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Texas False Claims Act Investigation Defense Attorneys

3131 McKinney Ave #600
Dallas, TX 75204
(Meeting location by appointment only)
Texas False Claims Act Investigation Defense Attorneys

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 attorneys is 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 attorneys serve clients in Texas and surrounding areas.

Based in Texas, the Oberheiden, P.C.’s nationally recognized Healthcare Fraud Defense Group is comprised exclusively of senior attorneys. Led by firm founder Dr. Nick Oberheiden, our Healthcare Fraud Defense Group offers decades of legal experience and deep government and industry insights for healthcare providers facing False Claims Act allegations throughout Texas.

Texas: A Key Battleground for False Claims Act Enforcement

Texas has become a key battleground in the federal government’s fight against suspected False Claims Act violations involving Medicare and other federal benefit programs. This is due in large part to the high number of federal program beneficiaries in the state (including Medicare, Medicaid, and Tricare participants), and the resultant high number of reimbursement claims submitted under these federal programs.

In fact, Texas is one of only two states in the country that is home to two separate teams from the government’s elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT). This is particularly significant given that there are only nine HEAT teams deployed across the entire United States. HEAT targets healthcare providers that submit reimbursements to the Centers for Medicare and Medicaid Services (CMS), and focuses heavily on claim volume when deciding to investigate suspected False Claims Act violations. Unfortunately, this approach (along with the False Claims Act’s “qui tam” provision discussed below) is leading many innocent providers in Texas to face unwarranted investigations.

The False Claims Act: An Overview

The False Claims Act is a federal law that is designed to protect taxpayers. It applies to individuals and businesses that have United States government contracts or receive compensation from the federal government under healthcare benefit programs and imposes both civil liability and criminal penalties for those who “knowingly” submit or cause the submission of false or fraudulent claims.

However, the word “knowingly” is misleading. This is because, in order to “knowingly” submit a false or fraudulent claim, you do not actually have to know that it was false or fraudulent. The False Claims Act “imputes” knowledge when a party should have known that a claim for payment violates the law, such as the common mistake of using an old billing code after a change in the Medicare billing system. Other common allegations in False Claims Act cases include things like:

  • Billing for services that were not actually provided or that were medically unnecessary
  • Billing for supplies, equipment, or medications that were never ordered or that were medically unnecessary
  • Double-billing for services, supplies, equipment, and medications
  • Unbundling and upcoding reimbursable services

The False Claims Act: Civil and Criminal Penalties

Individuals and companies found to have violated the False Claims Act can face both civil and criminal penalties. The extent of the penalties will depend on the nature of the government’s investigation and the scope of the alleged fraud, but in almost all cases are extremely severe. The penalties for False Claims Act violations are as follows:

  • Civil Penalties – In a civil case, individuals and companies can face treble damages (three times the government’s actual losses) and fines of up to $11,000 per false claim.
  • Criminal Penalties (18 U.S.C. § 287) – Healthcare providers who intentionally present false claims can face up to five years of federal imprisonment and fines of up to $250,000 for individuals and $500,000 for companies. As with civil fines, criminal fines apply on a per-claim basis.

What is a “Qui Tam” Lawsuit?

If you are being investigated under the False Claims Act, there is a strong chance that your case arose not out of a government-initiated enforcement action, but instead out of a claim filed by a competitor or disgruntled employee.

This is because the False Claims Act includes a provision that allows private citizens who have information about fraudulent billing practices to file lawsuits on behalf of the United States government. These are known as “qui tam” lawsuits. Unfortunately, all it takes to initiate a qui tam lawsuit is a simple allegation that an individual or company has violated the False Claims Act (see 31 U.S.C. § 3729), and as a result, qui tam litigation has become a go-to tool for interfering with law-abiding companies’ operations.

