The Health Care Industry

Today’s health care industry is characterized by a maze of rules and regulations as well as severe penalties for deviations from those rules. As in most professional occupations, the health care industry requires strict compliance with a wide range of regulations and standards of practice. But whereas noncompliance in other careers fields might result in a civil actions or termination, the worst-case scenarios of health care professionals is much more frightening.

Health care non-compliance may result in criminal charges. The penalties for those charges can be severe, and even the best and brightest in the field can find their freedom and their sterling reputations under assault.

Protecting Your Business

Health care fraud is being investigated by the Department for Health and Human Services (HHS), the Department of Justice (DOJ), the Office of Inspector General (OIG), and other federal agencies, such as the FBI and DEA.  Federal health care investigations may result in severe civil penalties and in more severe cases even in criminal prosecution. Effective compliance programs can mitigate these risks.

The Oberheiden & McMurrey, LLP is here to protect medical professionals from allegations of wrong doings. We bring years of experience to the table, coupled with a preparedness to do what it takes to keep our clients on the right side of the law.

We achieved that, principally, on two fronts:

  1. Defending those who’ve been accused of noncompliance, and
  2. Advising medical professionals and organizations as to how they can avoid allegations of noncompliance in the first place.

The United States’ health care laws are incredibly complex – more confusing now than ever. Doctors and health care professionals have enough on their plates without having to worry about dotted “i” on a bureaucrat’s worksheet, but nevertheless, prosecutors are often chomping at the bit to target a respected professional with an unfair allegation of wrongdoing.

The sooner our office gets involved in your case, the better. We recommend contacting us in the earliest stages of an inquiry, audit, or investigation — even if no charges have been filed and you have no reason to suspect that they will be. Our goal is to keep you in compliance, cooperate with investigations, and mount a proactive defense to any potential charges that might be filed.

The stakes couldn’t be higher. Don’t risk making a crucial error during such a sensitive time. With an experienced law firm on your side, you can maximize your chances for an optimal, best-case-scenario outcome.

Allegations of Non-Compliance

Health care fraud can result in serious penalties.  Any individual or business that contracts with and is paid by the U.S. government or does business that involves federally funded patients, whether directly or indirectly, is subject to federal health care fraud statutes.  The following sectors are under increased scrutiny:

  • Hospice Care Centers
  • Home Health Centers
  • Compound Pharmacies
  • Toxicology Laboratories
  • Physician Owned Entities
  • Hospitals
  • DME Companies
  • Physicians and Providers
  • Health Care Executives
  • Business Owners

Everyone makes mistakes. That is true of the most careful and accomplished among us. It is our belief that you shouldn’t have to pay for an error in judgment with your reputation and freedom.

As Tyler health care compliance attorneys, we have helped numerous nurses, physicians, pharmacists, administrators, and business organizations in the face of health care compliance violations. We are ready to put our proven strategies to work for you, holding the government accountable to the highest standards while preserving your business operations and your reputation.

Our goals are clear: achieve compliance, bring active investigations to an end, and achieve a dismissal of any pending charges against our clients.

Law Enforcement in East Texas on the Rise

Medical professionals face more scrutiny today than at any other time in American history. There are a few reasons for that. Recent studies revealing rampant financial losses due too fraud, abuse, and waste have prompted lawmakers to demand action from law enforcement. At the same time, legislatures and advocacy groups have introduced additional funding for fraud investigations. Increased political unrest has put new pressures on law enforcement agencies too.

Meanwhile, recent changes in the health care laws have increased the likelihood that mistakes are being made — the sheer result of confusion about what the law now requires.

Unfortunately, good practitioners — many of them innocent — get swept up in the new urgency to identify and prosecute abuse. That isn’t fair, and we’re here to fight it. While a wide range of errors may constitute health care compliance violations, the most common allegations involve:

  • Illegal kickbacks
  • Medicare fraud
  • Medicaid fraud
  • Falsifying medical records
  • Providing unnecessary care
  • Upcoding
  • Fraudulently billing for treatment
  • Bribes
  • Fraud related to prescriptions (these may overlap with criminal drug charges)
  • Any other misrepresentation of criminal omission related to health care compliance

Serving East Texas

If you are being investigated for fraud or if you want to take preemptive steps by having experienced attorneys review your existing or proposed contracts, you should engage attorneys that understand your industry and that can protect you from government scrutiny. The attorneys at Oberheiden & McMurrey, LLP now represent individual and corporate clients in East Texas.

nick-oberheidenDr. Nick Oberheiden has successfully defended health care executives, physicians, hospitals, laboratories, pharmacies and many other businesses against kickback, prescription fraud, false claims, and fraud allegations before the Office of Inspector General (OIG), Department of Justice (DOJ), Department of Defense (DOD), IRS, FBI, DEA, and other agencies.
lynette-byrdLynette S. Byrd served the U.S. Attorney’s Office as federal prosecutor and conducted civil health care investigations under Stark Law, False Claims Act, Anti-Kickback and other statutes.

Our Experience

Our experience in the health care industry is long and profound. We have advised health care executives, physicians, marketing groups, and businesses from virtually all sectors of the health care industry on corporate compliance, crisis management, employment matters, health care litigation, and health care fraud defense strategies. Among these industries are:

  • Home Health Centers
  • Hospice Care Centers
  • Hospitals & Surgery Centers
  • Pharmacies
  • Compound Pharmacies
  • Toxicology Labs
  • DNA & Blood Testing Centers
  • Individual Physicians
  • Health Care Executives

What makes our experience in health care compliance unique is the fact that we not just have former health care prosecutors on the team that know the government’s protocols and strategies, but also health care fraud defense attorneys that have constant interactions with the government in civil and criminal investigations. We have concluded a great number of these investigations with the result of no liability and no criminal charges for our clients and we apply that knowledge to the front end when we provide regulatory advice and establish effective compliance programs.

Health Care Fraud Defense & Compliance

  • Investigation by the Department of Health and Human Services for alleged False Claims Act and Stark Law violations
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services for alleged False Claims Act and Stark Law violations
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Defense and the U.S. Attorney’s Office for alleged Tricare Fraud
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Office of Inspector General and the U.S. Attorney’s Office for alleged Medicare Fraud
    Result: No civil or criminal liability, case dismissed.
  • Investigation by the Department of Health and Human Services for alleged False Claims Act and Stark Law violations
    Result: No civil or criminal liability, case dismissed.
  • Defense of nationally operating health care provider 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, case dismissed.
  • 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, case dismissed.

If you are under federal investigation or if you want to discuss steps to avoid federal scrutiny, you contact us to speak with one of our experienced health care fraud defense attorneys serving Tyler and East Texas today. All calls are free and confidential.

Oberheiden & McMurrey, LLP
903-472-0000
Call Us Today

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 & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.