Skilled Texas Medical Disability Fraud Defense Attorneys


Medical disability fraud is a form of federal healthcare benefit program fraud that has garnered increased attention in recent years. Benefit programs such as Medicare, Medicaid, Social Security Disability (SSD or SSDI), and Supplemental Security Income (SSI) lose billions of dollars to disability fraud each year not only to scam artists and patients who knowingly submit falsified benefit applications, but to healthcare providers who submit false and fraudulent claims for program reimbursement.

While some of these false and fraudulent claims are intentional, many are inadvertent. In fact, in our experience as healthcare fraud defense lawyers in Texas, the majority of providers who face federal investigations have been targeted as the result of human error. Overworked physicians fail to keep thorough records, billing administrators make coding errors, and other personnel make honest mistakes. Unfortunately, to the federal government’s data analytics software programs, these mistakes can look like examples of malicious healthcare fraud.

Healthcare Fraud Defense Attorneys in Dallas, TX

If your healthcare practice or medical business is being targeted in a medical fraud investigation, you need experienced legal representation. Federal authorities in Texas are vigorously pursuing civil and criminal charges against providers throughout the healthcare industry; and, if you are aware that you are being investigated, there is a good chance that federal authorities have been looking into your billing records for quite some time. You need an experienced legal team that can implement those constitutional and statutory protections that you may have available, and implement the goal to quickly resolve the investigation without charges being filed.

With our headquarters located in Dallas, we represent healthcare providers throughout Texas in federal medical disability fraud investigations. Whether you are a physician in Midland or Odessa, a durable medical equipment (DME) company executive in San Antonio, or a hospice administrator in Corpus Christi, we can act quickly to intervene in the investigation and fight on your behalf. Many of our attorneys are former federal healthcare prosecutors some with decades of experience in government and private practice. As such, we come with significant experience to understand the issues at hand and to address potential unnecessary consequences. In any case, the sooner we get involved, the sooner we can help with the goal to get you back to business. At Oberheiden, P.C., every case starts with a free and confidential consultation, so contact us now to put our defense team on your side.

Experienced Medical Disability Fraud Defense

Our healthcare fraud defense team represents Texas healthcare providers facing all types of disability fraud allegations. We routinely handle matters involving the U.S. Department of Justice (DOJ), the Centers for Medicare and Medicaid Services (CMS), the Social Security Administration’s Office of Inspector General (OIG), and other federal law enforcement agencies. We have significant experience in medical disability fraud investigations and prosecutions involving allegations of:

  • Billing for medically-unnecessary services and services not actually provided
  • Billing for non-allowable costs and submitting reimbursement requests that are non-compliant with the applicable billing regulations
  • Billing for services rendered by unlicensed or excluded healthcare providers
  • Double-billing federal programs and private health insurers
  • Falsifying patient records or test results in order to meet disability criteria
  • Overbilling federal disability benefit programs
  • Payment and receipt of illegal referral fees (also known as “kickbacks”)
  • Unbundling, upcoding, using the wrong billing code, and other coding violations

Our healthcare fraud defense team is led by managing partner Dr. Nick Oberheiden. Our healthcare defense team also includes several other former federal healthcare law prosecutors as well as career defense lawyers who have devoted their practices to staying current with federal benefit program billing regulations and helping healthcare providers avoid unjustified charges.

Meet the attorneys on our healthcare fraud defense team.

Answers to FAQs: Understanding Your Medical Disability Fraud Investigation

Q: How common is it to face a medical disability fraud investigation?

Medical disability fraud investigations have become far more common in recent years, particularly in Texas and other states where the government has identified a high rate of healthcare benefit program fraud. While a federal inquiry should never be considered “routine,” it is fair to say that, if you are facing a medical disability fraud investigation, you are not alone.

Agencies such as CMS, the DOJ, and the OIG are increasingly relying on data analytics to identify potential targets for healthcare fraud investigations. As a result, fully-justifiable program billings can trigger an investigation simply because they appear “anomalous” when compared to the billings of other similarly-situated providers. Whistleblower (or “qui tam“) actions are common triggers for federal investigations, and heightened awareness of both: (i) the ease of initiating a whistleblower claim, and (ii) the financial reward for being a whistleblower is leading to an increase in healthcare fraud investigations as well.

Q: What are the penalties for medical disability fraud?

The potential penalties in a medical disability fraud investigation depend upon: (i) the specific federal statute (or statutes) involved, and (ii) whether the investigation is civil or criminal in nature. Most medical disability fraud investigations involve allegations of submitting “false or fraudulent” claims under the False Claims Act (FCA). In a civil FCA case, the penalties can include:

  • Fines of roughly $21,500 per false claim (as of 2017)
  • Recoupments and treble damages (three times the government’s actual losses)
  • Pre-payment review and non-payment of future claims
  • Exclusion from Medicare/Medicaid and other healthcare benefit programs
  • Ancillary consequences, including potential licensing action

The primary difference between the penalties in civil and criminal cases is that, in criminal cases, prison time is also on the table. In a criminal FCA case, the penalties can include:

  • Up to $250,000 in fines
  • Up to five years of federal incarceration
  • Recoupments
  • Program exclusion
  • Ancillary consequences

When the government pursues multiple counts under the FCA, healthcare providers can easily face crippling financial penalties and the potential for decades of federal incarceration. Providers accused of medical disability fraud will often face penalties under the Stark Law and the Anti-Kickback Statute as well.

Q: What are some potential defenses to accusations of medical disability fraud for healthcare providers?

When we represent a client in a medical disability fraud investigation, we take a comprehensive approach that addresses the government’s case from all angles. We want to resolve the investigation as quickly as we can, and if at all possible we want to make sure our client is not formally charged. To this end, we deploy a number of different defense strategies. These strategies generally include:

  • Challenging the government’s evidence
  • Presenting exculpatory evidence
  • Proving that billing errors were unintentional
  • Asserting statutory safe harbors and exclusions
  • Asserting our client’s Constitutional rights

Facing an investigation does not mean that you will face charges, and facing charges does not mean that you are guilty. When you contact us, we will provide you with a straightforward assessment of your case and the outcomes that you can reasonably expect in light of the circumstances at hand. In all cases, our goal is to close our clients investigations without civil or criminal charges being filed.

Q: Am I required to provide my business’s billing records to the government during my investigation?

Maybe. The answer to this question depends on a number of factors, including whether you have received a subpoena or civil investigative demand, and whether investigators have probable cause to conduct a search of your premises. This is an area where you cannot afford to make mistakes, and one where we can quickly help you understand your legal rights and obligations.

Contact Qualified Texas Medical Disability Fraud Attorneys for a Free and Confidential Consultation

If you are under investigation or facing charges for medical disability fraud in Texas, it is important that you seek legal representation. We offer free initial consultations, and we are happy to answer your questions before you make a decision about your legal representation. To schedule an appointment with the healthcare fraud defense team at Oberheiden, P.C., please call (888) 356-4634 or inquire online today.