DEFENDING MEDICARE FRAUD IN HOUSTON

Medicare Fraud Is a Major Focus of Federal and Regional Law Enforcement Agencies

An unfortunate side effect of Houston’s booming medical industry is an increase in Medicare fraud in the Houston area and the accompanying increased scrutiny from federal healthcare fraud investigators. With Houston medical services providers under constant surveillance from federal authorities, even honest providers in the Houston area are increasingly finding themselves as the targets of healthcare fraud investigations.

Nationwide, the federal government has been cracking down on Medicare fraud over the past decade. In 2009, the Department of Justice (DOJ) joined with the Department of Health and Human Services (HHS) to create the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a federal investigative task force dedicated to combatting Medicare fraud nationwide. HEAT oversees regional Medicare Fraud Task Forces in nine cities throughout the country that have been named as “hot spots” for Medicare fraud. The Medicare Fraud Task Forces combine the efforts of federal, state, and local law enforcement agencies to fight fraud in their regions. Houston is one of the country’s centers for healthcare fraud investigations.

Penalties for Medicare Fraud

The punishment for Medicare fraud includes both civil and criminal penalties. In each case, the federal prosecutors have the discretion as to whether they pursue civil penalties, criminal penalties, or both civil and criminal penalties. Federal prosecutors are increasingly seeking both civil and criminal penalties against defendants for the same criminal activities. In some cases, prosecutors will pursue criminal activities against a provider and civil penalties against that provider’s business or practice for the same underlying criminal activities. Therefore, any Houston medical provider under investigation for Medicare fraud has a lot at stake pending the outcome of the investigation.

Civil Penalties. Civil penalties are monetary. They include fines of $10,781 – $21,563 per count of Medicare fraud. Additionally, a provider may have to pay up to three times the government’s damages incurred because of the provider’s fraudulent conduct, besides the government’s legal costs incurred for prosecuting the case. Most providers found guilty on civil charges of Medicare fraud will also be temporarily or permanently excluded from participating in federal healthcare programs, meaning they will be unable to seek payment from the programs for treating their beneficiaries.

Criminal Penalties. Criminal penalties are the most serious potential consequences of a Medicare fraud investigation, and they include incarceration and probation. A criminal conviction for Medicare fraud may result in up to 10 years of incarceration in federal prison per count of Medicare fraud. The penalties may be even more severe if aggravating circumstances are proven in the case. When a provider’s Medicare fraud results in serious physical injury to a patient, that provider may face up to 20 years in prison for each relevant count of fraud. Additionally, where a provider’s Medicare fraud results in the death of a patient, that provider may face up to life in prison. As with civil penalties, most providers found guilty of criminal Medicare fraud will be temporarily or permanently barred from participating in federal healthcare programs.

Our Defense Strategy

With such severe penalties on the line for our clients, Oberheiden, P.C. is dedicated to achieving the best possible outcomes from Medicare fraud investigations. Our number one priority in each case is to help our clients avoid criminal charges. Relying on the experience of former prosecutors and veteran healthcare fraud defense attorneys, we have developed proven defensive strategies to help our clients achieve successful outcomes. Our defensive strategy stems from these principles:

Early Intervention. We do not wait until a client has received criminal charges to get involved in their case. The minute our clients find out about a Medicare fraud investigation, we spring to action formulating a tailored defense for each client. From our experience, the earlier an attorney intervenes on behalf of the target of an investigation, the more likely that person will be to escape criminal charges. Therefore, we immediately take over all communications with the government on behalf of our clients, including responses to any subpoena requests. We assist our clients throughout the investigation, helping them make critical strategic decisions about their case.

No Criminal Charges. For every Medicare fraud investigation, our top priority is preventing criminal charges against our clients. We rely on our experience as former federal healthcare prosecutors and former federal healthcare investigators to interpret and anticipate the actions of the federal government in the investigations. In this way, we analyze if our client should speak to federal investigators or negotiate with prosecutors. At all times, we serve as the spokesperson on behalf of our clients to ensure that our clients do not inadvertently incriminate themselves or induce additional suspicion from investigators.

Depth of Understanding. All the attorneys at Oberheiden, P.C. are familiar in healthcare laws and regulations. In addition, we have a comprehensive understanding of how the healthcare industry operates on both a micro and macro level. Our clients therefore need not waste time or money teaching us about their practices or their businesses, billing codes, or terminology.

Our Success Stories

Oberheiden, P.C. represents clients in Houston and throughout the United States facing investigations by the DOJ, the HHS, the OIG the FBI, the DEA, and other federal agencies. Our clients include doctors, pharmacies, laboratories, hospitals, home health agencies, hospice agencies, medical marketers, and business owners. Our success stories include:

Successful Defense of a Healthcare Business against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud.