Headed by senior attorney Dr. Nick Oberheiden, The Oberheiden Law Group, PLLC’s Health Care Fraud Defense Group provides experienced and strategic representation for health care providers facing Medicare fraud investigations in Midland and Odessa, Texas.

Experienced Medicare Fraud Defense Lawyers Serving Midland and Odessa, TX

For medical service providers and other health care entities in Midland and Odessa, the threat of facing a federal investigation for Medicare fraud is a serious concern. Texas is one of only nine areas nationwide in which the federal government has stationed two teams from its elite Health Care Fraud Prevention and Enforcement Action Team (HEAT) task force. The fact that there are only nine HEAT teams across the entire country tells you just how serious the federal government is about targeting Medicare fraud in Texas. In addition, due to the large volume of Medicare reimbursement billings originating from Midland/Odessa area, the Centers for Medicare and Medicaid Services (CMS) is keeping a close eye on local providers, as well.

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. Due to HEAT’s strong presence and active enforcement efforts in Texas, health care companies in Midland and Odessa must be especially vigilant to avoid putting themselves on the federal government’s radar.

Understanding Medicare Fraud

Medicare Fraud: An Overview

”Medicare fraud” is a broad term that refers to submitting false or fictitious reimbursement claims to CMS under the federal Medicare program. Depending on the specific fraudulent practices involved, Medicare fraud can violate a number of different federal statutes. These include:

  • False Claims Act – The False Claims Act prohibits knowingly submitting false statements or making misrepresentations in connection with a claim for reimbursement under a federal health care benefit program (such as Medicare).
  • Anti-Kickback Statute – The Anti-Kickback Statute prohibits the knowingly soliciting, paying, or accepting any form of compensation in connection with a referral for services, medication, supplies, or equipment for which you receive reimbursement under 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” to entities in which the referring physician or an immediate family member has an ownership or financial interest (commonly referred to as “physician self-referrals”).

Depending on the circumstances, Medicare fraud may implicate violations of the Social Security Act and various provisions of the U.S. Criminal Code as well. In a Medicare fraud investigation, it is not unusual to face allegations for multiple offenses under a variety of different federal laws.

Common Examples of Medicare Fraud

Medicare fraud can take a number of different forms. Some of the most common forms include:

  • “Phantom billing” (billing for services that were never performed);
  • Providing and billing for medically unnecessary services, supplies and equipment;
  • Billing for supplies and equipment that were never purchased;
  • Obtaining fraudulent certifications for medically-unnecessary services and supplies (a common allegation in home health and hospice fraud investigations);
  • Double-billing;
  • Falsifying patient records;
  • Upcoding, unbundling, and other forms of coding fraud; and
  • Entering into illegal kickback arrangements with physicians, pharmaceutical companies, durable medical equipment (DME) companies, and other providers;

The DOJ is actively targeting both companies and individuals suspected of playing a role in Medicare fraud. As a result, physicians, nurses, home health care centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, DME companies, physician syndications, DNA testing centers, cancer treatment centers, and other health care service providers in the Midland and Odessa areas are all potentially at risk for becoming targets in federal Medicare fraud investigations.

Civil and Criminal Penalties for Medicare Fraud

To understand the penalties that you may be facing, you first need to determine whether your investigation is civil or criminal in nature. As discussed below, this is one of the first (and most important) steps in defending against a Medicare fraud investigation.

However, generally speaking, the penalties that you are likely to face if you are found responsible include: Recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, exclusion from federal health care programs (including Medicare), treble damages, government attorneys’ fees, criminal fines, and spending time in federal prison. The potential prison sentences for Medicare fraud include:

  • Medicare fraud – Up to 10 years in prison for each count of fraud.
  • Medicare fraud with 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.

As a physician and other medical professional, you may be at risk for professional discipline and loss of hospital privileges, as well.

Three Keys to Successfully Defending a Medicare Fraud Investigation

Early Intervention by Experienced Attorney

In a Medicare fraud investigation, early intervention is critical. It is important to do everything possible to keep your case civil (which keeps prison time off of the table), and this requires effective representation from the earliest stages of the investigation.

When you hire our defense attorneys of our Health Care Fraud Defense Group to represent you, we will seek to obtain answers to the following questions within the first hours of our engagement:

  • Is the case civil or criminal?
  • 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 investigation be resolved?

