Oberheiden Law Group PLLC
5728 Lyndon B Johnson Fwy #250
Dallas, TX 75240

Phone: 888-997-2520

Headquartered in Dallas, Texas, our Health Care Fraud Defense Group is led by senior attorney Dr. Nick Oberheiden. Together with the other attorneys in the Health Care Fraud Defense Group, Dr. Oberheidens provide strategic, aggressive representation for health care providers facing Medicare fraud investigations in the greater Dallas area. In each case, our goal is always the same: To help our client avoid any civil or criminal responsibility.

Medicare Fraud in Dallas, Texas

Dallas has long been a central focus of the federal government’s ongoing battle against Medicare fraud. Currently, Dallas is one of only nine areas in the nation in which the federal government has established a special task force to monitor, investigate, and prosecute health care providers suspected of Medicare fraud. This task force, known as the Health Care Fraud Prevention and Enforcement Action Team (HEAT), is a coordinated federal task force 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.

The Centers for Medicare and Medicaid Services (CMS) is also keeping a close eye on local Medicare providers in the greater Dallas area. As a result, companies in all facets of the Dallas health care industry are increasingly finding themselves the subjects of federal Medicare fraud investigations. Unfortunately, many of these investigations are misguided, leading numerous innocent providers to deal with the consequences of unwarranted federal investigations.

Understanding Medicare Fraud: Statutes, Common Forms, and Penalties

Statutes That Apply in Medicare Fraud Investigations

“Medicare fraud” is a general term that refers to submitting false or fictitious claims for reimbursement under the federal Medicare program. Medicare fraud potentially implicates a number of different federal statutes, including:

  • False Claims Act – The False Claims Act prohibits knowingly making false statements or misrepresentations in order to illegally obtain reimbursements under a federal health care benefit program (such as Medicare).
  • Anti-Kickback Statute – The Anti-Kickback Statute prohibits knowingly soliciting, paying, or accepting any form of remuneration or reward for a referral involving services, medication, supplies, or equipment reimbursed through Medicare or another federal health care benefit program.
  • Physician Self-Referral Laws (Stark Law) – The Stark Law prohibits physicians from making referrals for “designated health services” provided to Medicare and Medicaid patients to entities in which the referring physician or an immediate family member has an ownership or financial interest.

In Dallas, Texas Medicare fraud cases, prosecutors will frequently allege violations of the Social Security Act and bring related charges under various provisions of the U.S. Criminal Code.

In addition to prosecuting corporations suspected of submitting fraudulent reimbursement claims to CMS, the DOJ recently announced that it intends to vigorously prosecute individuals as well. As a result, physicians, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, and other Dallas health care service providers are all potentially at risk for facing severe civil and criminal penalties.

Common Forms of Medicare Fraud

The following are all among the most common forms of Medicare fraud. While each form has unique aspects, they all ultimately involve seeking to illegally obtain non-qualifying reimbursements from CMS:

  • Billing for services never performed (commonly referred to as “phantom billing”);
  • Billing for supplies and equipment that were never ordered;
  • Billing for medically unnecessary services;
  • Billing for medically unnecessary supplies and equipment;
  • Obtaining certification for medically unnecessary services;
  • Obtaining certification for medically unnecessary supplies;
  • Falsifying patient records;
  • Double billing;
  • Upcoding, unbundling services, and other forms of coding violations; and
  • Offering and accepting kickbacks.

Civil and Criminal Penalties in Medicare Fraud Investigations

If you are the target of a federal Medicare fraud investigation in Dallas, Texas the penalties you may face depend on whether the investigation is civil or criminal in nature. As a result, finding out whether your investigation is civil or criminal needs to be a top priority. In general terms, the potential penalties  for Medicare fraud include:

  • Recoupment requests;
  • Non-payment of future claims;
  • Civil fines of up to $11,000 per false claim;
  • Exclusion from future participation in federal health care programs (including Medicare);
  • Treble damages;
  • Government attorneys’ fees;
  • Criminal fines; and
  • Incarceration.

The possible prison sentences for Medicare fraud include:

  • Medicare fraud – Up to 10 years in prison for each count of fraud.
  • Medicare fraud resulting in serious bodily injury – Up to 20 years in prison (common in cases involving reimbursement requests for counterfeit or excessive medication).
  • Medicare fraud resulting in death – Life imprisonment.

For Dallas, Texas physicians and other medical professionals, the consequences of a Medicare fraud conviction can include professional licensing actions and loss of hospital privileges.

Defense Strategies for Medicare Fraud Investigations

Early Intervention: The Key to Success

In a Medicare fraud investigation, one of the most important, and earliest, tasks for your defense team will be to try to keep the investigation civil in nature. In a civil investigation, prison time is off of the table, and as compared to facing a criminal prosecution, keeping your case civil can greatly reduce the overall risks and consequences involved.