Here is a brief overview of the qui tam process:

1. A Private Citizen Files a Qui Tam Complaint

A private citizen (referred to as a “relator”) files a complaint in the local federal district court alleging that an individual or company has submitted fraudulent reimbursement claims under Medicare, Medicaid, Tricare, or another federal benefits program. The qui tam complaint is filed under seal (to protect the relator’s anonymity), and copies of the non-public complaint are provided only to the assigned judge and select government officials. Extensions to keep qui tam complaints sealed are regularly granted, and they will frequently remain under seal until the government has investigated the relator’s allegations.

2. The Government Investigates the Relator’s Allegations

Next, the government will conduct an initial assessment to determine whether: (i) the relator’s allegations are unsubstantiated and should be ignored; or, (ii) the allegations warrant a federal investigation. Investigations typically involve federal prosecutors as well as agents from the FBI, the OIG, and other federal agencies. During the investigation, the government will subpoena the defendant to produce any financial, billing, or other records that may provide evidence of a False Claims Act violation.

3. Will the Government Intervene?

Upon reviewing the subpoenaed records and making contact with the defendant’s attorneys to begin settlement negotiations, the government will decide to either intervene in the case or terminate its involvement (in which case the relator can still pursue its lawsuit independently). Intervention requires approval from the Department of Justice’s headquarters in Washington D.C. When the government intervenes, prosecutors will typically amend the relator’s complaint to include additional allegations under other federal anti-fraud laws such as the Anti-Kickback Statute and the Truth in Negotiation Act as well.

4. Case Settlement Negotiations Continue

Leading up to the decision to intervene, the prosecutors assigned to the case will continue to negotiate with the defendant’s attorneys regarding a possible settlement. Settling can often be a favorable option for defendants in qui tam lawsuits, and to date, not a single client of ours has been forced to cease its operations or close its business as a result of a False Claims Act settlement that we negotiated on their behalf.

5. The Case Closes and the Relator Gets Paid (if Successful)

If found liable in a qui tam lawsuit (if the case does not settle), providers can face liability for as much as three times the government’s losses plus fines of up to $11,000 per false claim. This can often lead to financial ruin for both individual and corporate defendants – as in many cases it adds up to millions of dollars in liability. If the government intervenes, the relator will receive up to 25 percent of the amount collected, and in cases of non-intervention, the relator collects up to 30 percent of the total recovery.

Three Tenets of a Successful False Claims Act Defense Strategy

With decades of experience handling False Claims Act investigations as both prosecutors and defense lawyers, our attorneys have developed a proven strategy for defending Texas healthcare providers in False Claims Act investigations. This strategy is grounded in three key tenets:

  • Avoid Criminal Charges. In every False Claims Act case we handle, our first priority is to keep the case civil so that our clients avoid the possibility of federal prison time.
  • Avoid Government Intervention. In order to keep the government from investigating, we will aggressively attack the relator’s claims and credibility. We will work quickly to convince the prosecutors that the relator is untrustworthy, that the relator’s allegations are baseless, and that the complaint does not warrant government involvement.
  • Negotiate a Favorable Settlement. If the evidence supports a possible violation, we will use our knowledge and experience in False Claims Act cases to negotiate our clients’ liability down to as little as possible.

Why Choose Oberheiden, P.C.?

When facing allegations under the False Claims Act, you need experience on your side. At Oberheiden, P.C., we have successfully defended physicians, practice owners, physician-owned entities, toxicology laboratories, medical device companies, pharmacies, service management organizations, healthcare marketing companies, hospitals, and many others in federal investigations across Texas, and nationwide. If you are serious about avoiding criminal charges and minimizing your liability, schedule a free consultation with our Healthcare 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 (Healthcare Service Provider)
    Result: No Liability.

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

Including Weekends
Oberheiden, P.C.
Serving the State of Texas and Surrounding Areas
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, P.C. is a Texas PC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

Why Clients Trust Oberheiden P.C.

  • 1,000+ Cases Handled
  • Available Nights & Weekends
  • Experienced Trial Attorneys
  • Former Department of Justice Trial Attorneys
  • Former Federal Prosecutors, U.S. Attorney’s Office
  • Former Agents from FBI, OIG, DEA
  • Cases Handled in 48 States
Email Us Call: 888-680-1745