Asserting Statutory Defenses

A thorough analysis will often reveal several favorable defenses that are available under the statutes implicated by your investigation. For example, in one recent Medicare fraud case, the government accused our client of fraudulently certifying a patient for home health care services. Using the facts of the case and our in-depth knowledge of federal health care law, we were able to successfully assert a recognized delegation exception that rendered the certification fully compliant with the law. In another recent case, we were able to convince the government that our client was protected by a safe harbor exception.

The Anti-Kickback Statute, the Stark Law, the False Claims Act, and other federal statutes all contain a number of safe harbors and other clauses that can be used to shield health care providers from liability for Medicare fraud.

Asserting a Lack of Evidence and Lack of Criminal Intent

If you are facing criminal charges, the government will be required to prove your guilt beyond a reasonable doubt. This means that the government must uncover sufficient evidence to convincingly establish that you committed an illegal act, and you did so with criminal intent.

Intentional health care fraud is rare in both Midland and Odessa. Medicare rules and regulations are exceedingly complex. Most incidents that prompt federal Medicare investigations result from basic organizational and human errors. Focusing on patient care and rapid growth can lead to mistakes, but these mistakes do not justify criminal penalties. Some of the issues that we commonly see include:

  • Hiring unqualified staff;
  • Inadequate supervision;
  • Relying on delegation & outsourcing;
  • Structural and organizational deficits;
  • Mistakes due to oversight or feeling overwhelmed; or
  • Following an ineffective Medicare compliance program.

Just because you are under investigation does not mean that you are guilty. Never assume that the government is right about your case. Our Midland and Odessa health care fraud defense attorneys will help you understand your situation and fight vigorously to secure a favorable outcome:

  • Case dismissed;
  • No criminal charges;
  • Maintaining your professional license;
  • Civil fine instead of a criminal plea;
  • Misdemeanor charge instead of a felony charge; and
  • No prison sentence.

Choosing the Right Defense Lawyer in Midland and Odessa

Health care fraud defense attorneys combine the best qualities of criminal lawyers and health care lawyers. Not only do experienced health care fraud defense lawyers know the Medicare system inside and out, but they also know how to quickly and effectively engage with federal prosecutors and fight to help clients avoid civil and criminal liability. This combination is essential when it comes to maximizing your chances of escaping punishment when the federal government has you in its sights.

Why Choose The Oberheiden Law Group, PLLC?

A Team of Dedicated Health Care Fraud Defense Lawyers on Your Side

At The Oberheiden Law Group, PLLC, our team of Texas health care fraud lawyers offers the experience of handling health care proceedings conducting criminal trials nationwide. Several of our defense attorneys come from senior positions within the DOJ, and the members of our Health Care Fraud Defense Group have decades of experience in Medicare fraud investigations. The four distinguishing characteristics of our firm are:

  • A track record of success;
  • Industry knowledge;
  • Familiarity with federal health care and criminal laws; and
  • Litigation & trial experience.

Our Health Care Fraud Defense Group takes a unique team approach to defending clients in Medicare fraud investigations. When you choose The Oberheiden Law Group, PLLC to represent you, our senior defense attorneys and former federal prosecutors will work together to build a comprehensive case strategy custom-tailored to the specific facts involved in your case.

A Broad Practice within Health Care Fraud Defense

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 that are facing Medicare fraud investigations in Midland and Odessa, Texas. This includes investigations involving:

  • The Department of Defense;
  • The Department of Justice;
  • The Drug Enforcement Administration;
  • The Federal Bureau of Investigation;
  • The Internal Revenue Service;
  • The Medicaid Fraud Control Unit;
  • The Office of Inspector General;
  • Midland, Odessa, and Texas law enforcement; and
  • Other state and federal law enforcement agencies

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.

Midland/Odessa Medicare Fraud Defense Attorneys

Nick OberheidenDr. Nick Oberheiden is a Harvard-trained and internationally educated health care fraud defense attorney offering services to clients in the Midland / Odessa, Texas area. Dr. Oberheiden has successfully represented and assisted health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, through accusations of political corruption, government investigations, and assisted with media campaigns, including 60 Minutes. He is best known for his ability to stop federal investigations before criminal charges can be filed. In addition to his health care defense practice, Dr. Oberheiden 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). Clients greatly benefit from Ms. Byrd’s experience of prosecuting health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. She regularly argues federal matters for her clients.

We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form to request a free consultation.

1-888-997-2520
Including Weekends
Oberheiden Law Group, PLLC
Serving Midland/Odessa, TX and Surrounding Areas
888-997-2520
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.