Texas Medicare Fraud Defense Lawyer

What Medicare Fraud Investigations Can Mean for Your Practice

Receiving notice of a Medicare audit or investigation can be overwhelming. Regulators and contractors like CMS, OIG, or UPIC often spend months reviewing your billing data before contacting you. By the time you receive a letter or subpoena, they may already believe violations occurred. The stakes are high, including fines, recoupment of funds, exclusion from federal programs, and possible criminal exposure.

Common issues that lead to Medicare investigations include:

• Billing for services not rendered
• Upcoding or unbundling claims
• Failing to document medical necessity
• Referrals that violate Stark Law (self-referral rules)
• Alleged kickbacks under the Anti-Kickback Statute
• Duplicate billing or improper use of provider numbers
• Overpayments not returned within 60 days

Civil penalties for confirmed violations can reach tens of thousands of dollars per claim, and criminal penalties can include prison time. Losing Medicare billing privileges can shut down your business entirely. Understanding what triggered the investigation is the first step in building a defense. Our team acts quickly to gather the facts, communicate with investigators, and protect your rights.

Defense Strategies for Medicare Fraud Cases

Every case is different, but the goal is the same: keep the case civil, avoid criminal prosecution, and resolve it in a way that allows you to continue practicing. We work to challenge flawed audits, question data sampling methods, and present evidence that supports the legitimacy of your billing practices.

Our defense process can include:

• Immediate review of audit letters, subpoenas, or CID requests
• Collecting and reviewing patient records and billing data
• Preparing formal responses to investigative agencies
• Negotiating repayment amounts when overpayments are proven
• Filing appeals of wrongful denials or revocations
• Seeking reinstatement of billing privileges if suspended

In many cases, we have been able to reduce alleged overpayment amounts, get billing privileges reinstated, or convince agencies not to refer cases for criminal prosecution. These outcomes can save providers from devastating financial and reputational harm.

Stark Law and the Anti-Kickback Statute

Two of the most common issues that lead to Medicare fraud allegations involve Stark Law and the Anti-Kickback Statute. Stark Law prohibits physicians from referring Medicare patients to entities with which they have a financial relationship, unless an exception applies. The Anti-Kickback Statute makes it illegal to offer, pay, solicit, or receive anything of value in exchange for referrals of federal healthcare program business.

Violations of these laws can result in severe penalties, including treble damages, exclusion from federal programs, and even criminal charges. Our attorneys understand how to review referral relationships, analyze contracts, and argue for safe harbor protections when applicable.

Agencies and Investigations We Handle

Medicare fraud defense often involves multiple agencies and contractors. We represent clients in actions brought by:

• Centers for Medicare and Medicaid Services (CMS)
• Office of Inspector General (OIG)
• Qlarant, Novitas, and other Medicare contractors
• Department of Health and Human Services (HHS)
• Texas Medical Board (TMB) and Board of Nursing (BON)
• State Medicaid Fraud Control Units

Our experience allows us to work directly with these entities to resolve investigations before they escalate. We know their processes, timelines, and what evidence they look for when deciding whether to escalate a case.

Who We Represent in Healthcare Fraud Investigations

Dike Law Group represents healthcare professionals and organizations across Texas, including:

• Physicians, surgeons, and specialists
• Ambulatory surgery centers
• Durable medical equipment suppliers
• Diagnostic testing facilities
• Home health agencies
• Pharmacies and pharmacists
• Hospitals and medical groups
• Nurse practitioners and physician assistants
• MSOs and healthcare executives

Whether you are a solo provider or a large healthcare organization, we tailor our defense to fit the scale of your business and the severity of the investigation. We understand how stressful these situations can be and work to protect your future.

Common Types of Cases We Defend

Our attorneys have handled thousands of healthcare-related matters, including:

• False Claims Act allegations
• Stark Law and Anti-Kickback Statute violations
• Billing for services under improper credentials
• Telehealth and telemedicine fraud claims
• Medicare and Medicaid exclusion cases
• RAC, UPIC, and ZPIC audits
• Prescription drug and compounding pharmacy investigations
• TRICARE fraud audits
• Medical license defense and board actions

We often work with experts to analyze claims data, review documentation, and build a strong factual record. This helps us show investigators that alleged violations were the result of errors, not intentional fraud.

Why Acting Quickly Matters

Time is not on your side when dealing with a fraud investigation. The longer you wait to respond, the more control the investigating agency has over the narrative. Early intervention allows us to open lines of communication, provide documentation, and potentially stop a civil matter from turning criminal.

We encourage clients to contact us as soon as they receive any of the following:

• Letter from CMS, OIG, or a Medicare contractor
• Subpoena or Civil Investigative Demand (CID)
• Notice of payment suspension or revocation of billing privileges
• Request for records related to patient services

Acting fast gives us the chance to control the flow of information, protect you from making statements that could be used against you, and start shaping a defense strategy from day one.

Protecting Your License and Reputation

Healthcare professionals spend years building their careers. A single investigation can put all of that at risk. Our focus is not only on legal defense but also on safeguarding your professional reputation. We handle cases discreetly to keep matters confidential whenever possible and work toward resolutions that allow you to continue practicing.

We understand that your patients, colleagues, and partners depend on you. That is why we fight to protect your name and ensure that your ability to practice medicine is preserved.

Proactive Compliance Services

Avoiding investigations is always better than defending one. We also help providers strengthen their compliance programs to reduce risk. Our services include:

• Drafting and reviewing compliance plans
• Reviewing and updating medical contracts
• Training staff on billing and documentation requirements
• Conducting internal audits to identify problem areas
• Advising on referral relationships and joint ventures

By addressing compliance issues early, we help clients avoid civil penalties, fines, and the stress of government audits.

Why Choose Dike Law Group

Our team has years of experience helping healthcare providers through audits, investigations, and compliance challenges. We know the unique pressures of running a medical business because we have been through it ourselves. We approach every case with determination to protect your livelihood and your ability to serve patients.

• Clients trust us because we:
• Have a track record of resolving cases efficiently and discreetly
• Focus exclusively on healthcare, business, and compliance law
• Understand the complexity of Medicare regulations
• Offer personal attention and clear communication throughout the process

Serving Texas Cities: Houston, San Antonio, Dallas, Fort Worth, Austin, El Paso, Arlington, Corpus Christi, Plano, Lubbock, Laredo, Irving, Garland, Frisco, McKinney, Denton, Midland, Abilene, Waco, Tyler, Beaumont, Odessa, Round Rock, Carrollton, Lewisville, McAllen, Wichita Falls, San Marcos, Galveston, Nacogdoches, Amarillo