Houston, Texas Medicare Fraud Defense Lawyers

Oberheiden, P.C., PLLC’s Healthcare Fraud Defense Group represents clients in Medicare and other federal program investigations in Houston, Texas and nationwide. The Healthcare Fraud Defense Group is managed by Dr. Nick Oberheiden. Dr. Oberheiden is an aggressive Medicare fraud defense attorney with noted experience in assisting physicians, executives, hospitals, and other healthcare service providers against such allegations in the Houston, Texas area. Choosing the right Houston, Texas Medicare fraud defense lawyer is crucial, as it can significantly impact the outcome of your case. Medical providers play a significant role in healthcare fraud cases, often involving fraudulent claims for services or tests that were not necessary or not performed. Federal and state agencies investigate and audit these medical providers, and those found guilty can face severe consequences, including criminal prosecution and loss of their Medicare or Medicaid privileges.

This page is intended as a resource for individuals and healthcare providers facing investigations in Houston, TX. Here you will find answers to the following questions:

• What constitutes Medicare fraud?;
• What are the potential penalties in federal prosecutions?;
• How can a lawyer can help with your Medicare fraud investigation?;
• How can you choose the best lawyer to represent you?; and
• What distinguishes Oberheiden, P.C. from other firms?

Medicare Fraud Enforcement in Houston, Texas

Houston is one of fifteen cities where the federal government closely watches for Medicare fraud. In Texas, the federal government relies on the Healthcare Fraud Prevention and Enforcement Action Team (HEAT) and the Medicare Fraud Strike Force (MFSF). False Medicare claims cost taxpayers billions of dollars per year. HEAT, along with other federal agencies, combats fraud in areas of the country where a high volume of Medicare reimbursement claims get submitted. In FY 2020, the Centers for Medicare & Medicaid Services (CMS) estimates improper payments at nearly $43 billion combined from Medicare Fee for Service and Medicare parts C and D. Federal health care benefit programs, like Medicare and Medicaid, are crucial in combating fraudulent activity with significant involvement from federal agencies to ensure compliance and enforcement.

Healthcare practitioners and businesses in Houston, Texas must be vigilant in avoiding billing mistakes. Such mistakes can lead the government to interpret the activity as Medicare fraud. However, even if you avoid making these types of mistakes, you could still face federal investigation. HEAT relies on data analysis as one of its primary tools for identifying potential sources of fraud. Unfortunately, this can lead to many innocent providers facing unwarranted investigations. The Department of Health and Human Services plays a key role in enforcing Medicare regulations, working closely with the Department of Justice to enhance scrutiny and enforcement efforts.

Medicare Fraud: An Overview

Submitting false or fictitious claims to the Centers for Medicare & Medicaid Services (CMS) is what is commonly referred to as Medicare fraud. The Medicare system is complex. As a result, providers are able to defraud the system of billions of dollars each year. This leads HEAT and other federal authorities to pursue almost any provider suspected of fraud.

Healthcare practitioners and businesses in Houston must be vigilant in avoiding healthcare billing mistakes. Such mistakes can lead the government to interpret the activity as Medicare fraud. However, even if you avoid making these types of mistakes, you could still face federal investigation. HEAT relies on data analysis as one of its primary tools for identifying potential sources of fraud. Unfortunately, this can lead to many innocent providers facing unwarranted investigations. The Department of Health and Human Services plays a key role in enforcing regulations, working closely with the Department of Justice to enhance scrutiny and enforcement efforts.

Medicare fraud is a broad term that can include violations of several federal laws:

• The False Claims Act;
• The Anti-Kickback Statute;
• The Physician Self-Referral Law (Stark Law);
• The Social Security Act; and
• The U.S. Criminal Code.

Some of the most common forms of this fraud include the following:

• Providing and billing for medically unnecessary services;
• Providing and billing for medically unnecessary supplies, and equipment;
• Phantom billing – billing for services that were never performed;
• Billing for supplies and equipment that were not actually purchased;
• Obtaining fraudulent certifications for services and supplies that are not medically necessary (a common allegation in home health and hospice fraud investigations);
• Double-billing and falsifying patient records;
• Upcoding and unbundling; and
• Offering and accepting kickbacks.

