Dallas Healthcare Fraud Defense Lawyers
4131 N Central Expy, #900
Dallas, TX 75204
972-846-8818
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Oberheiden, P.C. is a healthcare law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our Texas healthcare fraud attorneys are the former Chief Healthcare 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 Dallas healthcare fraud defense lawyers serve clients in Dallas, TX as well as throughout surrounding areas in Texas.
Oberheiden, P.C. defends Dallas clients against healthcare fraud allegations. Dr. Nick Oberheiden, a healthcare fraud defense lawyer, leads our Healthcare Fraud Defense Team.
Our dedicated team has experience with OIG and Grand Jury subpoenas, Medicare and Tricare audits, defense of fraud allegations, internal investigations, implementation of compliance programs, qui tam defense strategies, asset protection, criminal defense, and jury trials.
If you’re facing allegations of healthcare fraud or any of the other areas listed above, call us immediately. We’re available 7 days a week.
Healthcare Fraud in Dallas
There are nine areas in the United States where the federal government established specialized task forces to surveil, investigate, and prosecute Medicare fraud. Dallas is one of those nine areas. Healthcare practitioners and businesses should be aware that government prosecution is becoming more aggressive and frequent in this community compared to many others. These investigations are initiated by the Healthcare Fraud Prevention and Enforcement Team (HEAT). HEAT is a federal task force that is composed of prosecutors from the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), and the Federal Bureau of Investigation (FBI) along with many other government agencies.
Healthcare Fraud Explained
Federal healthcare fraud is the attempt to receive government funding through programs such as Medicare, Medicaid, Tricare, or federal workers’ compensation (DOL) through false and fraudulent information. It can take many different forms.
- Anti-Kickback Violations. Compensation in exchange for referrals is prohibited by healthcare laws. Any person – physicians, marketers, business owners – is subject to healthcare fraud prosecution for receiving monetary payment or offers in exchange for a patient referral.
- Stark Law. If a physician (or family member) has a compensation arrangement with any health services entities or practice, they may not, under law, refer patients to those facilities – unless one of the statutory exceptions applies.
- False Claims Act Violations. The False Claims Act applies to any submission made to Medicare. If a bill is submitted that is incorrect, even if unintentional, the statutes’ heavy-handed civil penalties may kick in. The government can investigate incorrect billing under the criminal provisions of the False Claims Act.
- Prescription Fraud. Physician practices with unusually high volumes of narcotic prescriptions are inspected by the government. Doctors who are under the suspicion of handing out unnecessary narcotic prescriptions may be investigated for insurance fraud and violations of DEA dispensing rules.
- Billing Fraud. Up-coding or billing code used for higher than the service level provided, phantom billing (services not provided), billing ghost patients, and billing for services deemed medically unnecessary will be investigated by the government.
- Certification Errors. Investigations of the health and hospice industry have been intensified by the government. The main allegation is that some physicians and nurses are fraudulently certifying the medical services needed, despite the patient not being homebound (home health) or not terminally ill (hospice).
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
Lynette S. Byrd
Former Department of Justice
Brian J. Kuester
Former U.S. Attorney
Former DA
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Joe Brown
Former U.S. Attorney & Former District Attorney
Local Trial & Defense Counsel
Amanda Marshall
Former U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Michael Koslow
Former Supervisory Special Agent (FBI)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Penalties
Healthcare fraud is a serious offense and the penalties can range from civil recoupment requests, non-payment of claims, and program exclusion to criminal prosecution, fines, and even incarceration. The general crime-fraud statute at 18 U.S.C. 1347 provides:
- Up to 10 years in prison for each count of healthcare fraud.
- Up to 20 years in prison, if the fraud resulted in serious bodily injury.
- Life in prison if the fraud resulted in the patient’s death.
How you may be prosecuted for healthcare fraud and whether you will receive a prison sentence is largely dependent upon all of the factors involved in your case, whether the prosecutor is interested in taking the case, and what the government believes was your primary motivating factor for committing the alleged fraud.
Because Oberheiden, P.C. has former experience as healthcare fraud prosecutors and because of our work as defense attorneys, we have a unique blend of experience and a distinct track record of helping our clients avoid criminal prosecution. If you’re being investigated or if you want to speak with us about the facts involved in your case, contact Oberheiden, P.C. right away. We’re available 7 days a week. The call is free and it’s confidential.
