Medicare/Medicaid Fraud Legal Defense Team Protecting Healthcare Professionals in the McAllen Area
Based in Dallas, Texas, Oberheiden, P.C., PLLC’s Healthcare Fraud Defense Group is headed by attorney Dr. Nick Oberheiden. Dr. Oberheiden is a nationally recognized healthcare fraud defense attorney with a strong history representing numerous healthcare service providers resulting in no civil or criminal liability.
Medicare/Medicaid Fraud in McAllen, Texas
Medicare/Medicaid fraud is a federal offense that involves submitting false claims for reimbursement under the federal Medicare/Medicaid program. Medicare/Medicaid fraud is a broad term that can implicate civil or potentially even criminal liability under the False Claims Act, the Anti-Kickback Statute, the Stark Law, the U.S. Criminal Code, and other federal laws. However, despite the wide range of laws that may apply, the hallmark of any Medicare/Medicaid fraud case is an allegation that a healthcare service provider illegally received money from the federal government.
McAllen, Texas sees numerous Medicare/Medicaid fraud investigations every year. McAllen is home to many hospitals, hospices, and other healthcare providers that rely on Medicare/Medicaid reimbursements in order to serve their patients. Due to the sheer volume of reimbursement requests coming out of the McAllen region, the Centers for Medicare and Medicaid Services (CMS) is keenly focused on investigating suspected fraud in this area of Texas. In fact, McAllen is one of only nine U.S. cities in which the federal government has established a Healthcare Fraud Prevention and Enforcement Action Team (HEAT) to monitor, investigate, and prosecute cases of suspected Medicare/Medicaid fraud. Medicare Fraud Strike Force is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and others.
As a result, healthcare service providers in McAllen, Texas, and their executives, must be particularly vigilant about both (i) maintaining effective compliance programs to avoid raising suspicion of possible fraudulent billings, and (ii) taking action at the first sign of a potential Medicare/Medicaid fraud investigation. While you may not ultimately be able to avoid a disruptive investigation once HEAT has you in its sights, acting quickly will give you the best chance to avoid facing civil or criminal charges.
Forms of Medicare/Medicaid Fraud
As outlined above, Medicare/Medicaid fraud is a form of healthcare fraud that involves the submission of false or fictitious reimbursement claims to the federal government. In a typical Medicare/Medicaid Fraud investigation, the government will allege one or more of a variety of fraudulent billing practices. Some of the most-common examples include reimbursement requests for false, excessive, or unauthorized services involving:
- Billing for services that were never performed (commonly referred to as “phantom billing”);
- Providing and billing for services that were not medically necessary;
- Billing for supplies and equipment that were not actually purchased;
- Purchasing and billing for supplies and equipment that were medically unnecessary;
- Obtaining fraudulent certifications for services that were medically unnecessary (a common allegation in home health and hospice fraud investigations);
- Obtaining fraudulent certifications for medically unnecessary supplies (including durable medical equipment (DME);
- Double-billing;
- Upcoding; and
- Offering or accepting kickbacks.
In a Medicare/Medicaid fraud investigation, physicians, nurses, executives, home healthcare centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, medical devices companies, physician syndications, DNA testing centers, cancer treatment centers, and other healthcare service providers can all fall within the federal government’s sights.
Understanding the Penalties for Medicare/Medicaid Fraud
For those convicted or found liable of Medicare/Medicaid fraud, the consequences can be severe. The potential penalties for Medicare/Medicaid fraud include recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, treble damages, attorney fees, criminal fines, criminal indictment, and federal imprisonment. The standard prison sentences in Medicare/Medicaid fraud cases are:
- Up to 10 years in prison for each count of fraud;
- Up to 20 years in prison if the fraud resulted in serious bodily injury (most common in cases involving counterfeit and excessive medications); and,
- Life imprisonment for fraudulent practices resulting in a patient’s death.
In addition, service providers and medical professionals can face exclusion from future participation in federal healthcare programs (including Medicare, Medicaid, and Tricare), and will often face licensing actions and loss of hospital privileges, as well.
Choosing the Right Defense Lawyer for Your Medicare/Medicaid Fraud Investigation
If you or your organization is under investigation for Medicare/Medicaid fraud, it is absolutely essential to select a law firm comprised of defense attorneys who have the skills and experience necessary to effectively represent you.
The Right Choice: A Team of Healthcare Fraud Defense Lawyers.
