Medicare/Medicaid Fraud Defense in Midland/Odessa, Texas

Headed by senior attorney Dr. Nick Oberheiden, The Oberheiden, P.C., PLLC’s Healthcare Fraud Defense Group provides experienced and strategic representation for healthcare providers facing Medicare/Medicaid fraud investigations in Midland and Odessa, Texas.

Experienced Medicare/Medicaid Fraud Defense Lawyers Serving Midland and Odessa, TX

For medical service providers and other healthcare entities in Midland and Odessa, the threat of facing a federal investigation for Medicare/Medicaid fraud is a serious concern. Texas is one of only nine areas nationwide in which the federal government has stationed two teams from its elite Healthcare Fraud Prevention and Enforcement Action Team (HEAT) task force. The fact that there are only nine HEAT teams across the entire country tells you just how serious the federal government is about targeting Medicare/Medicaid fraud in Texas. In addition, due to the large volume of Medicare/Medicaid reimbursement billings originating from Midland/Odessa area, the Centers for Medicare and Medicaid Services (CMS) is keeping a close eye on local providers, as well.

HEAT is a coordinated federal task force composed of prosecutors from the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and other federal agencies. Due to HEAT’s strong presence and active enforcement efforts in Texas, healthcare companies in Midland and Odessa must be especially vigilant to avoid putting themselves on the federal government’s radar.

Understanding Medicare/Medicaid Fraud

Medicare/Medicaid Fraud: An Overview

“Medicare/Medicaid fraud” is a broad term that refers to submitting false or fictitious reimbursement claims to CMS under the federal Medicare/Medicaid program. Depending on the specific fraudulent practices involved, Medicare/Medicaid fraud can violate a number of different federal statutes. These include:

• False Claims Act – The False Claims Act prohibits knowingly submitting false statements or making misrepresentations in connection with a claim for reimbursement under a federal healthcare benefit program (such as Medicare/Medicaid ).

• Anti-Kickback Statute – The Anti-Kickback Statute prohibits the knowingly soliciting, paying, or accepting any form of compensation in connection with a referral for services, medication, supplies, or equipment for which you receive reimbursement under Medicare/Medicaid or another federal healthcare benefit program.

• Physician Self-Referral Laws (Stark Law) – The Stark Law prohibits physicians from making referrals for designated health services to entities in which the referring physician or an immediate family member has an ownership or financial interest (commonly referred to as physician self-referrals).

Depending on the circumstances, Medicare/Medicaid fraud may implicate violations of the Social Security Act and various provisions of the U.S. Criminal Code as well. In a Medicare/Medicaid fraud investigation, it is not unusual to face allegations for multiple offenses under a variety of different federal laws.

Common Examples of Medicare/Medicaid Fraud

Medicare/Medicaid fraud can take a number of different forms. Some of the most common forms include:

• “Phantom billing” (billing for services that were never performed);
• Providing and billing for medically unnecessary services, supplies and equipment;
• Billing for supplies and equipment that were never purchased;
• Obtaining fraudulent certifications for medically-unnecessary services and supplies (a common allegation in home health and hospice fraud investigations);
• Double-billing;
• Falsifying patient records;
• Upcoding, unbundling, and other forms of coding fraud; and
• Entering into illegal kickback arrangements with physicians, pharmaceutical companies, durable medical equipment (DME) companies, and other providers;

The DOJ is actively targeting both companies and individuals suspected of playing a role in Medicare/Medicaid fraud. As a result, physicians, nurses, home healthcare centers, hospice care centers, nursing homes, registered care facilities, hospitals, pharmacies, toxicology laboratories, DME companies, physician syndications, DNA testing centers, cancer treatment centers, and other healthcare service providers in the Midland and Odessa areas are all potentially at risk for becoming targets in federal Medicare/Medicaid fraud investigations.

Civil and Criminal Penalties for Medicare/Medicaid Fraud

To understand the penalties that you may be facing, you first need to determine whether your investigation is civil or criminal in nature. As discussed below, this is one of the first (and most important) steps in defending against a Medicare/Medicaid fraud investigation.

However, generally speaking, the penalties that you are likely to face if you are found responsible include: Recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, exclusion from federal healthcare programs (including Medicare/Medicaid ), treble damages, government attorneys fees, criminal fines, and spending time in federal prison. The potential prison sentences for Medicare/Medicaid fraud include:

• Medicare/Medicaid fraud – Up to 10 years in prison for each count of fraud.
• Medicare/Medicaid fraud with serious bodily injury – Up to 20 years in prison (common in cases involving reimbursement requests for counterfeit or excessive medication).
• Medicare/Medicaid fraud resulting in death – Life imprisonment.

As a physician and other medical professional, you may be at risk for professional discipline and loss of hospital privileges, as well.

Three Keys to Successfully Defending a Medicare/Medicaid Fraud Investigation

Early Intervention by Experienced Attorney

In a Medicare/Medicaid fraud investigation, early intervention is critical. It is important to do everything possible to keep your case civil (which keeps prison time off of the table), and this requires effective representation from the earliest stages of the investigation.

