Protecting Professionals from Medicare Fraud Charges in the San Antonio Area

Medicare fraud allegations have reached nearly epidemic proportions in San Antonio, Texas and the surrounding areas. If you’re being investigated by the federal government, contact The Oberheiden Law Group right away. We are a Texas-based law firm providing legal defense strategies for Medicare fraud, criminal federal matters, and for government investigations. We can even assist you in minimizing the risk of Medicare fraud by implementing regulatory compliance policies. Oberheiden’s legal team is managed by a former Chief Health Care Fraud Coordinator from the Dallas U.S. Attorney’s Office. Several of our team members have former experience as Department of Justice prosecutors and senior trial attorneys. Our defense lawyers serve clients in San Antonio and throughout the entire State of Texas.

Doctors, nurses, other health care providers, facilities, businesses, executives, and related health care industry operators in San Antonio, Texas now have the benefit of accessing powerful legal advocacy if they are accused of Medicare fraud. The Oberheiden Law Group, PLLC provides Medicare fraud defense for San Antonio, Texas and the surrounding areas. Dr. Nick Oberheiden is a Harvard-trained health care fraud defense attorney and is the managing principal attorney of the Oberheiden Law Group. He assists clients in Garland, Dallas, Mesquite, Richardson, McKinney, and the surrounding areas.

Lynette Byrd is a former federal health care fraud prosecutor and brings her insight and experience to the Oberheiden Law Group’s clients. Prior to joining Oberheiden, Ms. Byrd prosecuted False Claims Act violations, Stark Law violations, Anti-Kickback violations, and health care fraud on behalf of the federal government.

The combined experience of the Oberheiden Law Group, PLLC provides San Antonio, Texas clients with vital insight and representation during Medicare fraud investigations.

The Basics of Medicare Fraud

Medicare fraud is a violation of federal law. It is the submission of a false claim to a government health care program for the purpose of reimbursement. It involves more than just Medicare. It also includes Medicaid, Tricare, and federal workers’ compensation. An accusation of Medicare fraud means that you violated one or more of the following statutes:

  • Violation of the False Claims Act
  • Violation of the Anti-Kickback Statute
  • Violation of the Physician Self-Referral Law (Stark Law)
  • Violation of U.S. criminal law
  • Violation of Social Security Act

Medicare fraud investigations can be brought against an individual or an entire company or entity.

San Antonio, Texas has a higher instance of Medicare fraud investigations than the majority of the United States. In fact, San Antonio is one of nine locations that is closely monitored by the government. This occurs because San Antonio has a large population that relies on a federal health care program for health care. This means that there are more claims filed in San Antonio. The federal government believes that the increase in claims also increases the possibility of Medicare fraud. That’s why the Medicare Fraud Strike Force pays special attention to the area.

The Medicare Fraud Strike Force monitors, investigates, and prosecutes Medicare fraud. This team is a hybrid agency of investigators and prosecutors from several agencies including the Department of Health and Human Services, the Office of Inspector General, the DOJ, DOD, FBI, IRS, and other agencies. If you’ve been contacted by a member of the Medicare Fraud Strike Force or any federal agency that states that you’re being investigated for Medicare fraud, call the Oberheiden Law Group without delay. We provide initial consultations free of charge and our consultations are totally confidential.

Medicare Fraud Investigations in San Antonio

We are commonly asked about what the most common trigger of Medicare fraud investigations are in San Antonio, Texas. The answer involves billing problems. When the government receives claims that it labels as fraudulent reimbursement requests, this is a common cause of Medicare fraud investigations. Claims that include excessive charges, unauthorized charges, or false charges may be labeled as fraudulent billing. The most common types of billing issues in San Antonio include:

  • Submitting a claim for medically unnecessary services or equipment
  • Submitting a claim for medical equipment that was never ordered
  • Submitting a claim for services that were never provided (phantom billing)
  • Submitting a claim for certification of medically unnecessary supplies, equipment, or services
  • Double billing
  • Charge inflation
  • Upcoding
  • Overuse of equipment
  • Overuse of services
  • Providing or accepting kickbacks

In San Antonio, the most commonly targeted individuals and entities include nurses, ARNPs, physician assistants, doctors, registered care facilities, nursing homes, hospitals, clinics, pharmacies, labs, medical device company, cancer treatment centers, and DNA centers. However, it’s important to note that anyone who practice medicine or provides health care services, equipment, or care and files claims for federal health care program reimbursement is at risk of being investigated for Medicare fraud.

Civil and Criminal Penalties for Medicare Fraud

Medicare fraud can bring with it civil and criminal charges. The penalties are severe. Civil penalties may include one or more of the following:

  • Recoupment requests
  • Treble damages
  • Non-payment of future claims
  • Fines up to $11,000 per false claim
  • Exclusion from federal health care programs
  • Attorney fees

Criminal penalties can occur on their own or you may face them along with civil penalties. They may include one or more of the following:

  • Criminal charges
  • Hundreds of thousands of dollars in fines
  • 10 years in federal prison for each count of Medicare fraud for which you are convicted
  • 20 years in federal prison for each count of Medicare fraud that caused serious bodily injury to the patient
  • Life sentence for Medicare fraud if it results in the death of the patient

Choosing the Right San Antonio Defense Lawyer

Medicare fraud is extremely serious. You must choose the right San Antonio defense lawyer. Should you choose a health care lawyer? Should you choose a criminal defense attorney? What type of attorney is the best attorney for Medicare fraud?

