McAllen False Claims Act Defense Attorney - Oberheiden, P.C.
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McAllen False Claims Act & Qui Tam Defense Lawyers

McAllen 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 McAllen as well as throughout Texas.

Under the False Claims Act, healthcare service providers and other companies in the healthcare industry can face severe civil and criminal penalties due to government investigations and private citizen-initiated “qui tam” lawsuits. If you are facing an investigation or a qui tam complaint under the False Claims Act, you need to take your situation extremely seriously. At Oberheiden, P.C., our nationally recognized Healthcare Fraud Defense Group brings decades of government and private experience to defending clients in False Claims Act matters in McAllen, TX and nationwide.

Experienced Representation for False Claims Act Defense in McAllen, TX

In years past, McAllen made national headlines for coming in second in the nation in terms of government spending per Medicare beneficiary. McAllen has recently dropped in this dubious ranking, but due to its history, it remains a key focus of the federal government’s enforcement efforts under the False Claims Act.

Due to high levels of fraud in McAllen and other cities throughout the state, the government has placed two task forces from its elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT) in Texas. Texas is one of only two states nationwide with two HEAT task forces, and there are only nine of these task forces nationwide. Currently, HEAT – along with other federal enforcement authorities – is aggressively investigating and prosecuting providers in McAllen suspected of False Claims Act violations involving Medicare and other federal benefit programs.

About The False Claims Act: Violations and Penalties

What Constitutes a Violation of the False Claims Act?

The False Claims Act makes it illegal to submit false and fraudulent claims for payment to the United States government. It applies in two primary scenarios: (i) where a person or business contracts with the federal government for goods or services, and (ii) where a person or business receives compensation under a federal healthcare benefit programs (such as Medicare, Medicaid, or Tricare).

In order to violate the False Claims Act, you must “knowingly” submit or cause the submission of false or fraudulent claim. But, unfortunately, this does not mean what you think it does. In order to “knowingly” submit a false or fraudulent claim, it is enough if you “should have known” that the claim was improper. This means that you do not actually have to know that a claim is false or fraudulent in order to “knowingly” submit a false claim. If, for example, you make the common mistake of using an outdated billing code, you can face liability under the False Claims Act based upon your “lack of due diligence” in staying current with the Medicare billing system.

Other examples of potential False Claims Act violations include:

  • Double-billing, unbundling and upcoding reimbursable services and supplies
  • Billing for medically unnecessary services, supplies, equipment, or medications
  • Billing for services, supplies, equipment, or medications that were not actually provided

What are the Penalties for Violating the False Claims Act?

Providers in McAllen, TX can face both civil and criminal penalties under the False Claims Act. These penalties include:

  • Civil Penalties – Three times the government’s actual losses (“treble damages”) and fines of up to $11,000 per false claim.
  • Criminal Penalties (18 U.S.C. § 287) – Up to five years of federal imprisonment and fines of up to $250,000 (for individuals) or $500,000 (for companies) per false claim.

In order to seek criminal penalties, the government must prove beyond a reasonable doubt that you “intentionally” (not just “knowingly”) submitted a false or fraudulent claim.

Have You Been Accused of Fraud in a “Qui Tam” Complaint?

If you have been accused of violating the False Claims Act, there is a strong chance that the accusations were lodged by one of your former employees or competitors. While HEAT and other federal authorities initiate many False Claims Act investigations in McAllen, a large number of investigations also arise out of so-called “qui tam” complaints.

Under the False Claims Act, private citizens have the ability to file “qui tam” lawsuits on behalf of the federal government when they believe that they have inside information about a possible billing violation. In order to initiate a qui tam action, all that is required is a simple allegation of a false or fraudulent claim (see 31 U.S.C. § 3729). Since qui tam litigation can be highly disruptive and claimants (called “relators”) are entitled to a portion of the government’s financial recovery, qui tam actions are becoming a growing problem for healthcare providers in McAllen and across the country.

This is what happens in a qui tam lawsuit:

  • The Complaint. The relator files a complaint in the U.S. District Court for the Southern District of Texas alleging that an individual or company has violated the False Claims Act. Qui tam complaint are filed under seal (meaning that they are only made available to the assigned judge and select government officials) in order to protect the relator’s anonymity.
  • Initial Assessment. Upon receiving the complaint, the government conducts an initial assessment to determine whether it should investigate. If the complaint appears to be unsubstantiated, the government will not get involved. However, if the complaint appears to be legitimate, the government will issue subpoenas requesting any records that may provide evidence of a possible False Claims Act violation.
  • Government Intervention. Depending on the results of the investigation, the government will either “intervene” (that is, prosecute the case on the relator’s behalf) or allow the relator to proceed with the complaint independently. If the government intervenes, it will typically amend the relator’s complaint to include additional causes of action under the Anti-Kickback Statute, the Truth in Negotiation Act, and other federal laws.
  • Settlement Negotiations. While this process is ongoing, prosecutors from the DOJ will be in negotiations with the defendant’s attorneys regarding a possible settlement. The sooner you hire an attorney, the better your chances of securing a settlement or avoiding liability entirely before the government decides to investigate or press charges.
  • Liability and Relator Compensation. When cases don’t settle, providers can often face hundreds of thousands or even millions of dollars in liability. Remember: The government can seek triple damages plus civil fines of $11,000 per false claim. The relator will collect up to 25 percent of the amount recovered if the government intervened, or up to 30 percent if it pursued the case independently.

Three Stages of a Successful False Claims Act Defense

With decades of experience as federal prosecutors and defense attorneys in False Claims Act investigations in McAllen, throughout Texas, and nationwide, the attorneys in our Healthcare Fraud Defense Group have developed tried and trusted strategies for helping clients fend off unsubstantiated complaints and unwarranted federal investigations. In False Claims Act cases, there is a fine line between excusable error and liability, and convincing the government not to seek penalties requires skilled advocacy and deep knowledge of federal healthcare laws and billing procedures. Based on our attorneys’ experience, we have developed a three-stage approach to defending clients in False Claims Act cases in McAllen, TX:

  • Avoid Criminal Charges
    Our first priority is always to avoid criminal charges. Years of experience as former federal healthcare prosecutors in charge of False Claims Act investigations and a focused practice on healthcare fraud defense allow us to quickly determine whether our clients’ cases civil or criminal in nature. If necessary, we can negotiate with the prosecutors assigned to your case in order to keep criminal penalties off of the table.
  • Prevent Government Intervention
    Since qui tam cases often involve unsupported claims asserted by whistle-blowing ex-employees or competitors with disingenuous agendas, we will aggressively confront these individuals, challenge their alleged evidence, and seek to destroy their credibility. By doing so, we can often convince the government not to get involved.
  • Negotiate a Favorable Civil Settlement
    If some measure of civil liability appears unavoidable, we will seek to negotiate the fines and penalties to a fraction of the government’s demand. Of course, if at all possible, we will seek to secure an outcome of no civil or criminal responsibility.

Put Experience on Your Side. Choose Oberheiden, P.C..

When facing the possibility of criminal penalties under the False Claims Act, you cannot afford to hire inexperienced representation. The attorneys in our Healthcare Fraud Defense Group have successfully defended numerous 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 nationwide. To put experience on your side for your McAllen, TX False Claims Act investigation, contact Oberheiden, P.C. for a free case evaluation 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 McAllen, Texas and Surrounding Areas

Additional Pages for McAllen, 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.

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