Litigation. Compliance. Defense. Health Care Fraud & Criminal Defense Trial Lawyers
Orange County 714-294-2000
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Laredo Medicare Fraud Defense Lawyers

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Experienced Medicare Fraud Defense for the Laredo, Texas Area

Oberheiden, P.C. is a health care law defense firm based in Dallas, Texas, with significant experience in the practice areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our group of attorneys are made up by the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, former lead prosecutors of the elite Medicare Fraud Strike Force, and other talented lawyers with years of relevant experience and degrees from prestigious institutions like Harvard Law School and Yale Law School. We serve clients in Laredo and throughout Texas.

Defining Medicare Fraud

Medicare fraud is a broad term that includes more than Medicare. However, since Laredo, Texas is one of nine areas in the United States that is heavily watched by the federal government for abuse of Medicare claims, that will be the focus of this content. Medicare fraud is the submission of fictitious or false claims to the government for payment on a claim from a government health care program. Common allegations include:

  • That you violated the False Claims Act
  • That you violated the Anti-Kickback Statute
  • That you violated Stark Law (the Physician Self-Referral Law)
  • That you violated the Social Security Act
  • That you violated the U.S. Criminal Code

Regardless of the alleged violation, the common thread in Medicare fraud is that health care providers, facilities, or businesses are receiving money illegally from false federal health care claims.

Since Laredo is in Texas, it is one of the nine most watched areas for Medicare fraud within the United States. In fact, there is a specialized task force that investigates and prosecutes Medicare fraud. Laredo is in an area that has a large number of Medicare recipients. More claims are filed here than in other areas. The federal government believes that this raises the risk of fraudulent claims being filed. Since the government watches Laredo closer, more health care professionals, facilities, and businesses have a higher risk of being accused of committing Medicare fraud.

Common Billing Issues That Result in Allegations of Medicare Fraud

Although there are many things that can cause you to face an allegation of Medicare fraud, one of the most common types involves billing practices and reimbursement requests. This usually involves false and/or excessive expenses, or billing for unauthorized services, supplies, or equipment. The most commonly involving billing practices are:

  • Phantom billing: billing for services that were never performed
  • Billing for medically unnecessary services
  • Billing for unordered supplies or equipment
  • Billing for medically unnecessary supplies
  • Certification for medically unnecessary services (this is commonly seen in health care and hospice fraud)
  • Certification of medically unnecessary supplies (DME is a common example)
  • Double billing
  • Upcoding
  • Bill inflation
  • Overuse of services or equipment
  • Offering or accepting kickbacks

Laredo area doctors, nurses, health care businesses, hospice care providers, nursing homes, registered care centers, physician syndications, DNA centers, cancer treatment facilities, DME organizations, and any other health care provider, service, or business is at risk of being investigated for Medicare fraud.

Civil and Criminal Penalties for Medicare Fraud

Being investigated for Medicare fraud puts you at risk of severe civil and criminal penalties. For civil charges, you could be forced to pay back the government for those claims, may not be paid on future claims, civil fines up to $11,000 per false claim, exclusion from federal health care programs, be ordered to pay treble damages, and pay attorney fees for the government.

In addition to civil charges, you could also face criminal charges. You could be forced to pay huge fines, have a criminal record, and be sentenced to time in federal prison. For each count of Medicare fraud, you could face 10 years in prison. If the fraud resulted in serious bodily harm (as often seen in counterfeit or excessive medication), you could be sentenced to 20 years per count. If the Medicare fraud resulted in the death of a patient, you could be sentenced to life.

Choose the Right Lawyer to Defend You

By now you know just how serious an allegation of Medicare fraud is for you and your business. Now, it’s time to learn how you can minimize the risk of facing those penalties. Your best option is to choose the right lawyer. This lawyer should have the skills and experience to defend you. You must find a lawyer who has experience in the intricacies of health care fraud cases. This is because time is important. You will not have the luxury of time to wait for someone inexperienced to learn more, or for your case to be someone’s first time working in such a delicate and yet dangerous arena. Many people immediately think that they should hire either a health care attorney or a criminal defense attorney. Yet, there’s a problem with both of these.

Those who hire a health care lawyer to assist and defend them from allegations of Medicare fraud may be in for a shock. Through our experience, we know that Medicare fraud is often charged in conjunction with federal criminal allegations such as tax evasion, wire fraud, or money laundering. Most health care lawyers don’t practice criminal law and they don’t have enough experience to help you. They may not be experienced enough to negotiate with the federal government on your behalf. If your case goes to trial, they may not have experience going against federal prosecutors.

Although criminal charges may be involved, the majority of criminal defense attorneys center their practice on the more common and classic criminal defenses, such as drugs, assault, etc. They may not have the experience you need for federal criminal matters, and they most likely won’t understand the finer points of health care law. Health care law isn’t a specific area for most criminal lawyers.

Choosing a Health Care Fraud Defense Lawyer

The ideal attorney Laredo, Texas Medicare fraud defense case is a health care fraud defense attorney. When you’re considering a health care fraud defense lawyer, look for the answers to these four specific questions:

  1. Do they have a track record of success?
  2. Do they have both health care industry and criminal law knowledge?
  3. Do they have intimate knowledge of health care laws?
  4. Do they have experience in litigation?