You need an attorney in San Antonio who will certainly know and understand health care law. They also need experience in the federal criminal charges that are often filed with it. Tax evasion, wire fraud, money laundering, and mail fraud are commonly included as charges in Medicare fraud cases.

You will also need an attorney that works as a San Antonio criminal defense lawyer. They should have extensive knowledge about health care law, medical, coding, and utilization rules. Because of the serious nature of Medicare fraud, you simply must choose the right attorney as early as possible in the process.

There is another option for Medicare fraud cases. You need the assistance of a health care fraud defense attorney in San Antonio. A health care fraud defense attorney will be experienced in handling both the civil and criminal components involved in Medicare fraud. As you are choosing the right attorney, look for the following four traits:

  1. A proven track record of success in Medicare fraud cases
  2. Industry experience
  3. Intimate understanding with health care laws and their exceptions
  4. Litigation and trial experience

When you’ve finished your initial research, you’ll want to contact the firms on your list and ask the following three questions to learn more about their experience with Medicare fraud:

  1. How many Medicare fraud cases have you handled during your career in law?
  2. How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
  3. How many Medicare fraud cases did you try in court?

Strategic Defense Strategies for Medicare Fraud

A strategic defense is necessary when faced with allegations of Medicare fraud. The Oberheiden Law Group, PLLC uses four guiding principles in each and every case. Although each case is different, these principles help us provide a custom solution that reflects the facts in each case.

Contacting the federal investigators right away. From our experience, we’ve learned that it is imperative to contact the federal investigators right away on behalf of our clients. When the federal government has a long period of time to investigate you without interruption, you run the risk of facing criminal charges. We contact the federal investigators to get answers to the most important questions:

  • What prompted the investigation?
  • What is the case about?
  • Is the matter civil or criminal?
  • Which federal agencies are involved in the investigation?
  • What is the ultimate goal of the investigation?
  • How can the matter be resolved?

Because of our extensive experience, we are often able to get answers to those questions within hours of our engagement.

Scrutinizing federal evidence. The federal government must present evidence to show that you’ve committed a crime. This evidence must meet a standard that is known as ‘beyond a reasonable doubt.’ We scrutinize the evidence presented to determine whether or not it meets the standard. Because of this, we regularly see the following results for our clients:

  • Dismissal of case
  • No criminal charges
  • Clients maintain their professional license
  • Civil fine without a criminal plea
  • Reduction of a felony to a misdemeanor
  • No prison sentence

No criminal intent. Criminal intent must also exist. This means that you must have planned to defraud the government. That rarely happens in San Antonio. Most Medicare fraud allegations start because an honest mistake was made. The most common mistakes in San Antonio include:

  • The use of unqualified staff
  • Inadequate supervision of staff
  • Delegation or outsourcing to entities who are not qualified
  • Business errors
  • Human errors
  • Oversight
  • Employees who are overwhelmed by their job duties
  • No Medicare compliance program
  • Inability to keep up with the quickly changing health care laws and rules

Although most investigations start because of a mistake, most individuals and businesses that are accused just accept the consequences. We work to show the federal government that our clients may have a made a mistake that needs to be corrected, but they are not deserving of criminal penalties.

Developing strategic defenses for each case. Although Medicare fraud cases certainly have some similarities, they are ultimately all different because of the involved facts. This is why we analyze each case to determine the appropriate strategic defenses for each case. In a recent Medicare fraud case, the government alleged fraudulent certification for home health care services by our client. We were able to prove to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant within the law. In another Medicare fraud case, we refused to admit liability. We were able to prove to prosecutors that our client acted within a safe harbor exception.

The Oberheiden Law Group, PLLC

The Oberheiden Law Group, PLLC provides strategic defense and legal advocacy for San Antonio health care practitioners, facilities, and related businesses. This includes business owners, attorneys, executives, individual providers, hospitals, pharmacies, labs, and other health care entities that are investigated for illegal kickbacks and fraudulent billing. We also assist businesses and providers with allegations of medically unnecessary services or equipment, services not rendered, or unlawful joint ventures. We provide assistance to our San Antonio clients with:

  • Health care fraud defense
  • Compliance program creation and implementation
  • Internal investigations
  • Asset protection
  • Licensure or disciplinary proceedings
  • Jury trials

The Oberheiden Law Group provides representation to individuals and businesses in San Antonio who are being investigated by the DOJ, DOD, FBI, DEA, OIG, Medicare Fraud Control Unit, San Antonio or Texas state law enforcement, and the IRS.

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.

Medicare Fraud Defense Lawyers Serving San Antonio, Texas

Nick OberheidenDr. Nick Oberheiden has successfully represented health care executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, during accusations of political corruption, government investigations, and directed media campaigns, including 60 Minutes. He assists clients in Dallas, Garland, Mesquite, Richardson, McKinney, and the surrounding areas. 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 from the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with health care law enforcement, and she 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 or by emailing us directly.

888-997-2520
Including Weekends
Oberheiden Law Group, PLLC
Serving San Antonio, 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.