The Oberheiden, P.C. is a Texas law firm providing Medicare/Medicaid fraud defense for healthcare practitioners and businesses in and surrounding Laredo, Texas. Dr. Nick Oberheiden is the managing principal attorney. Before joining Oberheiden, P.C., Lynette 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.
The Healthcare Fraud Defense Team uses its immense prosecutorial experience to provide Laredo, Texas clients with vigorous strategic defense against Medicare/Medicaid fraud allegations.
Medicare/Medicaid Fraud in Laredo, Texas
Medicare/Medicaid fraud is a serious federal offense. It involves the submission of false claims to a government healthcare program. Despite its name, Medicare fraud can include any federal healthcare program. It includes Medicaid, Tricare, and federal workers compensation. It can involve the violation of at least one of the following laws:
- False Claims Act
- Anti-Kickback Statute
- Stark Law (Physician Self-Referral Laws)
- Social Security Act
- U.S. criminal laws
All allegations of Medicare/Medicaid Fraud Strike Forcefraud have a common thread. They all involve a healthcare provider or entity filing a false claim to illegally receive money from a federal healthcare program.
Laredo, Texas is one of nine areas in the United States that is closely scrutinized by the federal government when it comes to Medicare/Medicaid fraud. This is because Laredo has a large number of Medicare/Medicaid recipients, providers, and entities file a large number of claims. Laredo is monitored by a specialized task force known as the Medicare Fraud Strike Force. Their job is to watch for, investigate, and prosecute Medicare/Medicaid fraud.
Healthcare providers, entities, and businesses in Laredo must understand how serious this allegation is. It can disrupt your life and ruin your business. If you’re being investigated by the Medicare Fraud Strike Force, you may be contacted by federal agents and prosecutors from multiple federal agencies including the DOJ, DOD, IRS, FBI, the Department of Health and Human Services, the Office of Inspector General, and other federal agencies.
Billing Fraud: The Most Common Medicare/Medicaid Fraud Allegation
One of the most common Medicare/Medicaid fraud allegations in Laredo, Texas involves allegations of billing fraud. This involves fraudulent billing practices and reimbursement requests. These practices and requests could be excessive, false, or unauthorized charges. The most common allegations include:
- 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
Medicare/Medicaid fraud investigations can happen to practically anyone involved in the healthcare industry in Laredo, Texas. The most commonly investigated include individual practitioners (including doctors and nurses), healthcare service providers, nursing homes, hospice, registered care facilities, hospitals, clinics, pharmacies, labs, DME companies, DNA centers, and cancer treatment centers. However, this list isn’t all-inclusive.
Examining the Penalties of Medicare/Medicaid Fraud
Medicare/Medicaid fraud can have severe civil and criminal penalties. Civil liabilities may include recoupment for claims, non-payment of future claims, fines of up to $11,000 per false claim, exclusion from federal healthcare programs, assessment of treble damages, and even attorney fees.
Criminal liabilities include fines that will cost you hundreds of thousands of dollars, a criminal record, and you could also 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.
You could face both civil and criminal penalties. You may face losing your professional license or face disciplinary proceedings. You could even lose your hospital privileges.
Choosing the Right Laredo, Texas Defense Attorney
Choosing the right defense attorney in Laredo, Texas is imperative because Medicare/Medicaid fraud is extremely serious. You need to find a defense lawyer who has the skills and the experience to fight the federal government and defend you against their allegations. Do not choose a healthcare fraud defense law team without specific experience in this area.
Some people in Laredo, Texas who are facing allegations of Medicare/Medicaid fraud consider hiring a healthcare defense attorney. Since Medicare/Medicaid fraud is often charged concurrently with federal crimes such as mail fraud and tax evasion, a healthcare attorney may not have the experience you need to defend you against federal criminal charges. They may not have the understanding of criminal law that you need them to have. Many do not have the training or experience that you’re going to need when it comes to negotiating with the federal government, or to develop a strategic defense if your case makes it to trial.
You need to hire a healthcare fraud defense lawyer who serves clients in the Laredo, Texas area. As you consider your choices, look for these four traits:
- A proven track record of success in Medicare/Medicaid fraud cases
- Industry knowledge
- Intimate understanding with healthcare laws and their exceptions
- Litigation and trial experience
However, once you find lawyers who have these four traits, you still need to gather a bit more information. Ask the following three question to assess their experience in Medicare/Medicaid fraud:
- How many Medicare/Medicaid fraud cases have you handled during your career in law?
- How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
- How many Medicare/Medicaid fraud cases did you try in court?
Defense Strategies for Medicare/Medicaid Fraud
Oberheiden, P.C. uses the unique blend of experience as former prosecutors with our years of defense experience. Doing this has led to our developing a proven track record of success. We’ve taken hundreds of cases to trial. We continue to use our insight and experience to develop strategic defenses for our Laredo area clients.
Early intervention with investigating bodies. We’ve learned that one of the best ways that we can minimize the risk of criminal charges for our Laredo clients is to get involved early with the investigating bodies. Within hours of our engagement, we can usually get the answers to some of the most important questions surrounding your case:
- 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?
Lack of evidence. The American justice system says that defendants are innocent until they are proven guilty. The standard that the government must meet with its evidence is to show beyond a reasonable doubt that you committed a crime. We test this Constitutional standard in each Medicare/Medicaid fraud case. Because we do this, 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. In addition to proving that you’ve committed a crime, the federal government must also show that you did so with criminal intent. We’ve learned that most Medicare/Medicaid fraud investigations in Laredo happen because of an honest mistake. They happen when providers are busy caring for patients and when healthcare businesses rapidly grow. Common mistakes that often cause Medicare/Medicaid fraud allegations include:
- Using unqualified staff
- Inadequate supervision
- Use of delegation and outsourcing
- Structural or organizational errors
- Human errors
- Oversight
- Employees who are overwhelmed
- Lack of a compliance program
- Quickly changing healthcare laws and rules
In Laredo, intentional Medicare/Medicaid fraud is extremely rare. Yet, when healthcare professionals, businesses, and entities are falsely accused, they often assume they’re guilty and accept the penalties regardless of the fact that they just made an honest mistake. We address the lack of criminal intent and work to prove to the government that our clients made an honest mistake and had no criminal intent to defraud the government.
Applicable defenses. We perform an in-depth analysis on each case. We closely look at the presented facts to find strategic and applicable defenses that we can use on behalf of our Laredo 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.
Laredo, Texas healthcare professionals and entities can benefit from calling Oberheiden, P.C. if they’re being investigated for Medicare/Medicaid fraud. Regardless of whether you’re being investigated for illegal kickbacks, fraudulent billing, allegations of medically unnecessary services or equipment, services not rendered, phantom billing, or unlawful joint ventures, we can help. Oberheiden, P.C. can help you with more than just Medicare/Medicaid fraud defense. We can help Laredo, Texas clients with:
- Healthcare fraud defense
- Compliance program creation and implementation
- Internal investigations
- Asset protection
- Licensure or disciplinary proceedings
- Jury trials
Oberheiden, P.C. represents individuals and entire businesses or healthcare systems in Laredo. If you’re 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, Laredo or Texas state law enforcement, or the IRS, call us now.
Contact us today to schedule your free consultation.
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.
Laredo, 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 Laredo 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.
Including Weekends