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Oberheiden Attorneys

Experienced Defense Lawyers Providing Health Care Fraud Defense in Rio Grande City, Texas

Rio Grande City, Texas health care providers, entities, and businesses have a high risk of being investigated for health care fraud by the federal government. The Oberheiden & McMurrey, LLP has extensive experience in health care fraud defense, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG and grand jury subpoenas, criminal defense, and internal investigations. Our Health Care Fraud Defense Team includes a former Chief Health Care Fraud Coordinator for the U.S. Attorney’s Office, several former health care fraud prosecutors, and elite former lead prosecutors of the Medicare Fraud Strike Force. We offer our services to clients in Rio Grande City as well as throughout Texas State.

If you’re in Rio Grande City, Texas and you’re being investigated by the federal government for health care fraud, call Oberheiden & McMurrey, LLP. Ask to speak with a member of our Health Care Fraud Defense Team. The initial call is confidential and free.

Rio Grande City, Texas Is Intently Monitored for Health Care Fraud

Rio Grande City, Texas is one of nine areas in the nation that is intently monitored by the federal government for health care fraud. The Medicare Fraud Strike Force is a team of federal prosecutors and investigators from the Department of Justice, Department of Health and Human Services, Office of Inspector General, the FBI, and other federal agencies. They monitor, investigate, and prosecute health care fraud.

The reason why Rio Grande City, Texas is so intently monitored is because of the number of federal health care program beneficiaries who live in the area. This causes more claims to be filed for reimbursement with the federal government. The increase in the number of claims makes the government believe that there is a higher likelihood of health care fraud. In 2016, the Department of Justice released a statement that they investigated around 300 cases of health care fraud. This breaks down to 80 cases involving individual providers and the rest of the cases centered on a health care entity or business. The agency recovered more than $900 million in fraudulently paid out claims.

What Is Federal Health Care Fraud?

Federal health care fraud is the filing of one or more false claims by a health care provider, business, or an entity in order to be reimbursed for medical services or equipment from a federal health care program such as Medicaid, Medicare, Tricare, or federal workers’ compensation. It is a violation of at least one of the following:

  • The Anti-Kickback Statute. Federal health care law outright prohibits kickbacks in exchange for referrals. Any individual (including doctors, marketing representatives, and business owners) is subject to prosecution for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
  • Stark Law. Stark Law, also known as the Self-Referral Law, prohibits doctors from referring patients to specific health care service entities if the doctor (or a member of the doctor’s immediate family) has an ownership or investment interest or if there is a compensation arrangement. Note, however, that there are statutory exceptions to this law.
  • False Claims Act. If you submit a claim to Medicare or any other federal health care program, you are required by law to abide by the False Claims Act. If the claim submitted to the federal government is discovered to be inaccurate, the federal government will likely launch an investigation into your billing practices under the criminal provisions of the False Claims Act.
  • Prescription Fraud. The federal government pays special attention to health care practices that have an unusually high number of narcotic prescriptions. If you are suspected of running a “pill mill,” you are at a high risk of being investigated for insurance fraud and for violating DEA dispensing rules.
  • Billing Fraud. The federal government is persistent about investigating the up-coding of claims. Up-coding means that the next higher code is used for a service when the billing is done. The federal government is also prone to investigating phantom billing (billing for services that were not provided), billing for patients who do not exist (referred to as ghost patients), and billing for equipment or services that are deemed not medically necessary.
  • Certification Errors. The home health care and hospice industry is frequently a practice that the federal government chooses to maintain a close eye on. The most common accusations include fraudulent certification for home health care and hospice care.

Oberheiden & McMurrey, LLP helps clients avoid criminal charges that may result from a health care fraud allegation. If you’re being investigated in Rio Grande City, Texas, call us right away. The call is free and confidential.

The Civil and Criminal Penalties of Federal Health Care Fraud

Health care fraud allegations in Rio Grande City, Texas and the surrounding areas can lead to civil or criminal charges. Civil penalties may include the repayment of the reimbursed claims, non-payment of future claims, and possible exclusion from federal health care programs. You could also be called before the state licensing board. You could lose your professional license or your hospital privileges.

Criminal penalties are extremely serious. You could be forced to pay expensive fines and you could even be sentenced to time in federal prison:

  • Up to 10 years for each count of health care fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
  • Life sentence if the health care fraud resulted in the death of a patient

Health care providers, businesses, and entities in Rio Grande City, Texas have one pressing question. What is the worst-case scenario for health care fraud allegations? The answer is criminal charges and a federal prison sentence. However, whether or not you will be charged criminally or receive a prison sentence depends on several factors, including the injuries suffered by the affected patients, whether the prosecutor plans to pursue criminal charges, and why the investigation was started.

