Whether they are civil or criminal charges, health care fraud charges can be very serious, resulting in severe punishments either way.
Health care fraud is a serious, if sometimes unfounded, charge.
Health care fraud charges can be civil charges or criminal charges. An early response from your Houston health fraud attorney can keep a civil investigation from becoming a criminal investigation leading to much harsher penalties.
If you face a charge of health care fraud in the Houston area and need a legal defense, notify veteran Houston white collar crime defense lawyer Neal Davis for a confidential legal review of your case.
Punishments for Health Care Fraud
With civil charges, physicians and other health care providers may lose their hospital privileges and their license to practice. Other civil case penalties may involve exclusion from federal healthcare programs, non-payment of future claims and repayment of existing claims.
As for criminal punishments for health care fraud, persons who are charged and convicted can be fined hundreds of thousands of dollars. They also face a criminal record and may have to serve time in a federal prison.
Enforcing prison time as a punishment for health care fraud is dependent on a number of elements in the case. These include the government’s reason for investigating the fraud, the prosecution’s intent when it comes to criminal charges and whether a patient suffered a severe injury or death due to health care fraud.
Keep in mind that about one-fourth of healthcare fraud cases involve individual health care practitioners – with the remaining three-fourths involving individual health care businesses. In any event, contact the Neal Davis Law Firm for help.
If a federal prison sentence is handed down, it can involve:
- As much as 20 years in prison for each count of health care fraud causing a patient’s serious injury
- As much as 10 years in prison for each count of health care fraud
- A life sentence in prison if a patient died due to health care fraud
Texas Health Care Fraud Cases
Throughout America, agents of the federal government are making sweeping arrests alleging misuse of the health care system. Some of these cases involve millions of dollars in alleged health care fraud, and often the federal focus is in Texas.
In fact, the Houston area reportedly is among nine places in the U.S. being monitored closely by federal authorities for alleged increases in health care fraud. That stems from the Houston area having a vast number of residents relying on federal healthcare programs and making claims for reimbursement.
Among last year’s health care fraud investigations in the Southern District of Texas (SDTX), including Houston, were charges against 22 persons in 11 different cases. The Department of Justice Medicare Fraud Strike Force and the U.S. Attorney’s Office (USAO) made these charges while alleging more than $135 million in health care fraud.
The defendants included a Houston physician charged with four counts of conspiracy to commit health care fraud by billing Medicare for Medicare beneficiaries’ home health services which were not medically necessary and often were not provided. This alleged scheme involved Medicare paying more than $15 million to many services which made claims to Medicare for fraudulent home health referrals.
In another case, charged with one count of conspiracy to commit health care fraud was the owner of a Houston clinic who allegedly sold signed certifications to home health agencies. These agencies then billed Medicare for home health services which were not medically necessary, were not provided, or both.
The USAO also prosecuted another Houston area case involving a rehabilitation center in Missouri City. That case alleged a $15 million health care fraud conspiracy.
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Types of Health Care Fraud
Health care fraud can mean many things.
Among the different kinds of health care fraud are the following:
- Stark Law violation: Also called the Self-Referral Law, the Stark Law prohibits physicians from referring patients to health care services of the physician or a member of his or her family who has a financial stake in such claims. (Stark is the name of a U.S. congressman who introduced the bill in 1988.)
- Errors in certification: A frequent allegation by federal authorities is fraudulent certification in the hospice and home health care industry.
- Billing fraud: One example of this is when claims are upcoded. That means the federal government is billed for the next higher amount. Billing fraud can also involve billing for services which were not needed medically, billing for services which were not provided (phantom billing) and billing for patients who do not exist (ghost billing).
- Violating the False Claims Act: Inaccurate claims to federal healthcare programs are violations of the False Claims Act. Authorities may explore billing procedures to determine if the act’s criminal provisions have been violated. Fines can be three times the total amount of the false claims and another $5,500 to $11,000 for each false claim.
- Prescription fraud: When health care providers prescribe an unusually large amount of narcotic drugs, federal officials often investigate. It then can be determined if the providers are violating dispensation rules of the Drug Enforcement Administration and are conducting a “pill mill” operation.
Defending Against Health Care Fraud Charges
The Neal Davis Law Firm can lead your attack in defending against charges of health care fraud. Such defense requires an in-depth knowledge of the intricate and elaborate federal laws pertaining to health care fraud.
Your Houston area health care fraud lawyer also must grasp the pertinent criminal statutes, Medicare guidelines and Health and Human Services regulations involved in such charges.
Also crucial is a keen understanding of the notification requirements, deadlines and collateral consequences resulting from a health care fraud charge.
In addition, defending against a charge of health care fraud may involve an attorney scouring hundreds of records and engaging experts. Such defense is especially important in the early stages of an investigation, in order to preempt or even prevent formal charges being made.
Named a Best Lawyer in America (2015-2022) for criminal defense and ranked among the top of Texas attorneys in white collar fraud, Houston criminal defense lawyer Neal Davis is known for getting results. For many defendants who have faced various charges, Neal Davis has succeeded in getting the charges dropped or preventing them from being filed in the first place.