Houston Medicare/Medicaid Fraud Defense Lawyers

Medicare/Medicaid Fraud Legal Defense Team Serving the Houston Area

The Oberheiden, P.C. is a Texas law firm providing Medicare/Medicaid fraud defense services for healthcare practitioners and healthcare businesses in and surrounding Houston, Texas. Oberheiden, P.C. is headed by Dr. Nick Oberheiden. Dr. Oberheiden in the managing principal attorney of Oberheiden, P.C. Attorney Lynette Byrd is also an integral team member. Until recently, Ms. Byrd prosecuted healthcare fraud, Anti-Kickback violations, False Claims Act violations, and Stark Law violations on behalf of the United States in her position at the US Attorney’s Office in Dallas, Texas.

Medicare/Medicaid Fraud in Houston, Texas

Medicare/Medicaid fraud is a serious federal offense that involves the submission of false claims to a government healthcare program. Although it is called Medicare/Medicaid fraud, it can include false claims submitted to Medicaid, Tricare, or even federal workers compensation as well. It involves violations of multiple laws including:

• False Claims Act
• Anti-Kickback Statute
• Stark Law (Physician Self-Referral Laws)
• Social Security Act
• U.S. criminal laws

The commonality of all Medicare/Medicaid fraud investigations involve either a healthcare provider or entity filing a false claim to illegally receive money from a federal healthcare program.

In Houston, Texas, Medicare/Medicaid fraud is closely monitored by the federal government. This is because of the large number of claims filed in the area since there is a large number of Medicare/Medicaid recipients. Houston is one of nine areas in the nation that is so closely watched by a specialized task force: The Medicare Fraud Strike Force. They monitor, investigate, and prosecute Medicare/Medicaid fraud.

All healthcare providers, entities, and businesses in Houston must understand just how seriously an allegation of Medicare/Medicaid fraud can be. If you’re being investigated by the Medicare Fraud Strike Force, you could be contacted by multiple federal agents and prosecutors, including the Department of Justice (DOJ), Department of Defense, Department of Health and Human Services, the Office of Inspector General, the FBI, the IRS, and other agencies.

Billing Fraud

Medicare/Medicaid fraud in Houston is often a result of alleged fraudulent billing practices and reimbursement requests. They could be for excessive, false, or unauthorized charges. Common types of billing fraud in Houston includes:

• Billing for medically unnecessary services
• Billing for medical equipment that was never ordered
• Billing for services that were never performed (commonly referred to as phantom billing)
• Billing for services that were never ordered
• Billing for medically unnecessary services
• Billing for medically unnecessary equipment
• Certification for medically unnecessary supplies
• Certification for medically unnecessary services
• Double billing
• Upcoding
• Inflating bills
• Overuse of equipment and services
• Offering or accepting kickbacks

Houston area doctors, nurses, healthcare services, registered care facilities, nursing homes, hospitals, pharmacies, labs, DME companies, DNA centers, and other providers are the most common targets of Medicare/Medicaid fraud investigations.

Medicare/Medicaid Fraud Penalties

An allegation of Medicare/Medicaid fraud can bring with it serious civil and criminal penalties. Civil liabilities include recoupment requests for claims, non-payment of future claims, fines of up to $11,000 per false claim, future exclusion from federal healthcare programs, treble damages, and legal fees.

Potential criminal liabilities also exist. You can even face both civil and criminal liabilities. Criminal liabilities include fines of hundreds of thousands of dollars, a criminal record, and you could face time in a federal prison. You could receive up to 10 years in federal prison for each count of Medicare/Medicaid fraud. If the patient sustains serious bodily harm, you could receive a sentence of up to 20 years per count. If the patient died as a result of Medicare/Medicaid fraud, you could face a life sentence.

Additionally, you could face licensing and disciplinary actions and lose your hospital privileges.

The Importance of Choosing the Right Houston Defense Lawyer

Being investigated for Medicare/Medicaid fraud in Houston can change your entire life. It is extremely important that you choose the right defense lawyer in Houston. You need a defense lawyer with the skills and experience to fight the federal government on your behalf. Your entire life is at stake. You cannot choose a lawyer without this crucial experience.

Many people in and around Houston facing Medicare/Medicaid fraud allegations think that they should hire a healthcare lawyer. However, Medicare/Medicaid fraud is often charged along with mail fraud, tax evasion, money laundering, and wire fraud. A healthcare attorney may not have the experience needed to assist you with federal criminal charges. They may not have a deep familiarity of criminal law that you need. They generally do not have the training or experience to negotiate with the federal government on your behalf, or the experience to develop a strategic defense to defend you in court.

