Midland, TX False Claims Act Defense Lawyer - Oberheiden, P.C.
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Midland and Odessa False Claims Defense Attorney

Midland and Odessa False Claims Defense Attorney

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 Midland/Odessa as well as throughout Texas.

Serving clients throughout Texas, including in Midland and Odessa, Oberheiden, P.C.’s nationally recognized Healthcare Fraud Defense Group is comprised exclusively of senior attorneys. The Healthcare Fraud Defense Group is led by firm founder Dr. Nick Oberheiden who offers extensive experience and deep industry insight for defending against False Claims Act allegations in the Midland/Odessa area.

False Claims Act Enforcement in Midland/Odessa, TX

In recent years, Texas has become a central focus in the federal government’s fight against suspected False Claims Act violations involving Medicare and other federal benefit programs. With their central locations on I-20, Midland and Odessa serve as important hubs for much of the West Texas region’s healthcare-related needs.

Texas is one of only two states nationwide in which the federal government has placed two teams from its elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT). The fact that there are only nine HEAT teams nationwide tells you just how focused the federal government is on targeting healthcare companies in Midland, Odessa, and other cities throughout the state. Composed 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 HEAT is specifically charged with investigating and prosecuting healthcare providers suspected of False Claims Act violations involving Medicare. It is currently aggressively pursuing both civil and criminal penalties against Midland and Odessa healthcare providers suspected of violating the False Claims Act.

What Providers in Midland and Odessa Need to Know about the False Claims Act

The False Claims Act: An Overview

The False Claims Act is a federal law that applies to individuals and businesses that have United States government contracts and that collect payments from the federal government under healthcare benefit programs (such as Medicare, Medicaid, and Tricare). Designed to protect taxpayers, the False Claims Act imposes civil liability and criminal penalties for those who “knowingly” submit or cause the submission of any false or fraudulent claim.

However, in order to “knowingly” submit a false or fraudulent claim, you do not actually have to know that it was false or fraudulent. This is because the False Claims Act “imputes” knowledge when a party should have known that a claim for payment violates the law. For example, if you make an honest mistake and use an obsolete (false) code after a change in the Medicare billing system, you can still face liability under the False Claims Act based upon your “lack of diligence” in staying up-to-date on the latest billing codes.

Civil and Criminal Penalties Under the False Claims Act

The potential penalties for violating the False Claims Act are severe. As a result, if you are under investigation or have been named in a qui tam complaint (see below), you need to take your situation extremely seriously.

Civil Liability

In a civil case, individuals and companies can face triple damages and fines of up to $11,000 per claim for knowingly submitting or causing submission of a false or fraudulent claim.

Criminal Liability (18 U.S.C. § 287)

Healthcare providers who intentionally present false claims can face criminal penalties. The criminal penalties under the False Claims Act include up to five years of federal imprisonment and fines of:

  • Felony False Claims Act Violations: $250,000 for individuals or $500,000 for companies
  • Misdemeanor False Claims Act Violations: $100,000 for individuals or $200,000 for companies

As with civil fines, these criminal fines apply for each individual fraudulent claim.

Qui Tam Litigation Under the False Claims Act

Across the country, most False Claims Act investigations are not initiated by the government, but instead by disgruntled former employees or competitors. This holds true in Midland and Odessa as well.

Under the False Claims Act, private citizens who have information about fraudulent billing practices can file a “qui tam” lawsuit to recover monies on behalf of the United States government. All it takes to initiate a qui tam action is a simple allegation that an individual or business has illegally received a payment as a result of submitting a false or fraudulent claim (see 31 U.S.C. § 3729). In Midland and Odessa, this is how a qui tam lawsuit works in practice:

1. A Private Citizen Files a Qui Tam Complaint

A private citizen (referred to as a “relator”) files a complaint with the U.S. District Court for the Western District of Texas alleging that an individual or company has violated the False Claims Act. To protect the relator’s anonymity, the qui tam complaint is filed under seal and copies of the non-public complaint are provided only to the assigned judge and certain government officials. If the relator requests, the complaint will be kept under seal until the government has conducted its investigation.

2. The Government Investigates the Relator’s Allegations

After the complaint is filed, the government will conduct an initial assessment and either: (i) reject the case immediately if the relator’s claims are unsubstantiated; or, (ii) if the complaint appears to allege a legitimate violation, federal prosecutors will investigate with the help of agents from the FBI, OIG, and other agencies. The investigative process typically involves serving subpoenas that require the defendant to produce any records that may provide evidence of a possible false or fraudulent claim.

3. Will the Government Intervene?

Based upon the results of the investigation and following initial settlement discussions with the defendant’s attorneys, the government must decide: Will it support the relator and intervene in the case? Or, will it drop out and let the realtor pursue the lawsuit independently? If the government chooses to intervene, it must obtain approval from the Department of Justice’s headquarters in Washington D.C., and the DOJ’s attorneys will typically amend the complaint to include additional causes of action under the Anti-Kickback Statute, the Truth in Negotiation Act, and other federal anti-fraud laws.

4. Case Settlement Negotiations Continue

During the investigation and while deciding whether to intervene, the prosecutors assigned to the case will be engaged in settlement negotiations with the defendant’s attorneys. Many cases will be resolved during the investigative process and before any charges get filed. However, the qui tam process moves slowly, and obtaining a favorable settlement can take several months or longer.

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

If the case does not settle, the defendant can face liability for as much as three times the government’s losses plus fines of up to $11,000 per false claim. In many cases, this will add up to hundreds of thousands or even millions of dollars in liability. The relator receives up to 25 percent of the amount collected if the government intervenes in the litigation, and up to 30 percent if the case proceeds without government intervention.

Three Tenets of a Successful Defense Strategy for False Claims Act Investigations

As the result of years of experience successfully defending clients in False Claims Act investigations across the country, the attorneys in our Healthcare Fraud Defense Group have developed a proven strategy for defending healthcare providers in False Claims Act investigations. This strategy has three key tenets:

  • Avoid Criminal Charges. In every False Claims Act case we handle, our first priority is to ensure that our client avoids facing criminal charges.
  • Avoid Government Intervention. We take action as soon as possible and aggressively attack the relator’s claims and credibility in order to convince the government that the allegations in the complaint do not justify the expense of government resources.
  • Negotiate a Favorable Settlement. If liability appears likely, we will seek to negotiate our clients’ liability down to a fraction of the government’s demand prior to trial.

Put Experience On Your Side

Oberheiden, P.C. is a team of experienced healthcare fraud defense attorneys and former federal prosecutors who 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 in the Midland/Odessa region, throughout Texas, and nationwide. To start building your defense strategy, schedule a free consultation with the attorneys in 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 Midland / Odessa, Texas and Surrounding Areas

Additional Pages for Midland/Odessa, 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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