Houston False Claims Act & Qui Tam Defense Lawyers

Our Houston False Claims Act & Qui Tam defense lawyers serve clients in Houston, Texas as well as those throughout the state. Oberheiden, P.C. is a healthcare law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our talented attorneys have years of relevant experience and several have graduated from the country’s best schools such as Harvard Law School and Yale Law School. Our Houston False Claims Act & Qui Tam defense attorneys serve Houston, Texas clients as well as those throughout the state.

Under the False Claims Act, healthcare service providers and companies receiving federal reimbursement can face severe penalties for submitting fraudulent claims. If you or your company have been accused of violating the False Claims Act, you need to act now. Our nationally recognized Healthcare Fraud Defense Group provides expert counsel for clients in False Claims Act matters throughout the Houston area and nationwide.

Headquartered in Texas, our Healthcare Fraud Defense Group is a team of senior attorneys. We take a unique approach giving each client the full breadth of our Houston False Claims Act & Qui Tam defense lawyer team with their collective government and private practice experience.

This page serves as a resource for those facing federal False Claims Act investigations and qui tam litigation in Houston, TX. Here you will find answers to the following questions:

• What is the False Claims Act?
• What Constitutes a Violation of the False Claims Act?
• What are the Penalties Under the False Claims Act?
• What is a “Qui Tam” Complaint?
• What are the Key Components of a Successful False Claims Act Defense Strategy?

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)

Houston is at the Center of the Government’s Fight Against Federal Program Fraud

Houston is home to one of only fifteen HEAT task forces nationwide. Local Medicare and other federal program providers have long been a focus of a crackdown on fraud. The Healthcare Fraud Prevention and Enforcement Action Team (HEAT) focuses specifically on enforcing the False Claims Act and other anti-fraud laws in key markets around the country.

In February 2023, a medical center was charged with over $21 million in fraudulent claims. This case shows how effective the government can be in investigating fraudulent practices. It also demonstrates how important protecting yourself is when you learn you are under suspicion of fraud. This case shows just how effective the government can be in investigating large-scale fraudulent practices, and demonstrates the importance of taking action to protect yourself as soon as you find out that you are under investigation.

Should you be notified of allegations of fraud committed by your business or medical practice, call Oberheiden, P.C. to speak to a Houston False Claims Act & Qui Tam defense lawyer, right away.

1. What is the False Claims Act?

The False Claims Act is a federal statute making it illegal to “knowingly” submit or cause the submission of a false or fraudulent claim for payment under a federal government contract or under a federal funds benefit program such as Medicare, Medicaid, or Tricare.

2. What Constitutes a Violation of the False Claims Act?

In order to “knowingly” submit a false or fraudulent claim, it is enough that you “should have known” the claim was unlawful had you conducted appropriate due diligence. This means that you do not actually have to know that a claim is false or fraudulent in order to “knowingly” submit an unlawful claim. As a result, common examples of False Claims Act violations include:

• Mistakenly using an outdated billing code
• Double-billing
• Unbundling and upcoding
• Billing for services that were not provided
• Billing for services that were medically unnecessary

3. What are the Penalties Under the False Claims Act?

Under the False Claims Act, providers can face both civil and criminal penalties. The penalties under the False Claims Act are as follows:

• Civil Penalties – Providers can face liability for three times the government’s actual losses (“treble damages”), plus fines of up to $11,000 per false claim.
• Criminal Penalties (18 U.S.C. § 287) – If the government proves a provider “intentionally” submitted a false claim, the provider can face up to five years in federal prison and fines up to $250,000 for individuals, or $500,000 for companies per false claim.

4. What is a “Qui Tam” Complaint?

The False Claims Act includes a “qui tam” provision which allows private citizens, referred to as relators, to file lawsuits to recover monies on behalf of the federal government (see 31 U.S.C. § 3729). A qui tam case can be highly disruptive. And, relators are entitled to a portion of any amount the government recovers. Therefore, these actions may arise not out of legitimate interest in protecting the government. They often result from self-interest and underhanded claims of angry former employees and competitors.

This is the process of initiating a qui tam lawsuit in Houston:

• The Complaint. The relator files a complaint in the U.S. District Court for the Southern District of Texas alleging one or more violations of the False Claims Act. The complaint is filed under seal to protect the relator’s identity.
• Initial Assessment. After receiving the complaint, the government conducts a preliminary review to determine if it should investigate. If the relator’s allegations are groundless, the government will not intervene. If the allegations look legitimate, the government issues subpoenas requesting any records that may be evidence of False Claims Act violations.
• Government Intervention. Following its investigation, the government decides to either: 1) intervene in the case and support the relator’s allegations. Or, 2) terminate its involvement and allow the relator to pursue its complaint alone. If the government does intervene, prosecutors usually amend the complaint to include more charges such as violations of the Anti-Kickback Statute, and the Truth in Negotiation Act.
• Settlement Negotiations. During these initial stages, prosecutors and the defendant’s Houston False Claims Act & Qui Tam defense attorney engages in negotiations about the chance of a settlement. Depending on the complexity of the case, it can take several months or longer for both sides to agree.
• Liability and Relator Compensation. If found liable, the defendant(s) can face penalties of three times the government’s losses plus civil fines of $11,000 per false claim. If the government intervenes, the relator is entitled to collect up to 25 percent of the amount recovered. If the relator pursued the case alone, it will collect up to 30 percent of the total damages recovered.

5. What are the Key Components of a Successful False Claims Act Defense Strategy?

Based on experience as federal prosecutors and healthcare fraud defense attorneys, the members of our Healthcare Fraud Defense Group developed a proven defense strategy for False Claims Act cases in Houston, TX. This strategy has three core components:

• Avoid Criminal Charges Our first priority is always to make sure that our client avoids criminal charges. This keeps jail time off of the table and limits the scope of the government’s investigation. When we take your case, we will seek to determine the nature of your case within the first hours of engagement.
• Prevent Government Intervention In qui tam actions, we seek to expose the flaws in the relator’s complaint, and we pursue all available opportunities to attack the relator’s credibility. We want to show the government that the complaint is unwarranted and is not worth the government’s time and resources.
• Negotiate a Favorable Civil Settlement If the evidence is such that civil liability appears certain, we seek to negotiate a settlement that results in the lowest possible fines and penalties. Our Houston False Claims Act & Qui Tam defense attorneys are highly skilled negotiators. To date, not a single one of our clients has been forced to cease operations or close their business as a result of a settlement we secured on their behalf.

If you are facing a federal investigation or have been named in a qui tam complaint in Houston, we encourage you to contact us immediately so we can begin communicating with the government and start building your defense. The Houston False Claims Act & Qui Tam defense attorneys and former federal prosecutors in our Healthcare Fraud Defense Group have successfully defended individuals and entities in federal cases in Houston and nationwide. We are ready to aggressively defend you against civil and criminal liability.

We are available to discuss your case. Call us directly or complete our contact form to schedule your free, confidential case evaluation today.

Oberheiden P.C.
440 Louisiana St UNIT 200
Houston, TX 77002
713-597-3388

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