Former federal prosecutors
offering unparalleled knowledge and a proven track record


Meet the Team
Oberheiden Attorneys

False Claims Act & Qui Tam Legal Defense Serving Miami, FL

Oberheiden & McMurrey, LLP is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our attorneys are the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented attorneys with years of relevant experience and education from the country’s best schools such as Harvard Law School and Yale Law School. Our attorneys serve clients in Miami as well as throughout Florida.

At the Oberheiden & McMurrey, LLP, we represent individuals and companies in the health care industry in False Claims Act matters throughout the greater Miami area.

Our Health Care Fraud Defense Group is led by a team of senior attorneys who combine to offer decades of experience on both sides of complex False Claims Act investigations and prosecutions in Miami and nationwide. The leaders of our Health Care Fraud Defense Group include: (i) Dr. Nick Oberheiden, our firm’s managing principal and a nationally recognized health care fraud defense lawyer and (ii) Lynette Byrd, a former federal prosecutor with extensive False Claims Act experience.

We have developed this page to serve as a resource for individuals and companies facing allegations of False Claims Act violations in Miami, FL. Continue reading to learn:

  • What Health Care Companies and Executives Need to Know About the False Claims Act
  • What to Expect if You or Your Company Has Been Named in a “Qui Tam” Lawsuit
  • What Our Attorneys Can Do to Help You Avoid Civil and Criminal Responsibility

Miami Tops the Federal Government’s List of Priorities in Program Fraud Investigations

Over the last decade or so, Miami’s health care industry has consistently remained in the government’s crosshairs due to suspected widespread fraud involving Medicare and other federal health care benefit programs (such as Medicare and Tricare). Miami has led the nation in Medicare spending per beneficiary, and to federal health care prosecutors, this means one thing: A high likelihood of substantial false and fraudulent claims. As a result, over the last several years, numerous local physicians, staffing companies, billing companies, consultants, and other health care industry participants have been held liable for hundreds of millions of dollars in civil and criminal penalties.

To combat Medicare fraud in Miami, the federal government has placed a task force from its elite Health Care Fraud Prevention and Enforcement Action Team (HEAT) in the area. HEAT is a joint effort of prosecutors from 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. With the help of other state and federal law enforcement authorities, HEAT is actively investigating and prosecuting companies and individuals suspected of False Claims Act violations in Miami, FL.

1. What Health Care Companies and Executives Need to Know About the False Claims Act

The False Claims Act is a federal law that imposes civil and criminal penalties on individuals and companies that “knowingly” submitting false or fraudulent claims for compensation under United States government contracts and federal benefit programs. It is a key tool in the government’s fight against health care fraud.

What Does it Mean to “Knowingly” Submit a False or Fraudulent Claim?

While the False Claims Act employs a “knowing” standard, you do not actually have to know that a false claim has been submitted in order to face penalties. If the information was available to you (in other words, if you “should have known,” had you conducted reasonable due diligence), this is enough to be held liable for a violation. As a result, health care companies, their executives, and other companies and individuals in Miami regularly face False Claims Act investigations based on allegations of:

  • Mistakenly using outdated (“false”) billing codes
  • Double-billing for services, supplies, medications, and durable medical equipment (DME)
  • Unbundling and upcoding reimbursable services
  • Billing for services, supplies, and medications that were not provided
  • Billing for services, supplies and medications that were medically unnecessary

Unfortunately, there is a fine line between a justifiable mistake and a “knowing” violation, and as a result (i) many well-meaning companies and individuals find themselves suddenly facing substantial unexpected liability, and (ii) many innocent providers end up facing unwarranted investigations.

What are the Risks of Violating the False Claims Act?

Violations of the False Claims Act can result in both civil and criminal penalties. The specific penalties in any one case will depend on the nature and extent of the alleged false and fraudulent claims involved.

Civil Penalties

Individuals and companies that “knowingly” submit false claims can be held liable for three times the government’s actual losses and fines of up to $11,000 per false claim.

Criminal Penalties (18 U.S.C. § 287)

For “intentional” violations of the False Claims Act, individuals and companies face criminal penalties that include up to five years of federal imprisonment and fines (also on a per-claim basis) of up to:

  • $250,000 (for individuals) or $500,000 (for companies) for felony offenses
  • $100,000 (for individuals) or $200,000 (for companies) for misdemeanor violations

2. What to Expect if You or Your Company Has Been Named in a “Qui Tam” Lawsuit

A “qui tam” lawsuit is a lawsuit that is brought by a private citizen on behalf of the United States government to collect monies owed. In order to initiate a qui tam lawsuit, all that is required is a simple allegation of a False Claims Act violation (see 31 U.S.C. § 3729). Qui tam lawsuits can be extremely disruptive (not to mention costly), and as a result, disgruntled former employees and unprincipled competitors will often file complaints for malicious purposes.

