Strategic Legal Representation for Health Care Professionals in Southern Texas
Health care fraud is an extremely complex area of law ??even by health care regulation standards.
These cases tend to arise suddenly, progress quickly, and carry substantial penalties. The defendants are often people you would never think of as criminals. People like you ? who have worked hard to rise up in the world of health care, only to have a federal investigation for fraud threaten to take it all away.
Doctors and clinic owners in Houston and southern Texas are especially at risk, given federal law enforcement’s keen interest in the Houston metro area and its surrounding cities.
Houston is home to a Medicare Fraud Strike Force. Only eight other cities in the United States have a federal Strike Force dedicated specifically to health care fraud. (Two of which are in Texas.) Accordingly, anyone submitting invoices to Medicare, Medicaid, or other federal benefit programs must be very careful not to make mistakes that might attract the Strike Force’s attention.
Health care professionals are sometimes surprised by how easy it is to trigger an investigation. Minor errors ??or even the mere mention of potential fraud by a scorned employee, patient, or competitor ??can shine a spotlight on your clinic. Once it’s there, that spotlight can do a lot of damage to your business, even if you are ultimately absolved of wrongdoing.
The best defense to a fraud investigation is to avoid one to begin with. If you’ve already been contacted by the Houston Strike Force or by other federal agents, then your best defense is to get an experienced federal health care defense lawyer on your side as soon as possible.
The earlier in the process you begin mounting a defense, the less likely you are to become embroiled in a long-term investigation. The longer investigations go on, the more likely they are to revoke your license or result in criminal charges.
At Oberheiden, P.C., we fight everyday to protect doctors, pharmacists, clinic owners, nurses, and other health care employees from overly aggressive federal investigators and prosecutors.
In fact ? we used to be those prosecutors. Ours is a federal health care law defense firm comprised of former federal health care fraud prosecutors. We have first-hand knowledge of how the government approaches these cases ??and how an aggressive defense lawyer can make all the difference. Let us a make that difference for you.
Contact Oberheiden, P.C. and ask for help with your Houston legal matter today.
Examples of Health Care Fraud Cases in Houston and Southern Texas
Health care fraud can encompass a wide range of allegations. These include:
False Claims Act violations ? Submitting false or fake claims for payment from Medicare, Medicaid, etc.
Stark Law violations ? Referring patients to health care service providers when you have a commercial or financial relationship with that provider.
These supposed “self-referrals” can happen completely by accident. Doctors may not even realize the provider is owned by a company they have stock in, for instance! Nevertheless, such an innocent referral could trigger legal liability for the referring physician under the Stark Law ? which is one of the few major health care fraud provisions that do not require the government to prove intent.
Anti-Kickback Statute violations ? Exchanging kickbacks for patient referrals or other business opportunities.
Controlled Substances Act violations ??Providing prescriptions for controlled substances outside the narrow confines of the CSA. Even lawful behaviors can trigger investigations in these cases if the government identifies your business practices as unusual.
Medicare Fraud ? Improper coding, performing medically unnecessary services or procedures, inefficient billing, bending the Medicare rules, inflating charges, billing the government for services you never actually provided (“phantom billing”), etc.
Houston Strike Force Examples
- In 2016, a Houston nurse living in Harris County, Texas was convicted on three counts of scheming to defraud the U.S. Medicare system. The case involved allegedly false claims submitted through a home health care agency.
- In May 2017, a Houston-area psychiatrist was convicted for participating in a $158 million scheme to submit false claims for a partial hospitalization program (PHP), a form of intensive outpatient treatment for patients with mental illness.
- In July 2017, an investigation by Houston Medicare Fraud Strike Force led to the indictment of a doctor and clinic manager suspected of running a pill mill in Houston.
- Also in July 2017, a medical doctor in Harris County, Texas was convicted on one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive illegal kickbacks.
- In August 2017, a Houston home health care agency owner was sentenced to 480 months in federal prison for conspiring to defraud Medicaid and Medicare of more than $17 million.
The Houston Health Care Fraud Strike Force is one of the most active strike forces in the country. These are only a few of the many, many cases this federal team initiates every year. In fact, nearly every month brings new headlines of fraud crackdowns in Houston and throughout southern Texas. It is likely the Strike Force is actively investigating new matters at this very moment.
