center on representing business owners, health care executives, health care providers, hospitals, pharmacies, laboratories, and other entities in the health care industry in the following core areas:

  • Health care fraud defense;
  • Compliance programs and their implementation;
  • Internal investigations;
  • Qui tam defense;
  • Asset protection;
  • Licensure & disciplinary proceedings; and
  • Jury trials.

What distinguishes Oberheiden & McMurrey, LLP from other law firms serving Laredo, Texas is our broad experience within the area of health care fraud defense. Our clients range from individual providers to entire health care systems, and we regularly represent clients who 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, the Medicaid Fraud Control Unit, Laredo and Texas law enforcement, the Internal Revenue Service, and other state and federal agencies.

Our Track Record

  • Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of a health care services company against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act and Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged health care fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability.
  • Defense of a physician owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.

Medicare Fraud Defense Attorneys in Laredo, Texas

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney. Dr. Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during allegations of political corruption, government investigations, and during local and national media campaigns, including 60 Minutes. He is well-known for stopping federal investigations before criminal charges are filed. In addition to his health care defense practice, Dr. Oberheiden assists with internal investigations, implements corporate compliance programs for his clients, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Ms. Byrd’s Laredo, Texas clients greatly benefit from her experience working with the Department of Justice. She prosecuted health care fraud, Anti-Kickback violations, False Claims Act violations, and Stark violations on behalf of the United States. Ms. Byrd’s immense experience with health care law enforcement makes her a valuable asset and she regularly argues federal matters for her clients.

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

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving Laredo, Texas and Surrounding Areas
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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