If you or your company has been named in a qui tam lawsuit in Miami, here is a brief overview of what you can expect over the months to come:

Initial Government Assessment

After the private citizen (referred to as a “relator”) files a complaint, the government will conduct an initial assessment of the allegations. If the allegations appear to be legitimate (i.e., they indicate that a false or fraudulent claim has been submitted), government attorneys and federal agents will conduct an investigation. This investigation typically involves subpoenaing corporate, financial, billing, and other records from the defendants in the case.

Decision on Government Intervention

Based on records obtained and initial negotiations with the defendants’ attorneys, the government’s attorneys will make a decision: They will either terminate the government’s involvement in the case; or, they will seek approval from the DOJ headquarters in Washington D.C. to intervene in the litigation. If this approval is granted, the government’s attorneys will often amend the relator’s complaint to include causes of action based upon violations of the Anti-Kickback Statute, the Truth in Negotiation Act, and other anti-fraud laws.

Negotiations Regarding Settlement

During the assessment and investigative stages of the case, the attorneys for both sides will be engaged in negotiations regarding settlement. Qui tam cases tend to move slowly, so at a minimum you can expect several months to lapse before there is a settlement offer on the table.

Liability and Relator Compensation

If the case doesn’t settle and the defendants are held civilly responsible, as noted above, they can face “treble damages” (three times the government’s losses) plus civil fines of $11,000 per false claim. The False Claims Act’s qui tam provisions entitle the relator to up to 25 percent of the amount recovered, or up to 30 percent if the relator pursued a successful case after the government declined to intervene.

3. What Our Attorneys Can Do to Help You Avoid Civil and Criminal Responsibility

As you can see, allegations of False Claims Act investigations need to be taken extremely seriously. If you wait to take action, you can increase your chances of facing criminal charges or civil liability can increase substantially. At Oberheiden & McMurrey, LLP, we have developed a proven defense strategy that emphasizes early and consistent intervention in order to prevent our clients’ cases from reaching the point where the government presses charges. This strategy is built on three key goals:

  1. Keep the Case Civil. Our first priority is always to keep our clients’ cases civil. We do not want you facing criminal charges.
  1. Prevent the Government from Intervening. In qui tam litigation, we take aggressive action in order to prevent the government from intervening. This includes shedding light on the holes in the relator’s allegations and doing everything possible to destroy their credibility.
  1. Negotiate Strategically for a Favorable Settlement. If civil liability appears certain, we will center on negotiating a settlement that reduces your exposure to a fraction of the government’s initial demand.

To get started on your False Claims Act defense in Miami, FL, contact Oberheiden & McMurrey, LLP and request a free consultation with our Health Care Fraud Defense Group today.

Our Track Record

  • False Claims Act Investigation (Pharmacy)
    Result: No Liability.
  • False Claims Act Investigation (Pharmacy)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Laboratory Group)
    Result: No Liability.
  • False Claims Act Investigation (Physician)
    Result: No Liability.
  • False Claims Act Investigation (Physician)
    Result: No Liability.
  • False Claims Act Investigation (DME Company)
    Result: No Liability.
  • False Claims Act Investigation (MSO)
    Result: No Liability.
  • False Claims Act Investigation (MSO)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Physician Syndication)
    Result: No Liability.
  • False Claims Act Investigation (Device Company)
    Result: No Liability.
  • False Claims Act Investigation (Health Care Service Provider)
    Result: No Liability.

False Claims Act Defense Attorneys Serving Miami

Nick OberheidenDr. Nick Oberheiden is a highly respected health care fraud defense attorney who represents clients in qui tam litigation and government-initiated investigations and prosecutions involving alleged violations of the False Claims Act and a wide variety of other federal health care and anti-fraud laws. He has experience defending clients in matters involving virtually all federal agencies, including: the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL). Dr. Oberheiden holds a Juris Doctor from the University of California, Los Angeles and a Ph.D. in law from the University of Heidelberg in Germany.

Lynette ByrdLynette S. Byrd is also a former federal prosecutor, having handled numerous high-profile fraud investigations during her time as an Assistant United States Attorney (AUSA). Ms. Byrd is an experienced negotiator and trial lawyer, and the firm’s clients benefit immensely from the insights she gained while serving in the Department of Justice. She regularly handles a wide variety of health care fraud matters, including allegations of violations under the False Claims Act, the Anti-Kickback Statute, and other federal laws.

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

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving Miami, Florida 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.

IF YOUR FREEDOM IS AT STAKE

YOU SHOULD CONTACT US TODAY

Contact the Experienced Attorneys of Oberheiden & McMurrey, LLP Now for a Confidential Consultation

Contact Us Now
×