San Antonio, Texas Medicare Fraud Defense Lawyers

Experienced Medicare and Health Care Fraud Defense Attorneys Serving all of San Antonio

The Criminal Defense Firm has significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our health care law defense firm is comprised of the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force, as well as other talented lawyers with years of relevant experience and educational backgrounds from the country’s best universities and law programs.”Our lawyers” serve clients in San Antonio and throughout the state of Texas.

The Criminal Defense Firm is a Texas law firm that provides Medicare fraud defense for health care providers and businesses in and surrounding San Antonio, Texas.

What Is Medicare Fraud?

Medicare fraud is a violation of federal law. It is the submission of a false claim to a government health care program. Despite its name, the program can be Medicare, Medicaid, Tricare, or federal workers compensation. It includes the violation of at least one of the following laws:

• Violation of the False Claims Act
• Violation of the Anti-Kickback Statute
• Violation of the Physician Self-Referral Law (Stark Law)
• Violation of U.S. Criminal Law
• Violation of Social Security Act

Medicare fraud investigations involve either a provider or an entity who files a false claim with a federal health care program in order to illegally receive a payment from that program. San Antonio, Texas is closely monitored for instances of Medicare fraud. In fact, it is one of nine locations in the United States that is closely watched by the Medicare Fraud Strike Force. Their job is to watch for, investigate, and prosecute Medicare fraud.

The government believes that because San Antonio is the home to many recipients of federal health care that there is a greater chance that Medicare fraud will occur. During 2016, the Department of Justice announced that it had investigated more than 300 cases of Medicare fraud and recovered more than $900 million in fraudulent claims.

The Medicare Fraud Strike Team is a hybrid team with investigators and prosecutors from multiple federal agencies including the Department of Health and Human Services, the Office of Inspector General, the DOJ, DOD, FBI, IRS, and other agencies. If you’ve been contacted and told that you’re being investigated for Medicare fraud, call The Criminal Defense Firm right away.

Billing Problems: The Leading Issue in San Antonio Medicare Fraud Investigations

In San Antonio, the leading issues that causes Medicare fraud investigations is problems with billing. This can be problematic billing practices or reimbursement requests including excessive, false, or unauthorized charges. This is commonly referred to as billing fraud. The most common types in San Antonio include:

• Billing for medically unnecessary services
• Billing for unordered medical equipment
• Phantom billing (billing for services that were never referred)
• Billing for unordered services
• Billing for medically unnecessary services or equipment
• Certification for medically unnecessary supplies, equipment, or services
• Double billing
• Upcoding
• Inflating charges
• Overuse of equipment
• Overuse of services
• Providing or accepting kickbacks

The most commonly investigated individuals and entities in San Antonio include individual practitioners (including nurses, ARNPs, and physician assistants), health care service providers, registered care facilities, nursing facilities, hospitals, clinics, pharmacies, laboratories, medical device companies, DNA centers, and cancer treatment facilities.

A Look at Medicare Fraud Penalties

Allegations of Medicare fraud include serious civil and criminal penalties. Civil penalties include:

• Recoupment requests
• Treble damages
• Non-payment of future claims
• Fines up to $11,000 per false claim
• Exclusion from federal health care programs
• Attorney fees

Criminal penalties are extremely serious and may include:

• Criminal charges
• Hundreds of thousands of dollars in fines
• 10 years in federal prison for each count of Medicare fraud for which you are convicted
• 20 years in federal prison for each count of Medicare fraud that caused serious bodily injury to the patient
• Life sentence for Medicare fraud if it results in the death of the patient

You could also face licensing and disciplinary actions as well as the loss of your hospital privileges.

Selecting the Right San Antonio Defense Lawyer

It is imperative that you choose the right San Antonio defense lawyer. Your defense lawyer needs the skills and the experience to take on the federal government. Do not choose a lawyer without this experience.

Many people and businesses in San Antonio who are facing a Medicare fraud investigation choose a health care lawyer. However, you should be aware that Medicare fraud is often charged in addition to serious federal criminal acts including tax evasion, wire fraud, mail fraud, and money laundering. Many health care attorneys do not have the needed criminal law experience that you need. They may not have the negotiation experience that is needed to help you with the federal government or be able to develop a strategic defense for you if your case goes to trial.

Others believe that they should hire a San Antonio criminal defense lawyer. However, most criminal defense lawyers don’t have federal crime experience. They also may not have the familiarity needed with billing, coding, and medical utilization rules.

