Three persons have been charged in Houston for participating in a nearly $7 million Medicaid fraud and kickback scheme involving a local dental clinic, says United States Attorney for the Southern District of Texas Alamdar S. Hamdani.
According to My Texas Daily, one suspect, of Humble, was arrested last week. Two others, from Houston, were arrested on a similar charge last August and now face a superseding indictment.
The charges allege that one of the Houston men operated the Floss Family Dental Care clinic in Houston, while the other two men served as the clinic’s managers.
The superseding indictment asserts that the first man and other clinic employees submitted fraudulent claims to Medicaid for pediatric dental services, including cavity fillings that were either not provided by the clinic or were not conducted by licensed persons.
The indictment also alleges that the clinic employed an unlicensed individual to practice dentistry under the operator’s direction and that Medicaid was billed as if the services were provided by a licensed dentist.
The three defendants are also accused of paying kickbacks to marketers and to caregivers of Medicaid-insured children in order to bring them to the Floss clinic for dental services. In addition, the indictment claims that the clinic’s operator laundered Medicaid funds from the Floss business account to his personal bank account via multiple transactions in excess of $100,000.
The indictment also claims that between 2019 and 2021, the dental clinic billed Medicaid almost $6.9 million, which resulted in about $4.9 million in payments to the clinic from Medicaid.
Each of the three defendants could face substantial fines and prison time if convicted. The charges against them include:
- Money laundering,
- Conspiracy to pay and receive kickbacks,
- Payment of healthcare kickbacks,
- Conspiracy to commit healthcare fraud, and
- Healthcare fraud.
The investigation of this Houston healthcare fraud case was conducted by the Texas Attorney General’s Medicaid Fraud Control Unit, the Department of Health and Human Services’s Office of Inspector General and the FBI.
Prosecuting the case are Assistant U.S. Attorney Grace Murphy and Special Assistant U.S. Attorney Kathryn Olson.
Get an experienced Houston healthcare fraud defense lawyer
Persons who face an accusation, claim or charge of healthcare fraud in the Houston area must engage a knowledgeable and experienced healthcare fraud defense lawyer to protect their legal rights.
The case above involves federal fraud charges, though fraud charges can also be made based on Texas laws, depending on the nature of the fraud crime. Texas fraud charges can involve the following:
- Fraudulent misrepresentation
- Fraudulent inducement
- Fraudulent nondisclosure
- Statutory fraud
- Fraudulent transfer
- Negligent misrepresentation
As for federal healthcare fraud crimes, the punishments for these crimes can be quite severe:
- For one count of healthcare fraud, a defendant can face up to 10 years in prison.
- For one count of healthcare fraud causing serious injury to a patient, a defendant can face up to 20 years in prison.
- For one count of healthcare fraud causing death to a patient, a defendant may be sentenced to life in prison upon conviction.
The Houston area is reportedly among the top places in the United States being monitored closely by federal authorities for healthcare fraud. That owes in part to the fact that the Houston area has a large number of residents who rely on federal healthcare programs, and those programs can involve claims for reimbursement—claims that must be valid.
Healthcare fraud can take many forms
The many forms that healthcare fraud can take include the following:
- Billing fraud, which can occur when a claim is upcoded and the federal government is billed for the next higher amount. Billing fraud may also mean services were billed to the federal government that were not needed medically or were not even provided (known as “phantom billing”). Billing fraud may also mean that charges for non-existent patients were billed to the federal government (known as “ghost billing”).
- Prescription fraud, which often involves healthcare providers prescribing an unusually large amount of narcotic drugs. The providers then may be found to be violating dispensation rules of the Drug Enforcement Administration in order to conduct a “pill mill” operation.
- Violating the False Claims Act, which occurs when inaccurate claims are made to federal healthcare programs. Authorities can probe billing procedures to see if the False Claims Act’s criminal provisions have been violated. Upon conviction, a defendant can face a fine that is 3 times the total amount of the false claims, along with $5,500 to $11,000 for each false claim.
- Stark Law violations, or violating a law also known as the Self-Referral Law. That law prohibits physicians from referring patients to healthcare services of the physician himself or herself, or referring patients to healthcare services of another member of his or her family who has a financial stake in such claims.
- Errors in certification, which involve fraudulent certifications in the hospice and home.
Defenses against healthcare fraud charges
A skilled healthcare fraud defense attorney can use a number of defenses against such charges. In order to do so, a defense lawyer must have substantial knowledge of the elaborate and complex federal laws against healthcare fraud and pertinent criminal laws, Medicare guidelines and Health and Human Services regulations.
Your Houston healthcare fraud defense lawyer must also understand notification requirements, deadlines and collateral consequences that can play a part in a healthcare fraud charge.
Fraud can take many forms
Fraud can also involve cybercrimes such as internet “phishing” to mislead people in order to gain their personal information, as well as fraud to claim unemployment or other benefits.
Additionally, fraud can involve such crimes as:
All such offenses are crimes that can lead to years in prison and high fines if convicted.
The Neal Davis Law Firm has won awards for handling white-collar crime cases. If you live in Houston, Sugar Land, The Woodlands, Conroe or elsewhere in the Houston area, contact us today to arrange a confidential consultation for your fraud case.