Houston, Texas Healthcare Fraud Defense Attorneys
Houston Healthcare Defense Team Lead
Contact Nick440 Louisiana St #200
Houston, TX 77002
713-597-3388
Oberheiden, P.C. is a healthcare law defense firm with experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our firm features talented attorneys with years of relevant experience and education from the country’s leading schools such as Harvard and Yale Law Schools. Our Houston, Texas healthcare fraud defense lawyer serves clients in Houston as well as throughout Texas.
If you’re facing an accusation of healthcare fraud in Houston, Texas or the surrounding area, call Oberheiden, P.C. to speak with a Houston, Texas healthcare fraud defense attorney today. We have extensive legal experience in:
- OIG and grand jury subpoenas,
- Medicare and Tricare audits,
- fraud allegation defense,
- internal investigations,
- compliance programs,
- qui tam defense,
- protection of assets,
- criminal defense, and
- jury trials.
Dr. Nick Oberheiden is a Harvard-trained lawyer and negotiator. Dr. Oberheiden provides legal assistance to clients in Houston and throughout Texas. Dr. Oberheiden is a healthcare fraud defense lawyer, and he is the managing partner of Oberheiden, P.C.
You have legal options. Call Oberheiden, P.C. now and ask to speak with a member of our Healthcare Fraud Defense Team. Initial calls are free and confidential.
Houston, Texas Is Monitored for an Increase in Healthcare Fraud Violations
Houston, Texas is one of fifteen locations in the nation closely monitored for healthcare fraud violations. The area is overseen by the Medicare Fraud Strike Force. The Medicare Fraud Strike Force is a team of prosecutors and investigators from several federal agencies.
Houston, Texas and its surrounding areas are monitored because of the large number of residents who rely on federal healthcare programs. This increases the number of claims filed for payment. In areas where more claims are filed, the federal government watches for an increase in healthcare fraud. Healthcare fraud is alive and well in the United States. In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year.(OIG/HHS)
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
Lynette S. Byrd
Former DOJ Trial Attorney
Partner
Brian J. Kuester
Former U.S. Attorney
Hon. Kevin McCarthy
55th Speaker, U.S. House of Representatives (ret.)
Government Consultant
Mike Pompeo
Of Counsel
Former U.S. Secretary of State
John W. Sellers
Former Senior DOJ Trial Attorney
Linda Julin McNamara
Federal Appeals Attorney
Nicholas B. Johnson
Former Prosecutor
Roger Bach
Former Special Agent (DOJ)
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Ray Yuen
Former Supervisory Special Agent (FBI)
The Definition of Healthcare Fraud
Healthcare fraud is an attempt to receive payment from a federal government healthcare program for medical services or equipment from an incorrect or misleading claim. Federal healthcare programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. Healthcare fraud includes at least one of the following laws:
- Anti-Kickback Statute – Federal healthcare law restricts the exchange of money or other valuables for patient referrals. Any person may face prosecution for violating this act if they offer or provide payment or other valuables in exchange for referrals.
- Stark Law – This law bars physicians from referring patients to certain healthcare entities if the physician or an immediate family member has an ownership or investment interest in the entity. Or, if there is a compensation arrangement between the providers. There are statutory exceptions to this law.
- False Claims Act – If you submit a claim to a federal healthcare program, you must ensure that your claim is accurate. Otherwise, it is a violation of federal law. The federal government may begin an investigation into your billing practices under the criminal provisions of this act.
- Prescription Fraud – Prescribing a high volume of narcotics is closely watched by the federal government. If you’re suspected of operating a “pill mill,” you may be targeted for insurance fraud or violating DEA dispensing rules.
- Billing Fraud – One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates allegations of phantom billing (services not provided), ghost patients (patients who do not exist), and billing for medically unnecessary services or equipment.
- Certification Errors – The federal government pays close attention to the home healthcare and hospice industry. The most common allegation is fraudulent certification for care.
Oberheiden, P.C. has a track record of successful representations and in helping our clients avoid criminal charges.
Oberheiden, P.C. has a history of successful representations and in helping our clients avoid criminal charges. If you or your healthcare practice or your business are being investigated for healthcare fraud in Houston, Texas, contact Oberheiden, P.C. now. Our initial consultations are confidential and free of charge.
Frequently Asked Questions
Which providers are most commonly investigated for healthcare fraud?
No healthcare provider, medical device producer, hospital, or practice group is immune from fraud allegations. Medical professionals, including doctors and nurses, are often scrutinized for their involvement in Houston healthcare fraud cases. However, some are at greater risk than others. Which providers interest the federal government is less the type of business, and more industry practices. That said, federal law enforcement and authorities tend to target the following providers:
- DNA testing facilities
- Drug rehabilitation facilities
- Healthcare marketing agencies
- Home healthcare agencies
- Hospice providers
- Hospitals
- Mobile healthcare clinics
- Outpatient surgical centers
- Toxicologists and toxicology laboratories
No matter the nature of your business, if you are targeted in a healthcare fraud investigation, it is important to contact a Houston, Texas healthcare fraud defense attorney to discuss your options today.
What are the penalties of healthcare fraud?