If the answer is yes to those four questions, then you should move on and ask the lawyer these three questions:

  1. How many Medicare fraud cases have you handled?
  2. Out of those cases, how many resulted in no civil charges, no criminal charges, or dismissals?
  3. How many of the health care fraud cases that you’ve handled did you try in court?

Oberheiden, P.C. Uses Proven Defense Strategies. During the decades that we’ve been defending clients from allegations of Medicare fraud, we’ve handled hundreds of proceedings. Out of those, we took more than several criminal cases to trial. Some of our Health Care Fraud Defense Team members formerly held senior positions within the Department of Justice. These experiences taught us some valuable lessons about the use of proven defense strategies for Laredo, Texas clients. Although each case is different, there are defense strategies that can be used by us right away to help minimize your risk of facing criminal charges.

Early intervention with federal investigators.Our Health Care Fraud Defense Team gets involved early with federal investigators. It’s imperative that we do this so that we limit the amount of time the government has to investigate our Laredo clients uninterrupted. It’s like removing a weed at the root so that it doesn’t have a chance to spread throughout the entire garden. The longer that the government investigates you, the more risk you face that the investigation will turn criminal. Oberheiden, P.C. opens up the channels of communication with federal investigators to get answers to the most important questions:

  1. What is this investigation about?
  2. Who all is under investigation?
  3. Is the investigation civil or criminal?
  4. Which agencies are involved in the investigation?
  5. What started this investigation?
  6. What is the government’s goal?
  7. What can be done to resolve the investigation?

Usually, we can get the answers to these questions within just a few hours after we are retained by our Laredo, Texas clients.

Assert a lack of evidence to support the Medicare fraud charges. The American justice system requires the federal government to provide evidence to show that you committed a crime. They must prove it under a legal standard known as “beyond a reasonable doubt.” Oberheiden, P.C. tests this standard in each case. Doing this has resulted in dismissals, no criminal charges filed, reducing a felony to a misdemeanor, no prison time, and clients only paying civil fines.

Assert a lack of criminal intent. In addition to proving that you committed a crime, the government must also prove that you had criminal intent. Criminal intent, in simple terms, means that you knew what you were doing was a crime, but that you did it anyway. This isn’t just about you, either. It could also be if someone in your Laredo medical practice or business makes a mistake and submits a claim. It is presumed that you knew or should have known what was going on. Yet, Oberheiden, P.C. knows that the majority of Medicare fraud triggers in Laredo, Texas aren’t because someone planned to commit fraud. Our clients are dedicated to the care of their patients and sometimes that focus causes negligence in other areas such as:

  • The hiring and use of unqualified staff
  • Lack of proper supervision
  • Improper delegation
  • Overuse of outsourcing
  • Organizational mistakes
  • Human errors
  • Lack of oversight
  • Employees who feel overwhelmed by their workload
  • Lack of a compliance program
  • Constantly shifting Medicare rules and laws

These errors may be things that need to be addressed, but they’re not criminal acts. Unfortunately, the federal government tries to treat these mistakes as criminal acts. Health care services, businesses, facilities, and providers often just presume that they’re guilty and just accept the charges and penalties. Retaining Oberheiden, P.C. can improve your chances of showing the government that there was no criminal intent.

Utilizing applicable Medicare fraud defense. Oberheiden, P.C. looks at each case individually. This enables us to find and utilize the applicable Medicare fraud defenses for each case. Recently, one of our Medicare fraud cases involved a government allegation that our client fraudulently certified the need for health care. We used a delegation exception to show the government that the certification was fully compliant within the law. In another case, we did not admit liability on behalf of our client. Instead, we showed the government that our client acted within a safe harbor exception.

Oberheiden, P.C.

Oberheiden, P.C. represents Laredo, Texas business owners, health care executives, lawyers, doctors, nurses, entire hospital systems, pharmacies, labs, and other health care businesses. Our Health Care Fraud Defense Team can help you:

  • Identify and implement health care fraud defenses
  • Implement a corporate compliance program
  • Assist with internal investigations
  • Provide qui tam defense
  • Help protect your assets
  • Represent you during licensure or disciplinary proceedings
  • Represent you in a jury trial

If you’re in Laredo, Texas and you’re being investigated by the Department of Justice, Department of Defense, the FBI, the DEA, the Office of Inspector General, HEAT, the Medicare Fraud Control Unit, Laredo or Texas law enforcement, or the IRS, call us right away. The sooner you call us, the sooner we can help. We’re available 7 days a week.

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 Laredo, Texas

Nick OberheidenDr. Nick Oberheiden has used his Harvard training and international education to successfully represent health care executives, business owners, public officials, physicians, and lawyers in high-profile prosecutions, in political corruption scandals, government investigations, and assisted in media campaigns, including 60 Minutes. He is best known for stopping federal investigations before criminal charges are levied. In addition to his health care defense practice, Dr. Oberheiden leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.

Lynette ByrdLynette S. Byrd is a former Assistant United States Attorney (AUSA). Detroit, Michigan clients greatly benefit from Ms. Byrd’s former experience with the Department of Justice where she prosecuted health care fraud, Anti-Kickback violations, False Claims Act and Stark violations. Lynette has immense experience with health care law enforcement and regularly argues federal matters for her clients.

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

1 (214) 469-9009
Including Weekends
Oberheiden, P.C.
Serving Laredo, TX and Surrounding Areas
(800) 810-0259
(214) 469-9009
www.criminaldefense.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden, P.C. is a Texas firm with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503