WSJ logo
Forbes logo
Fox News logo
Bloomberg logo
Los Angeles Times logo
The Epoch Times logo
Telemundo logo
NY Post logo
NBC logo
Daily Beast logo
USA Today logo
Miami Herald logo
CNBC logo
Dallas News logo

Houston False Claims Act & Qui Tam Defense Lawyers

Houston False Claims Act & Qui Tam Defense Lawyers

The 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 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 attorneys serve clients in Houston as well as throughout Texas.

Under the False Claims Act, healthcare service providers and other companies that receive federal reimbursements through Medicare, Medicaid, Tricare, or another federal benefit program can face severe penalties for submitting fraudulent claims. If you or your company has been accused of violating the False Claims Act, you need to act fast. At Oberheiden, P.C., our nationally recognized Healthcare Fraud Defense Group provides experienced and aggressive representation for clients in False Claims Act matters throughout the Houston area and nationwide.

Headquartered in Texas, our Healthcare Fraud Defense Group is led by a team of senior attorneys. Our Healthcare Fraud Defense Group takes a unique team approach that affords each client the full breadth of our attorneys’ collective government and private-practice experience.

This page is intended as a resource for those facing federal False Claims Act investigations and qui tam litigation in Houston, TX. Here you will find answers to the following questions:

  • What is the False Claims Act?
  • What Constitutes a Violation of the False Claims Act?
  • What are the Penalties Under the False Claims Act?
  • What is a “Qui Tam” Complaint?
  • What are the Key Components of a Successful False Claims Act Defense Strategy?

Houston is at the Center of the Government’s Fight Against Federal Program Fraud

Houston is home to one of only nine HEAT task forces nationwide, and local Medicare and other federal program providers have long been a central focus of the federal government’s crackdown on fraud. The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) is comprised 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, and is tasked specifically with enforcement of the False Claims Act and other anti-fraud laws in key markets around the country.

Recently, prosecutors charged 22 individuals in Houston in the largest national Medicare fraud takedown in history. The government’s Medicare Strike Force and Medicare Fraud Control Unites in 23 states participated in the sting which involved 301 individuals, including 61 doctors, and approximately $900 million in false billings. This case shows just how effective the government can be in investigating large-scale fraudulent practices, and demonstrates the importance of taking action to protect yourself as soon as you find out that you are under investigation.

1. What is the False Claims Act?

The False Claims Act is a federal statute that makes it illegal to “knowingly” submit or cause the submission of a false or fraudulent claim for payment under a federal government contract or under a federal benefit program (such as Medicare, Medicaid, or Tricare).

2. What Constitutes a Violation of the False Claims Act?

Importantly, in order to “knowingly” submit a false or fraudulent claim, it is enough if you “should have known” that the claim was unlawful had you conducted appropriate due diligence. This means that you do not actually have to know that a claim is false or fraudulent in order to “knowingly” submit an unlawful claim. As a result, common examples of False Claims Act violations include:

  • Mistakenly using an outdated billing code
  • Double-billing
  • Unbundling and upcoding
  • Billing for services that were not provided
  • Billing for services that were medically unnecessary

3. What are the Penalties Under the False Claims Act?

Under the False Claims Act, providers can face both civil and criminal penalties. The penalties under the False Claims Act are as follows:

  • Civil Penalties – In civil cases, providers can face liability for three times the government’s actual losses (“treble damages”), plus fines of up to $11,000 per false claim.
  • Criminal Penalties (18 U.S.C. § 287) – If the government alleges that a provider “intentionally” submitted a false claim, the provider can face up to five years of federal imprisonment and fines of up to $250,000 (for individuals) or $500,000 (for companies) per false claim.

4. What is a “Qui Tam” Complaint?

The government is not alone in its fight against federal program fraud. The False Claims Act includes a “qui tam” provision which allows private citizens (referred to as “relators”) to file lawsuits to recover monies on behalf of the federal government (see 31 U.S.C. § 3729). Since qui tam litigation can be highly disruptive and relators are entitled to a portion of any amount the government recovers, qui tam actions often arise not out of a legitimate interest in protecting the government, but instead out of the self-interests and disingenuous allegations of disgruntled former employees and competitors.

This is what happens when a relator initiates a qui tam lawsuit in Houston:

  • The Complaint. The relator files a complaint in the U.S. District Court for the Southern District of Texas alleging one or more violations of the False Claims Act. The complaint is filed “under seal” in order to protect the relator’s anonymity.
  • Initial Assessment. Upon receiving the complaint, the government will conduct a preliminary review to determine whether it should conduct an investigation.  If the relator’s allegations are unsubstantiated, the government will not get involved. However, if the allegations appear to be legitimate, the government will issue subpoenas to the defendant(s) requesting any corporate, financial, billing, or other records that may provide evidence of False Claims Act violations.
  • Government Intervention. Following its investigation, the government will decide to either (i) intervene in the litigation and support the relator’s allegations, or (ii) terminate its involvement and allow the relator to pursue its complaint independently. If the government does intervene, attorneys at the DOJ will usually amend the relator’s complaint to include additional causes of action (such as violations of the Anti-Kickback Statute and the Truth in Negotiation Act).
  • Settlement Negotiations. During these initial stages, the DOJ’s attorneys and defendant’s fraud defense lawyers will engage in negotiations regarding the possibility of a settlement. Depending on the complexity of the case, it can take several months or longer before both sides are ready to agree upon a settlement.
  • Liability and Relator Compensation. If found liable, the defendant(s) will face penalties including three times the government’s losses plus civil fines of $11,000 per false claim. If the government intervenes, the relator is entitled to collect up to 25 percent of the amount recovered. If the relator pursued the case independently, it will collect up to 30 percent of the total damages recovered.

5. What are the Key Components of a Successful False Claims Act Defense Strategy?

Based on decades of experience as federal prosecutors and healthcare fraud defense attorneys, the members of our Healthcare Fraud Defense Group have developed a proven defense strategy for False Claims Act cases in Houston, TX. This strategy has three core components:

  • Avoid Criminal Charges
    Our first priority is always to make sure that our client avoids criminal charges. This keeps jail time off of the table and limits the scope of the government’s investigation. When we take your case, we will seek to determine the nature of your case within the first hours of our engagement.
  • Prevent Government Intervention
    In qui tam actions, we seek to expose the flaws in the relator’s complaint, and we pursue all available opportunities to destroy the relator’s credibility. We want to show the government that the complaint is unsupportable and does not warrant the government’s time and resources.
  • Negotiate a Favorable Civil Settlement
    If the evidence is such that civil liability appears unavoidable, we will seek to negotiate a settlement that results in the smallest possible fines and penalties. Our attorneys are skilled negotiators, and to date not a single one of our clients has been forced to cease operations or close their business as a result of a settlement that we have secured on their behalf.

If you are facing a federal investigation or have been named in a qui tam complaint in Houston, we encourage you to contact us immediately so that we can open a dialogue with the government and start building your defense. The defense attorneys and former federal prosecutors in our Healthcare Fraud Defense Group have successfully defended physicians, practice owners, physician-owned entities, toxicology laboratories, medical device companies, pharmacies, service management organizations, healthcare marketing companies, hospitals, and other individuals and entities in federal cases in Houston and nationwide, and we are prepared to aggressively defend you against civil and criminal liability.

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: Westbury, Chinatown, Sharpstown, Braeburn, Missouri City and ALL of Houston!
Zip Codes: 77096, 77074, and 77071 – and ALL of Houston!

Additional Pages for Houston, Texas

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 Federal 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
Email Us Call: 888-680-1745