To avoid letting a civil investigation turn into a criminal trial, early intervention is key. You will need to hire a defense team that can establish a dialogue with the prosecutor’s office and get answers to pressing questions such as:

  • Is the case civil or criminal in nature?
  • What prompted the investigation?
  • What is the case about?
  • Who else is under investigation?
  • Which agencies are involved?
  • What is the government’s ultimate goal?
  • How can the issue be resolved?

When you choose The Oberheiden Law Group, PLLC to represent you, our Health Care Fraud Defense Group will strive to obtain answers to these questions within the first hours of our engagement.

Statutory Defenses to Allegations of Medicare Fraud

Once we have determined the nature of the case, we can begin to assess which defenses you may have available. The Stark Law, the Anti-Kickback statute, and other health care laws contain a variety of safe-harbor provisions. The Stark Law contemplates certain exemptions to the so-called “designated health services” that are covered by the statute’s prohibitions on self-referrals. Depending on the specific allegations in your case, a number of other defenses may be available, as well.

Key Defenses in a Criminal Medicare Fraud Prosecution

In criminal Medicare fraud cases, the government must prove the suspect’s guilt beyond a reasonable doubt. This requires proof that an illegal act was committed, and that the illegal act was committed with criminal intent.

Despite what you may read in the news about high-profile, multi-million-dollar Medicare fraud scams, intentional health care fraud is rare in Dallas, Texas. In fact, most incidents that prompt action by HEAT, the DOJ, and other law enforcement agencies result from basic organizational and human errors. These errors frequently result from non-criminal causes such as:

  • Hiring unqualified staff;
  • Inadequate supervision;
  • Overreliance on delegation or outsourcing;
  • Organizational mistakes;
  • Mistakes resulting from oversight or from feeling overwhelmed; and
  • An ineffective Medicare compliance program.

While these may be issues that will need to be addressed, the law is clear. They do not establish criminal intent. You should never assume that you are guilty simply because you are under investigation. There is too much on the line, and you have nothing to lose by scheduling a free, confidential consultation with our Health Care Fraud Defense Group.

Choosing the Right Defense Firm for Your Medicare Fraud Investigation

Given the severe implications of a Medicare fraud investigation, you simply cannot afford to go with inexperienced representation. Health care attorneys and criminal lawyers both have their limitations when it comes to defending against a federal Medicare fraud investigation. So, what type of lawyer should you choose?

The Right Choice: A Team of Health Care Fraud Defense Lawyes in Dallas, Texas

Health care fraud defense lawyers combine the best qualities of criminal lawyers and health care lawyers. An experienced health care fraud defense attorney will not only know the Medicare system inside and out, but will have extensive experience in all aspects of the criminal justice process as well.

Why Choose The Oberheiden Law Group, PLLC?

Our Team Approach and Decades of Health Care Law Experience

The Oberheiden Law Group, PLLC’s Health Care Fraud Defense Group brings decades of experience to defending clients in Medicare fraud investigations. Our defense law team has handled over 1,000 health care proceedings across the country and conducted more than 200 criminal trials, and many come from senior positions within the DOJ. As a result, our Health Care Fraud Defense Group offers:

  • A successful track record;
  • Industry knowledge;
  • A deep familiarity with federal health care and criminal laws; and
  • Litigation & trial experience.

At The Oberheiden Law Group, PLLC we take a team approach to defending our clients. When you choose our Health Care Fraud Defense Group to represent you, you will have a team of senior defense attorneys and former federal prosecutors working together to help you avoid facing civil or criminal charges.

Our Target is Health Care Fraud Defense

Our clients range from individuals to entire health care systems. We regularly represent business owners, health care executives, lawyers, health care providers, hospitals, hospices, pharmacies, laboratories, medical device companies, and other entities in the health care industry in Dallas. Our core practice areas include:

  • Health care fraud defense;
  • Compliance programs;
  • Internal investigations;
  • Qui tam defense;
  • Protecting assets;
  • Licensure & disciplinary hearings; and
  • Jury trials.

Our Track Record

  • Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of a health care 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.
  • Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged health care fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
    Result: No civil or criminal liability.
  • Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No civil or criminal liability.
  • Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare fraud.
    Result: No civil or criminal liability.
  • Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
    Result: No civil or criminal liability.

Dallas, Texas Medicare Fraud Defense Attorneys

Nick OberheidenDr. Nick Oberheiden uses his Harvard training and international education to benefit his health care fraud defense clients. He has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, allegations of political corruption, government investigations, and during media campaigns, including 60 Minutes. Dr. Oberheiden is well known for his ability to stop federal investigations before criminal charges can be filed. In addition to his health care defense practice, he leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Her Dallas clients benefit from her former experience of working with the Department of Justice. She prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd regularly argues federal matters for her clients.

We are available every day of the year. You can call us directly or complete our contact form to request a free consultation.

888-997-2520
Including Weekends
Oberheiden Law Group, PLLC
Serving Dallas, Texas and Surrounding Areas
www.medicare-lawyer.com
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. The Oberheiden Law Group PLLC is a Texas PLLC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.