When you hire our defense attorneys of our Healthcare Fraud Defense Group to represent you, we will seek to obtain answers to the following questions within the first hours of our engagement:

• Is the case civil or criminal?
• What prompted the investigation?
• What is the case about?
• Who else is under investigation?
• Which agencies are involved?
• What is the government?s ultimate goal?
• How can the investigation be resolved?

Asserting Statutory Defenses

A thorough analysis will often reveal several favorable defenses that are available under the statutes implicated by your investigation. For example, in one recent Medicare/Medicaid fraud case, the government accused our client of fraudulently certifying a patient for home healthcare services. Using the facts of the case and our in-depth knowledge of federal healthcare law, we were able to successfully assert a recognized delegation exception that rendered the certification fully compliant with the law. In another recent case, we were able to convince the government that our client was protected by a safe harbor exception.

The Anti-Kickback Statute, the Stark Law, the False Claims Act, and other federal statutes all contain a number of safe harbors and other clauses that can be used to shield healthcare providers from liability for Medicare/Medicaid fraud.

Asserting a Lack of Evidence and Lack of Criminal Intent

If you are facing criminal charges, the government will be required to prove your guilt beyond a reasonable doubt. This means that the government must uncover sufficient evidence to convincingly establish that you committed an illegal act, and you did so with criminal intent.

Intentional healthcare fraud is rare in both Midland and Odessa. Medicare/Medicaid rules and regulations are exceedingly complex. Most incidents that prompt federal Medicare/Medicaid investigations result from basic organizational and human errors. Focusing on patient care and rapid growth can lead to mistakes, but these mistakes do not justify criminal penalties. Some of the issues that we commonly see include:

• Hiring unqualified staff;
• Inadequate supervision;
• Relying on delegation & outsourcing;
• Structural and organizational deficits;
• Mistakes due to oversight or feeling overwhelmed; or
• Following an ineffective Medicare/Medicaid compliance program.

Just because you are under investigation does not mean that you are guilty. Never assume that the government is right about your case. Our Midland and Odessa healthcare fraud defense attorneys will help you understand your situation and fight vigorously to secure a favorable outcome:

• Case dismissed;
• No criminal charges;
• Maintaining your professional license;
• Civil fine instead of a criminal plea;
• Misdemeanor charge instead of a felony charge; and
• No prison sentence.

Choosing the Right Defense Lawyer in Midland and Odessa

Healthcare fraud defense attorneys combine the best qualities of criminal lawyers and healthcare lawyers. Not only do experienced healthcare fraud defense lawyers know the Medicare/Medicaid system inside and out, but they also know how to quickly and effectively engage with federal prosecutors and fight to help clients avoid civil and criminal liability. This combination is essential when it comes to maximizing your chances of escaping punishment when the federal government has you in its sights.

Why Choose Oberheiden, P.C.?

A Team of Dedicated Healthcare Fraud Defense Lawyers on Your Side

At Oberheiden, P.C., our team of Texas healthcare fraud lawyers offers the experience of handling healthcare proceedings conducting criminal trials nationwide. Several of our defense attorneys come from senior positions within the DOJ, and the members of our Healthcare Fraud Defense Group have decades of experience in Medicare/Medicaid fraud investigations. The four distinguishing characteristics of our firm are:

• A track record of success;
• Industry knowledge;
• Familiarity with federal healthcare and criminal laws; and
• Litigation & trial experience.

Our Healthcare Fraud Defense Group takes a unique team approach to defending clients in Medicare/Medicaid fraud investigations. When you choose Oberheiden, P.C. to represent you, our senior defense attorneys and former federal prosecutors will work together to build a comprehensive case strategy custom-tailored to the specific facts involved in your case.

A Broad Practice within Healthcare Fraud Defense

We regularly represent business owners, healthcare executives, lawyers, healthcare providers, hospitals, hospices, pharmacies, laboratories, medical device companies, and other entities in the healthcare industry that are facing Medicare/Medicaid fraud investigations in Midland and Odessa, Texas. This includes investigations involving:

• The Department of Defense;
• The Department of Justice;
• The Drug Enforcement Administration;
• The Federal Bureau of Investigation;
• The Internal Revenue Service;
• The Medicaid Fraud Control Unit;
• The Office of Inspector General;
• Midland, Odessa, and Texas law enforcement; and
• Other state and federal law enforcement 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.

Midland/Odessa Medicare/Medicaid Fraud Defense Attorneys

Dr. Nick Oberheiden is a Harvard-trained and internationally educated healthcare fraud defense attorney offering services to clients in the Midland / Odessa, Texas area. Dr. Oberheiden has successfully represented and assisted healthcare executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, through accusations of political corruption, government investigations, and assisted with media campaigns, including 60 Minutes. He is best known for his ability to stop federal investigations before criminal charges can be filed. 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 of prosecuting healthcare fraud, Anti-Kickback violations, False Claims Act, and Stark violations on behalf of the United States. She regularly argues federal matters for her clients.

We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form to request a free consultation.