Our Results in Medicare & Health Care Fraud Federal Law Defense Cases
We are proud to have successfully defended numerous doctors, owners, and health care professionals against overzealous governmental investigations.
At Oberheiden, P.C., we seek to achieve the following goals for our clients:
- ?Case dismissed
- No criminal charges
- No civil liability
- No prison sentence
- Investigation ends
- ?Client maintains their state medical and professional licenses
- ?Civil fines without a criminal plea
- ?Reduction of a felony to a misdemeanor
Defense Strategies for Houston Health Care Federal Law Fraud Cases
If you are currently under an active investigation for fraud, you may feel frightened, intimidated, or worried about the potential consequences. While these matters are very serious, it is important that you not make irrational decisions based on fear. Let an experienced federal law defense attorney walk you through the process and fight for the best possible outcome on your behalf.
There are many ways to defend against an allegation of fraud. Depending on the specific facts and circumstances of your case, these might include:
- Negotiation. We have found that getting involved early in the investigation and negotiating with the government is often the best way to produce an optimal resolution. The longer investigators are involved with you or your clinic, the greater the chance is that they will develop reasons for prosecuting you. By taking a tactful yet firm stand for our clients’ rights, we are often able to bring these investigations to an end before they ever reach that point.
- Challenging evidence. The government’s case against you must ultimately rest on evidence. But evidence is not always as relevant or admissible as the government would like to believe. An experienced Houston health care federal law defense attorney can challenge the prosecution’s evidentiary assertions at every turn.
- Questioning intent. In most cases, simply making a mistake is not enough to warrant prosecution or conviction for a crime. Rather, the prosecution must prove you knowingly and intentionally committed fraud. As you can imagine, willful fraud is relatively rare. Nevertheless, the government frequently attempts to prosecute accidental mistakes. As federal defense lawyers, it is our job to challenge the intent element, which (in many cases) is an absolute barrier to conviction.
- Arguing for exceptions. In a recent case, our office successfully argued that our client fell within a safe harbor exception to Medicare fraud rules and was therefore acting lawfully when it certified home health care services to the Centers for Medicare & Medicaid Services. Many health care fraud laws include similar exceptions. An experienced attorney can identify relevant safe harbor provisions that might apply in your case.
- Defending your expertise. Federal agents are sometimes quick to assume they know what is or isn’t “medically necessary,” but few of them have medical degrees. Moreover, even fully qualified doctors can reasonably disagree about what is medically necessary. In bringing allegations of fraud, the government has the burden of proving your recommended course of treatment was not medically necessary. We are here to hold them to that burden.
Meet Our Houston Health Care Fraud Defense Lawyers
Dr. Nick Oberheiden is an experienced attorney, author, and legal contributor to media outlets. He has significant experience on issues pertaining to federal health care law, including health care fraud, federal enforcement actions and the Medicare Fraud Strike Force (Houston). He has successfully defended numerous individuals and corporate clients (including doctors and health care practices) against federal criminal charges and regulatory enforcement actions. Dr. Oberheiden holds a PhD in law, a Juris Doctorate from the UCLA School of Law, and has been trained in negotiation at Harvard Law School.
Lynette S. Byrd defends both individual and corporate clients who are accused of federal crimes or under investigation by state / federal agencies, including by the Houston Medicare Fraud Strike Force. Ms. Byrd is a former federal prosecutor, and she served for several years as an Assistant U.S. Attorney for the Northern District of Texas. While representing the federal government, she worked on a number of high-profile cases, including one of the largest health care fraud cases in her district, and collected millions of dollars for the government on behalf of taxpayers. Today, she puts her experience as a former prosecutor to work for health care providers and their organizations against enforcement actions brought on by the Strike Force and other federal offices.
Contact the Determined Federal Law Defense Lawyers at Oberheiden, P.C.
If you or your practice is currently facing an audit or investigation involving an alleged violation of federal health care law in Houston or southern Texas, you should take urgent action to protect your legal interests. Please contact Oberheiden, P.C. right away.
To schedule a free and confidential consultation with a federal health care law defense attorney for the Houston area, simply dial (888) 727-0472 or contact us online today.