Health Care Fraud and Compliance Violations Attorney Serving Tyler and all of East Texas

Health care fraud has been receiving increased government attention in the Eastern District of Texas. In this context, health care fraud is a broad term that refers to the submission of a fraudulent or false claim to a government program such as Medicare, Medicaid, Tricare, or federal workers’ comp. Also covered by that description are illegal financial relationships between referring health care providers and businesses, often referred to as kickbacks.

  • Medicare Fraud
  • Tricare Fraud
  • DOL/Workers Comp
  • False Claims Act
  • Stark Law (Physician Self-Referrals)
  • Anti-Kickback Violations

Health care fraud is a serious offense and not an area to experiment with. Mistakes in the handling of an OIG or Grand Jury subpoena, or investigations by law enforcement could result in years of incarceration in federal prison. The aggressive prosecution of health care fraud in Tyler and surrounding communities in recent times requires you to choose defense attorneys that have (1) a profound understanding of health care regulations, (2) proven experience with government investigations, and (3) an impeccable track record in the specific area of health care law.

Who Are the Targets?

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

What Are the Penalties?

Health care fraud is prosecuted by the FBI, the Department of Justice (DOJ), the Department for Health and Human Services (HHS), the Department of Justice (DOJ), the Office of Inspector General (OIG), and other federal agencies. Lately, there has been a trend of involvement by the Drug Enforcement Administration (DEA) and state drug enforcement agencies as well, particularly in the area of compound drugs and pharmacy investigations. Health care fraud may be investigated in one of two ways:

  • Civil Liability:
    In many cases, investigations result in only civil liability. In these cases, defendants will be found liable for civil fines of up to $11,000 per false claim as well as recoupment requests, non-payment of any future claims, exclusion from participation in other federal health care programs, triple damages, and attorney’s fees. Such findings are most often imposed against companies, but may also be levied against individuals such as the CEO or CFO of the company.
  • Criminal Charges:
    In other cases, a federal investigation can lead to criminal charges for the individuals involved. If this happens, federal prosecutors indict the responsible individuals before the U.S. District Court and seek incarceration in federal prison on a guilty finding. These cases require an experienced attorney who understands both federal criminal procedure and health care law.

Importantly, criminal liability for federal health care fraud does not require any specific intent to violate the law. In fact, the government does not even need to prove that an individual knew that the transaction was fraudulent or illegal. The federal standard is: should-have-known.

Tyler Criminal Defense Attorneys for Alleged Health Care Compliance Violations

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 career fields might result in a civil action or termination, the worst-case scenario for health care professionals is much more frightening.

In many contexts, health care noncompliance results 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.

Oberheiden & McMurrey, LLP is here to protect medical professionals from allegations of wrongdoing. 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 achieve 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 every 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.

Everyone makes mistakes. That is true even 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 Is Cracking Down on Health Care Compliance

Medical professionals face more intense scrutiny today than at any other time in American history. There are a few reasons for that. Recent studies revealing rampant financial losses due to 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 compliance now requires.

Unfortunately, good practitioners — many of them innocent — get swept up in this new urgency to identify and prosecute abuse. That isn’t fair, and we’re here to fight it.

Examples of Criminal Health Care Compliance Allegations

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 relating to prescriptions / filling prescriptions (these may overlap with criminal drug charges)
  • Any other misrepresentation or criminal omission related to health care compliance

Early Action

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.

What Type of Lawyer Do I Need?

If you are being investigated for fraud, you need a team of experienced attorneys that understand the complexities of health care rules as well as the nuances of federal criminal procedure. You need attorneys that know how to avoid criminal charges in health care investigations. At Oberheiden & McMurrey, LLP, you will find a team of passionate, dedicated, and experienced attorneys.

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 record in health care fraud defense shows results of no civil and no criminal liability for clients involved in investigations of Medicare fraud, Tricare fraud, Medicaid fraud, OIG investigations, DOL fraud cases, and allegations of violations of the False Claims Act, Stark Law, and Anti-kickback investigations. We pride ourselves for bringing our experience and skillset to the East Texas community. Compare for yourself, this is our track record:

Health Care Fraud (Recent Case Results)

  • Defense of laboratory against investigations by the Department of Defense and the U.S. Attorney’s Office for alleged Medicare Fraud
    Result: No civil or criminal liability, case dismissed.
  • Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Medicare fraud.
    Result: No civil or criminal liability, case dismissed.
  • 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, 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 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, case dismissed.
  • Defense of a surgical implant company against an investigation by various branches of the federal government for alleged 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.
  • Defense of a physician owned entity against an investigation by the Office of Inspector General for alleged fraud.
    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 should speak with one of our experienced health care fraud and compliance defense attorneys today. All calls are free and confidential.

Oberheiden & McMurrey, LLP
(800) 810-0259
Call Us Today

Free Case Review with Tyler Health Care Compliance Attorneys

To get started with a free case review, please contact our Tyler health care compliance attorneys right away. We can review the facts of your case and help you determine your best steps for moving forward.

Reach out as soon as possible — time is of the essence.

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.