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)

Potential Penalties for Medicare Fraud

Federal fraud investigations can be civil or criminal in nature. Finding out the nature of the investigation is critical to understanding possible ramifications. Based on the nature of your investigation, the potential penalties can include recoupment requests, non-payment of future claims, civil fines of up to $11,000 per false claim, exclusion from future participation in federal healthcare programs, treble damages, government attorneys’ fees, civil and criminal penalties, and long-term imprisonment. Federal prison sentences for Medicare fraud are:

• Up to 10 years for each count of Medicare fraud;
• Up to 20 years for fraud resulting in serious bodily injury; and
• A life sentence for fraud that results in a patient’s death.

How a Lawyer Can Help with Your Medicare Fraud Investigation

Our Healthcare Fraud Defense Group has three primary strategies for successfully defending clients in Houston, Texas. While each case is unique, these strategies are the most effective for easing the consequences and avoiding civil or criminal charges:

1. Early Involvement with Investigating Agencies

In Medicare fraud investigations, early intervention with agencies is critical. When you find out about the investigation, the government has already invested time and resources in building a case against you. To level the playing field, you need to retain a Houston, Texas Medicare fraud defense attorney as soon as possible.

A federal prosecutor plays a significant role in these Medicare fraud investigations, particularly in establishing elements such as knowledge and intent. Interaction with a federal prosecutor can indicate whether the health care fraud charges are civil or criminal, making immediate legal advocacy essential to navigate potential criminal implications and protect against prosecution.

At Oberheiden, P.C., we immediately reach out to our government contacts for answers to these key questions:

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

With this information, we can quickly build and apply a defense strategy to fit the unique circumstances of your investigation.

2. Attacking the Government’s Case

In a criminal Medicare case, the government must prove its stance beyond a reasonable doubt. Such a high standard requires the government’s attorneys to develop a case filled with convincing evidence.

As a result, we center on exposing cracks in the government’s case. In particular, we target the government’s duty to prove you committed a crime and that you did so with criminal intent. Mistakes happen. They aren’t criminal, and they shouldn’t put you in federal prison.

Having knowledgeable Houston, Texas Medicare fraud defense attorneys is crucial in navigating these accusations and protecting your rights.

3. Making Effective Use of Key Healthcare Fraud Defenses in Houston, Texas

Our team will use all relevant legal defenses available given the facts of your case. In a recent case, prosecutors alleged our client had falsely certified a patient’s need for home healthcare services. We successfully argued that a delegation exception rendered our client’s action fully compliant with the law. In another case, we used a safe harbor provision to help our client avoid federal prosecution. These are just two examples of numerous defenses that may be available.

Having a skilled health care fraud defense team is crucial to protect your career and reputation from severe repercussions associated with health care fraud allegations.

Our firm has extensive experience in handling healthcare fraud cases, navigating complex legal challenges such as healthcare fraud investigations and regulatory audits. This experience allows us to develop proactive defense strategies to safeguard the future of those accused.

How to Choose the Best Lawyer to Represent You

When it comes to a healthcare fraud investigation, most healthcare lawyers and criminal lawyers do not have the knowledge and experience needed to represent you effectively. So, who should you choose? The answer is a Houston, Texas Medicare fraud defense attorney.

The Right Choice: A Houston, Texas Healthcare Fraud Defense Lawyer in Houston, Texas

Healthcare fraud defense lawyers combine the knowledge and abilities of healthcare lawyers and criminal lawyers. This expertise will be the best choice for your fraud investigation. When researching healthcare fraud defense lawyers in Houston, Texas you should use the following four criteria:

• Proven record of success;
• Healthcare industry knowledge;
• Deep understanding of healthcare laws; and
• Litigation and trial experience.

To learn more about the experience of the attorney, you should ask these three questions:

• How many Medicare fraud cases have you manaaged during your career?
• How many of these cases resulted in neither criminal nor civil penalties or dismissals for your clients?
• How many healthcare fraud cases have you tried in court?

About Oberheiden, P.C.

Oberheiden, P.C.’s Healthcare Fraud Defense Group includes former federal prosecutors and experienced defense lawyers. They have handled hundreds of healthcare proceedings and conducted several criminal trials. Our defense lawyers regularly represent clients ranging from individual providers to entire medical systems involving:

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

If you are facing a federal investigation in Houston, Texas then we encourage you to contact us immediately for a free and confidential consultation and case evaluation.

We are available every day of the year to discuss your situation. You can call or email us directly, or complete our online contact form.

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

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