Others hire a Houston criminal defense attorney. Yet, a criminal defense lawyer isn’t always prepared to defend you against charges assessed against you by the federal government. They may not understand the intricacies involved in healthcare law, and you won’t have time to properly educate the attorney in billing, coding, and medical utilization rules.

The ideal solution in Houston is a healthcare fraud defense lawyer. As you consider your options, look for these four traits:

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

Yet, before you pay your retainer, you need to ask three questions to get a better idea of the attorney’s experience in Medicare/Medicaid fraud:

1. How many Medicare/Medicaid 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/Medicaid fraud cases did you try in court?

Medicare/Medicaid Fraud Defense Strategies

Oberheiden, P.C. uses a unique blend of experience, and we have a proven track record of success. We?ve taken hundreds of cases to trial. Many of our Healthcare Fraud Defense Team attorneys have experience working in senior positions with the Department of Justice where they prosecuted Medicare/Medicaid fraud on behalf of the federal government. This gives us an incredible amount of insight that we put to work for our Houston clients. We use our insight and our experience to develop strategic defenses for each of our clients.

Early Intervention with the Federal Government. Throughout our careers, we’ve learned that early intervention is one of the keys to minimizing the risk of criminal charges. We get involved early and learn what can be done to resolve the investigation before it becomes criminal. The more time that the federal government has to investigate you without interruption, the more likely it is that you may face criminal charges. Oberheiden, P.C. will contact the involved agencies and get answers to the most important questions:

• What is the case about?
• What prompted the investigation?
• Is this a criminal or a civil matter?
• Which federal agencies are involved?
• Who all is under investigation?
• What is the ultimate goal of the government?
• How can the investigation be resolved?

We work to get these answers for you within hours of our engagement.

Lack of Evidence. In the United States, the federal government must have evidence that proves you committed a crime. The standard that they must meet is beyond a reasonable doubt. We will test this standard in each Medicare/Medicaid fraud case. By doing so, we’ve routinely seen the following results:

• 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

Lack of Criminal Intent. During our time as healthcare fraud defense lawyers we’ve learned that most of the Medicare/Medicaid fraud investigations in Houston occur because of a business or human error. They happen because providers are busy taking care of their patients. Healthcare businesses that have rapid growth can also have a higher instance of mistakes. Common mistakes that result in Medicare/Medicaid fraud allegations include:

• The use of unqualified staff
• Lack of adequate supervision
• Delegation and outsourcing
• Structural or organizational mistakes
• Human errors
• Oversight
• Overwhelmed employees
• No compliance program
• Quickly changing healthcare laws and rules

Intentional Medicare/Medicaid fraud in Houston, Texas is rare. However, when hospitals, providers, and businesses realize they’re being investigated, they often just assume that they’re guilty and they accept criminal penalties that they truly don’t deserve if they’ve only made an honest mistake. We address the lack of criminal intent and work to show that our clients made honest mistakes and had no intention of defrauding the federal government.

Using Applicable Defenses. Our Healthcare Fraud Defense Team performs a thorough analysis in each case. Relying solely on the presented facts often reveals strategic and applicable defenses that can be used to assist our clients. For instance, in a recent Medicare/Medicaid fraud case that we handled, the government alleged fraudulent certification for healthcare 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/Medicaid fraud case, we refused to admit liability. We were able to prove to prosecutors that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. provides advocacy and legal representation for Houston healthcare business owners, attorneys executives, individual providers, hospitals, pharmacies, labs, and other healthcare entities that are investigated for illegal kickbacks, fraudulent billing, and allegations of medically unnecessary services or equipment, services not rendered, or unlawful joint ventures. We provide assistance to our Houston area clients with:

• Healthcare fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection from lawsuit
• Licensure or disciplinary proceedings
• Jury trials

Oberheiden, P.C. provides representation to both individuals and entire businesses or healthcare systems in Houston, Texas who are being investigated by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, DEA, the Office of Inspector General, Medicare Fraud Control Unit, Houston or Texas state law enforcement, and the IRS.

Contact our offices today to see how we can represent you.

Our Track Record

• Defense of Medicare/Medicaid laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare/Medicaid Fraud.
  Result: No civil or criminal liability.

• Defense of a healthcare 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/Medicaid laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged Healthcare Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating healthcare company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of healthcare marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare/Medicaid 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/Medicaid 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/Medicaid 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 healthcare 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/Medicaid 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.

Houston, Texas Medicare/Medicaid Fraud Defense Attorneys

Dr. Nick Oberheiden is a Harvard-trained and internationally educated healthcare fraud defense attorney. Dr. Oberheiden has successfully represented healthcare 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 Houston and the surrounding areas. In addition to his healthcare 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 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 healthcare fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. Ms. Byrd has immense experience with healthcare 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.