Frequently Asked Questions
What are the penalties for opioid prescription fraud?
Criminal violations of the Control Substances Act are subject to 21 U.S.C. 841 and, if charged as a conspiracy with co-defendants, to 21 U.S.C. 846. These two statutes authorize federal prosecutors to petition the court for up to ten years of federal incarceration for each criminal violation and even a life sentence for medical professionals if the alleged misconduct has led to the death of a patient.
- 21 U.S.C. 846: Conspiracy to Distribute Controlled Substances
- 21 U.S.C. 841: Criminal Violation of the Controlled Substances Act
- 18 U.S.C. 1347: Healthcare Fraud
Don’t let this happen to you. If the DEA is after you or if your practice has been shut down by a DEA search warrant, it is important for you to consult with an experienced lawyer immediately to protect your rights and to avoid being found guilty. It’s your life, your livelihood, and most DEA cases are fixable. Make the right attorney decision and fight back.
How can I avoid healthcare fraud charges in Dallas, Texas?
There are few ways medical providers can avoid health care fraud charges. The best way, by far, is to take a proactive approach by developing and implementing a comprehensive healthcare fraud compliance program. A compliance program helps avoid civil and criminal charges in two ways. First, by ensuring that all employees and supervisors understand the organization’s compliance objectives and unique risk areas––the better informed an organization is, the less likely a violation is to occur. The other way that a compliance program helps avoid healthcare fraud charges is that it can help convince investigators that a potential violation was an isolated incident and that pursuing charges is not necessary. The assistance of a knowledgeable Dallas federal healthcare fraud defense attorney is helpful in defending against allegations of healthcare fraud as well as in the creation of a comprehensive compliance program to avoid charges in the first place.
I am accused of healthcare fraud. What now?
You probably already know that healthcare fraud is a serious allegation, how serious exactly, is what you and a health care fraud lawyer at Oberheiden, P.C. should discuss. In general, the sooner clients contact us when facing healthcare fraud charges and the sooner we can address potential problems with the prosecutors, the better the chances to bury the investigation quickly.
Which federal government agencies investigate claims of healthcare fraud?
For the most part, the Federal Bureau of Investigations is the federal agency that leads a healthcare fraud investigation. However, the FBI routinely relies on assistance from other agencies, including:
- The Centers for Medicare and Medicaid Services (CMS)
- The Department of Defense (DOD)
- The Department of Health and Human Services (HHS)
- The Department of Justice (DOJ)
- The Department of Labor (DOL)
- The Drug Enforcement Administration (DEA)
- The Office of Inspector General (OIG)
One of these agencies, for example, may receive a tip that a provider is engaging in healthcare fraud. That agency will then look into the allegations and, at some point, involve the FBI. If you are at the center of a healthcare fraud investigation or audit, no matter what federal agency is involved, it is important you contact a dedicated Dallas, Texas federal healthcare fraud defense attorney as soon as possible.
When Is Healthcare Fraud Criminal?
Healthcare fraud cases can be both civil and criminal. In many healthcare investigations, it is often unclear how a case will be prosecuted. The U.S. Attorney’s Office is divided into a civil and a criminal division that employs federal prosecutors to work in both divisions. The fact that a prosecutor is leading the investigation is not enough of an indication that a case is criminal. This applies to federal agents, as well. Contact from an OIG or FBI agent does not automatically mean that they are making an inquiry about a criminal case. Many agents investigate civil matters.
The determination of the nature of a case can initially depend on a skillful interpretation of the requests made in an OIG subpoena, the tone of the inquiry, or the underlying allegations. There are some indications that would suggest a criminal prosecution rather than a civil matter – warrants, seizure warrants, arrest warrants, issuance of target letters, the involvement of criminal prosecutors, the involvement of the IRS, or the issuance of grand jury subpoenas.
If you’re a Dallas, Texas healthcare provider, facility, or business and you’re being investigated and aren’t sure if it is criminal or civil, please call us now. We’ve represented entire healthcare systems, executives, healthcare practices, individual providers, and other healthcare industry organizations. If you’ve received contact from the DOJ, the DOD, FBI, DEA, OIG, Medicaid Fraud Control Unit, Dallas or Texas law enforcement, or the IRS, don’t wait. Call us now.