Oberheiden & McMurrey, LLP provides legal representation for health care providers, health care systems, entities, and businesses in Rio Grande City, Texas and the surrounding areas facing this allegation. We use our experience as both former health care prosecutors and as defense attorneys to develop the proper defenses for each client. If you’re under investigation, call us right away. The call is free and confidential.

Determining If the Investigation Is Criminal

Health care fraud investigations can be civil or criminal. They often start off as civil and then become criminal. This is why you should contact Oberheiden & McMurrey, LLP as soon as you can after discovering that you’re being investigated.

Contact by a federal prosecutor isn’t a sign that you should use to determine if the investigation against you is criminal. This is because federal agencies have both civil and criminal prosecutors. Signs of a criminal investigation include the receipt or serving of search warrants, seizure warrants, arrest warrants, target letters, contact from a federal criminal prosecutor, involvement from the IRS, or the receipt of a grand jury subpoena.

Health Care Fraud Defenses

Oberheiden & McMurrey, LLP provides health care fraud defense to individuals and entire companies being investigated by the federal government in Rio Grande City, Texas and the surrounding areas. We’ve managed hundreds of health care fraud defense cases. Many of our attorneys have former experience as health care auditors and as former health care fraud prosecutors with the Department of Justice and with the Medicare Fraud Strike Force. We use this experience to develop the proper legal defenses for each of our clients.

Immediate legal advocacy. The main objective of our law firm is to help our clients avoid criminal charges. We’ve learned that the most efficient way to do this is to immediately contact the federal government to begin to advocate on behalf of our clients. This provides less time for the government to investigate you without interruption. This is important because when there is a long period of uninterrupted time, you may face criminal allegations. After we are retained, we immediately reach out to make contact with the federal government. Within hours, we can usually get answers to the important questions:

  • What is the investigation about?
  • What is the purpose of it?
  • How long will the investigation take?
  • What is the most likely outcome?

Proving lack of criminal intent. The federal government must prove that you committed a crime and that you acted with criminal intent. They must present evidence that meets a high legal standard. Often, the federal government will try to use billing inaccuracies to prove that you committed a crime. We’ve found that billing inaccuracies usually don’t occur because someone acted with criminal intent to defraud the government. They happen because of a mistake. Mistakes should certainly be corrected, but they should not lead to criminal repercussions. The most common errors that cause health care fraud investigations include hiring unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the frequently changing laws and rules that are involved in health care .

Choosing strategic legal defenses for each case. Our lawyers review each case to determine the right legal defenses. This may include researching and using applicable statutory loopholes and exceptions. For instance, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either lessen or entire resolve a health care fraud case.

Defending your professional reputation. Allegations of health care fraud can damage your professional reputation. Oberheiden & McMurrey, LLP will help protect your reputation both inside of and outside of the courtroom. Our attorneys will correct misinformation presented to the public by the media about our clients. We also address slanderous comments.

If you’re being investigated for health care fraud in Rio Grande City, Texas or the surrounding areas, call Oberheiden & McMurrey, LLP right away. The call is free and confidential.

Our Track Record

The commitment of Oberheiden & McMurrey, LLP is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former health care prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home health care entities, and many other health care organizations against any form of alleged health care fraud. Here are some recent examples of our case outcomes.

  • Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation 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.
  • Representation of a Health Care Marketing Group Against an Investigation by the Office of Inspector General for Alleged Health Care Fraud.
    Result: No civil or criminal liability.
  • Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
    Result: No civil or criminal liability.
  • Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
    Result: No civil or criminal liability.
  • Representation of Health Care Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
    Result: No civil or criminal liability.
  • Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
    Result: No civil or criminal liability.
  • Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
    Result: No civil or criminal liability.

Health Care Fraud Defense Lawyers Serving Rio Grande City, Texas

Nick OberheidenNick Oberheiden is a 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 accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. He is most known for stopping federal investigations before criminal charges can be filed. In addition to his health care defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, 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). Clients greatly benefit from Ms. Byrd’s experience from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she regularly argues federal matters for her clients.

We are available every day of the year. You can call us directly or complete our contact form or by emailing us directly.

800-810-0259
Including Weekends
Oberheiden & McMurrey, LLP
Serving Rio Grande City, 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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