Legal Defense Team Fighting Charges of Violating the False Claims Act for Health Care Professionals in the Houston Area
Houston, Texas health care practitioners, clinics, facilities, and businesses are at a higher risk of being investigated for violating the False Claims Act than most other places in the United States. If you’re in the Houston area and you have been notified that you’re under investigation, call Oberheiden & McMurrey, LLP. We practice in health care fraud defense and provide services in the Houston area. Harvard-trained Dr. Nick Oberheiden is the managing principal lawyer.
Lynette Byrd, a former federal prosecutor, is also an integral member of the team of health care defense lawyers. Prior to joining the Oberheiden & McMurrey, LLP, Ms. Byrd prosecuted False Claims Act violations, health care fraud, Stark Law violations, and Anti-Kickback violations.
Why Houston Providers Face a Greater Chance of Investigation
The United States federal government watches for and investigates violations of the False Claims Act throughout the entire nation. However, Houston area health care providers, facilities, and businesses face a higher risk of investigation. It is one of nine areas in the United States more closely watched by the federal government. This is because Houston and its surrounding area has a large number of residents who are beneficiaries of some form of federal health care. This increases the number of claims filed, and causes the government to pay more attention to the area.
In 2016, the Department of Defense announced that they had investigated a record-breaking 300 cases related to the False Claims Act, and recovered more than $900 million using the Medicare Fraud Strike Team. The Medicare Fraud Strike Team is a federal task force that monitors, investigates, and prosecutes False Claims Act violations. It’s comprised of prosecutors and investigators from several different federal agencies. If you’re investigated for an alleged violation, you may come into contact with multiple federal agencies including the Department of Justice, Department of Defense, DEA, FBI, IRS, Department of Health and Human Services, and the Office of Inspector General. Contact Oberheiden & McMurrey, LLP immediately if you’re being investigated.
False Claims Act Basics
The False Claims Act is a federal law that applies to any person or organization that has direct or indirect contracts with and who will be paid by the federal government on health care claims. The law creates civil and criminal liability for individuals, organizations, contractors, or businesses who knowingly submit or cause the submission of a false claim for approval and payment.
In this sense, the use of the word “knowingly” is more than your having actual knowledge. It means that if you didn’t know, you should have known that whatever happened would likely be a violation of the law. It’s a concept called due diligence. For instance, if you hire someone to do your medical coding, it is ultimately your responsibility to ensure that he or she is using the appropriate codes. Using obsolete codes or just using the wrong codes can be a violation of the False Claims Act. As a health care professional, it is your legal obligation to ensure that the appropriate codes are used before a claim is sent to the federal government.
Facing Criminal and Civil Penalties
If you’re investigated and prosecuted for violating the False Claims Act, you may face serious and life-altering criminal and civil penalties.
Criminal penalties include paying fines that will cost you hundreds of thousands of dollars. You may also be indicted. You could also receive up to five years in federal prison. Civil penalties can include an assessment of treble damages, fines of up to $11,000 per claim, requests for recoupment, exclusion from federal health care programs, and future claims being denied. You may also face state licensure and disciplinary proceedings, and lose your hospital privileges.
What Is a Qui Tam Lawsuit?
Qui tam lawsuits are often the cause of a federal investigation into your practice or business. Qui tam is a Latin phrase that means “he who sues for the king and himself.” The originating goal was for private citizens to have a means to protect the federal government if they knew that the federal government was the victim of fraud. In Houston, however, the motives behind a qui tam lawsuit usually isn’t actual health care fraud. These lawsuits are routinely filed by disgruntled former employees and competitors who just want to run you out of business.
In Houston, qui tam lawsuits are filed in the Southern District of Texas federal court system. These lawsuits are sealed. The identity of the plaintiff is known only to the presiding judge and to the involved federal investigating bodies.
When the qui tam lawsuit is filed, the government is notified. They will start their investigation. False Claims Act investigations can take a long time. It is common for extensions to be filed and granted in these cases. During the investigation, you will receive subpoenas for your financial, business, communication, and billing records. These subpoenas can come from multiple federal agencies including the DOD, DOJ, DEA, FBI, IRS, and OIG.
After the government receives and reviews your documents, it will decide whether they will support the lawsuit, or if it will reject it. If the government support it, this is known as an intervention. You will likely face additional charges. If the lawsuit against you is successful, the plaintiff who filed the qui tam suit will receive 25 percent of the judgment against you as a reward. If the government declines to support the lawsuit, the matter isn’t entirely over. The plaintiff can proceed on their own against you. If they win, they will be entitled to receive 30 percent of the recovered funds as a reward.
If you’re notified that you are the defendant of a qui tam lawsuit or that you’re being investigated for violating the False Claims Act, you need the experience of a health care fraud defense attorney. Oberheiden & McMurrey, LLP can get into contact with the federal government on your behalf and work to negotiate a settlement and reduce the possibility of criminal charges.
False Claims Act and Qui Tam Strategic Defenses
Although each case is different, Oberheiden & McMurrey, LLP has developed three core principles. We’ve used these principles to assist clients throughout the United States. We developed these principles using our combined firm experience in both health care fraud defense and federal health care fraud prosecution.
- Our first goal is to reduce the risk of criminal charges for our Houston clients. Oberheiden & McMurrey, LLP will use our experience and our open lines of communication to contact the federal prosecutors involved to get answers to important questions, such as the type of charges you’re facing, why the investigation started, and what can be done to resolve the matter. We can usually get the answers to these questions within the first few days after our engagement.
- Houston, Texas clients facing a qui tam lawsuit receive specific defenses. We work to discredit the evidence and the credibility of the plaintiff. We do this to show the federal government that the lawsuit has no merit and does not deserve to be supported by the government.
- Where civil liability is likely to be present, we work to negotiate a fair settlement on your behalf. We’ve negotiated original federal demands down to a small portion. To date, none of our clients in similar situations have been required to shut down their practice or their business.
If you’re notified of a qui tam lawsuit or a federal investigation involving your health care practice or business, call Oberheiden & McMurrey, LLP immediately. Initial consultations are confidential and free of charge. You can email us, call us, or use our contact form.
Call Oberheiden & McMurrey, LLP now to speak with our Health Care Fraud Defense Team about your case. Initial consultations are free and confidential.
False Claims Act Defense Attorneys Serving Houston, Texas
Dr. Nick Oberheiden has represented clients in qui tam lawsuits, False Claims Act investigations, Medicare/Medicaid fraud investigations, Tricare fraud investigations, Stark Law violations, and anti-kickback proceedings before virtually all federal agencies including, but not limited to, the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL). Dr. Oberheiden is trained in negotiations by Harvard Law School and holds a Juris Doctor from the University of California, Los Angeles, as well as a Ph.D. in law.
Lynette S. Byrd is a former Assistant United States Attorney (AUSA). Detroit clients greatly benefit from Ms. Byrd’s previous experience with the Department of Justice, where she prosecuted health care fraud, Anti-Kickback violations, violations of the False Claims Act, and Stark Law 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 to discuss your case. You can call us directly or complete our contact form or by sending us an email.
Oberheiden & McMurrey, LLP
Serving: Westbury, Chinatown, Sharpstown, Braeburn, Missouri City and ALL of Houston!
Zip Codes: 77096, 77074, and 77071 – and ALL of Houston!