Defending Healthcare Fraud in Dallas, Texas
Oberheiden, P.C. has many healthcare fraud defense lawyers who handled healthcare audits and fraud investigations as former employees of the Department of Justice. They are a valuable part of our team and can offer their insights and experience with our Dallas clients. Their insights and experience are part of the reason why we’re able to provide strategic, custom defenses for our clients.
- Immediate Defense. During an investigation, our number one goal is to help our Dallas clients avoid criminal charges. We believe in intervening as early as possible. This allows us time to make an impact on the investigation. When you retain our criminal defense firm, we will work to protect your rights, freedom, and livelihood. We can answer the most pressing questions you may have in regard to your case: What is the case about? What is the purpose of the investigation? How long will it take? What is the likely outcome?
- No Criminal Intent. The U.S. Constitution requires the government to prove criminal intent beyond a reasonable doubt. Many prosecutors will attempt to claim that inaccuracies in billing records are evidence of a defendant’s intent. We know that innocent mistakes happen. Innocent mistakes do not equate to fraudulent intent. We can demonstrate that misinformation in billing records can be the result of organizational or human error and not fraudulent intent. We know that unqualified staff, delegation and outsourcing errors, lack of oversight, and insufficient supervision can lead to errors. The constantly changing healthcare system and billing rules can contribute to billing errors, but they should not lead criminal liability.
- Applicable Legal Defenses. Oberheiden, P.C. has healthcare law experience to introduce applicable defenses and statutory loopholes to defend our clients. For example, we have won many cases by demonstrating how exceptions in the Stark Law and in medical necessity certifications apply to our clients, and either mitigate or entirely nullify the government’s fraud case.
- Protecting Your Reputation as a Healthcare Provider. Unfounded allegations of fraud in Dallas, Texas go far beyond establishing legal strategies and defense plans against government investigations. Many of our clients are equally concerned about their reputation and their perception in the public. The media has the power to ruin someone’s reputation or to ignite rumors about wrongdoings. Our healthcare fraud defense lawyers routinely intervene upon slanderous reporting. We can obtain news spots and opportunities to correct and rectify errors by educating the audience about the truth.
Oberheiden, P.C. – Dallas Healthcare Fraud Defense Firm
The commitment of Oberheiden, P.C. is to avoid criminal charges and healthcare fraud penalties and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced healthcare fraud defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, healthcare entities, and many other healthcare organizations against any form of alleged healthcare 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 healthcare 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 healthcare marketing group against an investigation by the Office of Inspector General for alleged healthcare 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 Healthcare 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.
Call us today and speak to one of our experienced Dallas healthcare fraud lawyers directly. We are available to discuss your situation in a free and confidential call, including on weekends.
972-846-8818
Including Weekends
Oberheiden, P.C.
Serving: Allen, Arlington, Balch Springs, Bedford, Burleson, Carrollton, Cedar Hill, Cleburne, Colleyville, Coppell, Denton, DeSoto, Duncanville, Euless, Farmers Branch, Flower Mound, Fort Worth, Frisco, Garland, Grand Prairie, Grapevine, Greenville, Haltom City, Hurst, Irving, Keller, Lancaster, Lewisville, Little Elm, Mansfield, McKinney, Mesquite, North Richland Hills, Plano, Richardson, Rockwall, Rowlett, Sachse, Southlake, The Colony, Waxahachie, Weatherford, Wylie
Additional Pages for Dallas, Texas
- Dallas corporate compliance
- Dallas corporate investigations
- Dallas employment litigation defense
- Dallas False Claims Act & Qui Tam defense
- Dallas federal criminal defense
- Dallas grand jury subpoenas
- Dallas hospice & home health fraud defense
- Dallas hospital compliance and audits
- Dallas ICE and I-9 audit defense
- Dallas Medicare fraud defense
- Dallas pharmacy compliance and audits
- Dallas white collar criminal defense
- Northern District of Texas CID
Oberheiden P.C.
4131 N Central Expy, #900
Dallas, TX 75205
972-846-8818
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