Healthcare fraud is extremely serious and can result in civil or criminal penalties. Civil penalties may include repayment of claims, non-payment of future claims, and exclusion from federal healthcare programs entirely. You could be called before the state disciplinary board, lose your license, and/or lose your hospital privileges. Criminal penalties can include fines that cost you hundreds of thousands of dollars, criminal indictment, or a prison sentence of:
- Up to 10 years for each count of healthcare fraud
- Up to 20 years for each count of fraud resulting in serious bodily injury
- Life sentence if the healthcare fraud results in death
Clients ask us about worst-case scenarios for healthcare fraud in Texas. Criminal prosecution can depend on many factors. The severity of the injury received by a patient, if the prosecutor has interest in pursuing criminal charges, and the reason the investigation began, are a few. If you’re being investigated for healthcare fraud in Houston, Texas, you should call Oberheiden, P.C. today to speak to an experienced Houston, Texas healthcare fraud defense lawyer, today. Our firm can tell you about your options. Initial consultations are confidential and free of charge.
Is your healthcare fraud investigation criminal?
Healthcare fraud charges can be civil or criminal in nature. Oberheiden, P.C. utilizes early intervention and a strategic defense to help our Houston, Texas clients. If you are being investigated, contact us promptly.
It’s not always easy to know if you are facing civil or criminal charges. The U.S. Attorney’s Office and other federal agencies have both a civil and a criminal division. So, being contacted by a federal prosecutor doesn’t always mean a criminal charge is imminent. However, civil cases can become criminal in nature. Oberheiden, P.C. can help by contacting federal prosecutors on your behalf. If you’re contacted by a federal prosecutor, call us right away.
Determining charges depends on the legal reading of many factors including OIG subpoenas, and the manner in which the inquiry or allegations are made. Expect criminal prosecution if you receive a(n):
- search warrant,
- seizure warrant,
- arrest warrant,
- target letter,
- IRS involvement,
- grand jury subpoena, or
- there is involvement of a federal criminal prosecutor.
If you have questions about the charges you may face, call Oberheiden, P.C. now. We provide counsel for providers, entire healthcare systems, and other related healthcare businesses.
Healthcare Fraud Defense
Oberheiden, P.C. works on behalf of Houston, Texas healthcare fraud defense clients. Many of the members on our Healthcare Fraud Defense Team have experience as healthcare auditors and as former federal healthcare fraud prosecutors. This experience gives our Houston, Texas clients valuable insight and legal defense for their healthcare fraud cases.
Immediate legal advocacy. Our main goal is to help our clients avoid criminal indictment. Experience has taught us that the best way in which we can advocate for our clients is to quickly contact the federal government. This immediate contact limits the amount of time the federal government has to pursue its case against you. We work to protect your career and your freedom. We can get answers to some important questions typically within a few hours after you retain us. Here are a few initial questions we will ask on your behalf:
- What is the investigation about?
- What is the purpose of it?
- How long will the investigation take?
- What is the most likely outcome?
Testing Constitutional standards. The federal government must prove beyond a reasonable doubt that you committed a crime. They must also show that you acted with criminal intent. When criminal charges look certain, we test if the government will be able to meet Constitutional standards. The government will try to use billing inaccuracies to prove you had criminal intent. Oberheiden, P.C. knows this most often happens as the result of an organizational or human error. These mistakes should not be held to criminal standards. We have provided successful legal defense for clients across the United States by proving that inaccuracies are a result of human or organizational error and not criminal intent. Some factors leading to such mistakes are:
- unqualified workers,
- delegation errors,
- outsourcing errors,
- lack of oversight,
- insufficient supervision, and
- constantly changing laws and rules in healthcare billing.
Although these issues should be corrected, they should not lead to criminal conviction.
The use of strategic healthcare fraud defense. Oberheiden, P.C. develops strategic healthcare fraud defenses for each client. Many of the cases we’ve successfully defended were won because of statutory loopholes and exceptions. For example, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either ease or entirely resolve a healthcare fraud case.
Defending your professional reputation. We are committed to doing more than providing healthcare fraud defense. We are determined to defend your image. Allegations of healthcare fraud can be damaging. Many of our clients express concern about how these allegations will affect their career and future. The media has a lot of power and your reputation could be destroyed by their rumors. Our attorneys address instances of slander, and seek opportunities to correct misinformation about our clients. Call our Houston, Texas healthcare fraud defense lawyers today to learn more about your legal options. The initial call is confidential and free of charge. Call us today to learn more about your legal options. It is confidential and there is no charge for your initial call.
Our Track Record
The commitment of Oberheiden, P.C. is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. Here are some recent examples of our case outcomes.
- Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud.
Result: No civil or criminal liability.
- Representation 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.
- Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud.
Result: No civil or criminal liability.
- Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks.
Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations.
Result: No civil or criminal liability.
- Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations.
Result: No civil or criminal liability.
- Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud.
Result: No civil or criminal liability.
- Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud.
Result: No civil or criminal liability.
We are available every day of the year. You can call us, complete our online contact form, or email us directly.
Oberheiden P.C.
440 Louisiana St UNIT 200
Houston, TX 77002
713-597-3388
Additional Pages for Houston, Texas
- Houston federal criminal defense
- Houston business litigation defense
- Houston federal appeals
- Houston tax attorney
- Houston whistleblower defense
- Houston white collar criminal defense
- Houston False Claims Act & Qui Tam defense
- Houston health compliance defense
- Houston hospice & home health fraud defense
- Houston Medicare fraud defense