You should hire a health care fraud defense lawyer who provides services to the San Antonio area. As you do your research, look for the following four traits:

1. A proven track record of success in Medicare fraud cases
2. Industry experience
3. Intimate understanding with health care laws and their exceptions
4. Litigation and trial experience

Additionally, when you narrow down your options, you should ask the following three questions so that you may better understand the amount of experience that the potential firm has:

1. How many Medicare fraud cases have you handled during your career in law?
2. How many of those cases resulted in no civil or criminal charges or in dismissals for your clients?
3. How many Medicare fraud cases did you try in court?

Defense Strategies for Medicare Fraud

The Criminal Defense Firm has three core principles that we use to help our clients in San Antonio. Although each case is different, these three principles have assisted us in the hundreds of cases that we’ve taken to trial.

Early intervention on your behalf. The longer that the government has to investigate you without interruption, the more likely it is that you will face criminal charges. Early intervention is the key to minimizing this risk. We get involved early to get answers to your questions. We contact the involved investigating agencies to get answers to questions such as:

• What prompted the investigation?
• What is the case about?
• Is the matter civil or criminal?
• Which federal agencies are involved in the investigation?
• What is the ultimate goal of the investigation?
• How can the matter be resolved?

The Criminal Defense Firm strives to get answers for you within the first hours of our engagement.

Addressing a lack of evidence. The federal government has a very high Constitutional burden to meet. They must use evidence that meets a legal standard known as “beyond a reasonable doubt” to show that you committed a crime. We test this standard in each case that we take. We’ve seen the following results on a regular basis:

• Dismissal of case
• No criminal charges
• Clients maintain their professional license
• Civil fine without a criminal plea
• Reduction of a felony to a misdemeanor
• No prison sentence

No criminal intent. Additionally, the federal government must prove that you acted with criminal intent. We know from years of experience that most San Antonio Medicare fraud investigations don’t start because of criminal intent. They start because of a mistake. Intentional Medicare fraud is rare. Common mistakes that result in Medicare fraud investigations include:

• Unqualified staff
• Inadequate supervision
• Delegation or outsourcing to entities who are not qualified
• Business errors
• Human errors
• Oversight
• Employees who are overwhelmed by their job duties
• No Medicare compliance program
• Inability to keep up with the quickly changing health care laws and rules

Despite the fact that most people never intend to commit Medicare fraud, many health care providers, entities, and businesses just presume that they are guilty when they find out that they’re being investigated. Instead of fighting, they accept the harsh criminal penalties for what wasn’t a crime but was, rather, an honest mistake.

The goal of The Criminal Defense Firm is to show the federal government that our San Antonio clients had no criminal intent. We work to show that you made a mistake. While that mistake may certainly need to be corrected, it isn’t deserving of criminal charges.

Applicable defenses for each case. Our Health Care Fraud Defense Team thoroughly examines and analyzes each case to determine strategic and applicable defenses. In a recent Medicare fraud case, the government alleged fraudulent certification for home health care services by our client. We were able to prove to the government that our client was protected by a recognized delegation exception that rendered the certification fully compliant with the law. In another Medicare fraud case, we refused to admit liability. We were able to prove to prosecutors that our client acted within a safe harbor exception.

The Criminal Defense Firm

The Criminal Defense Firm provides strategic defense and advocacy for San Antonio health care practitioners, facilities, and related businesses. This includes business owners, attorneys, executives, individual providers, hospitals, pharmacies, labs, and other health care entities that are investigated for illegal kickbacks, fraudulent billing, and allegations of medically unnecessary services or equipment, services not rendered, or unlawful joint ventures. We provide assistance to our Houston area clients with:

• Health Care fraud defense
• Compliance program creation and implementation
• Internal investigations
• Asset protection
• Licensure or disciplinary proceedings
• Jury trials

The Criminal Defense Firm provides representation to individuals and businesses in San Antonio who are being investigated by the DOJ, DOD, FBI, DEA, OIG, Medicare Fraud Control Unit, San Antonio or Texas state law enforcement, and the IRS.

Our Track Record

• Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of a health care 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 laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged health care Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare 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 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 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 health care 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 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.

Medicare Fraud Defense Attorneys Serving San Antonio, Texas

We are available every day of the year. You can call us directly or complete our contact form or email us directly.