You need healthcare defense law team with the right mix of healthcare law experience and a strong record in healthcare fraud defense. Before paying any money to a defense attorney, you should test the lawyer’s experience in Medicare/Medicaid Fraud cases with the following THREE GOLDEN QUESTIONS:
- How many Medicare/Medicaid fraud cases have you handled so far?
- How many of the healthcare fraud cases that you handled resulted in no civil and no criminal charges or dismissals for your clients?
- How many healthcare fraud cases have you tried in court?
Proven Defense Strategies
Throughout their extensive careers, the attorneys of Oberheiden, P.C. have handled more than hundreds of healthcare cases and trials across the country. Many of our attorneys come from senior positions within the Department of Justice. While every case is different, based on our experience, the following defense strategies have proven to be extremely successful for helping our clients avoid criminal charges:
Early Intervention
To protect yourself, it is critical to engage with a legal defense team as soon as possible. The longer the government can investigate before you hire legal representation, the higher the chance there is that your case will turn into a criminal matter. Don’t let the government build its case. Hire lawyers with open channels with the government who can immediately initiate a dialogue with their government contacts and get fast answers to questions like:
- What is this case about?
- What prompted the investigation?
- Is the case civil or criminal?
- What agencies are involved?
- Who else is under investigation?
- What is the government?s ultimate goal?
We strive to provide our clients with these answers as soon as possible often within the first hours of our engagement.
Lack of Evidence
The U.S. justice system places a heavy burden on the government to prove punishable misconduct. In fact, in order to find you guilty of Medicare/Medicaid fraud, the government must prove beyond a reasonable doubt that you committed an illegal act with criminal intent. Our attorneys put this constitutional standard to the test in every single case, often resulting in:
- Case dismissed;
- Avoidance of criminal charges;
- Retain your professional license;
- Civil fine and no criminal plea;
- Misdemeanor, no felony; and
- No prison time.
In the vast majority of cases in McAllen, Texas, the incidents that prompt Medicare/Medicaid fraud investigations originate from organizational and human errors, not criminal intent. These errors frequently occur because healthcare providers are focused on caring for their patients. In addition, targets of investigations almost always are experiencing rapid growth. In both scenarios, we commonly find the following causes for errors:
- Unqualified staff;
- Supervision errors;
- Delegation & outsourcing;
- Structural deficits;
- Organizational mistakes;
- Human error;
- Oversight and overwhelmed;
- Lack of compliance program; and
- Constantly changing rules
While these may or may not be issues that require corrective action, one thing is clear: they do not constitute criminal intent.
Applicable Defenses
Finally, a thorough analysis will often reveal several favorable defenses that are available for clients facing Medicare/Medicaid fraud investigations. For example, in a recent Medicare/Medicaid fraud case that we handled, the government alleged that our client fraudulently certified the need for healthcare services. We convinced the government that a recognized exception of the statute applied, rendering the certification fully compliant with the law. In another case, we refused to admit liability and ultimately convinced the prosecutors that our client acted within a safe harbor exception.
About Oberheiden, P.C.
At Oberheiden, P.C., we represent business owners, healthcare executives, lawyers, healthcare providers, hospitals, pharmacies, laboratories, and other entities in the healthcare industry that find themselves under investigation for illegal kickbacks, fraudulent billing practices, and various other allegations of Medicare/Medicaid fraud. These include providing medically unnecessary services, billing for services not rendered, and unlawful joint ventures between referring physicians and ancillary-income businesses. Our practice areas include:
- Healthcare fraud defense;
- Compliance programs;
- Internal investigations;
- Qui tam defense;
- Asset protection;
- Licensure & disciplinary proceedings; and
- Jury trials.
Our clients range from individual providers and executives to entire healthcare systems. We represent clients in McAllen, Texas who are under investigation by the Department of Justice, the Department of Defense, the Federal Bureau of Investigation, Drug Enforcement Administration, the Office of Inspector General, the Medicaid Fraud Control Unit, McAllen and Texas law enforcement, the Internal Revenue Service, and other state and federal agencies.
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.
McAllen, Texas Healthcare 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, scores of political corruption, government investigations, and media campaigns, including 60 Minutes. He is best known for eliminating potential criminal charges in federal investigations. Dr. Oberheiden also 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. Byrrd’s former experience of working with the Department of Justice, where she prosecuted healthcare fraud, Anti-Kickback violations, False Claims Act violations, and Stark violations on behalf of the United States. Ms. Byrd has valuable experience with healthcare law enforcement, and she regularly argues federal matters for her clients.
You can call us directly or complete our contact form to request a free consultation.
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