Texas Medicare Fraud Defense Lawyers

Health care fraud takes on many forms and can range from small misdemeanors to huge multi-million dollar operations that result in felony charges. Because Medicare billing is largely based on a honor system, there are a large number of organizations and authorities on both the federal and state level that lead health care fraud investigations and press health care fraud charges in order to uphold the law.

Health care fraud and Medicare fraud investigations are common, but all too often cases, are not valid or are not supplemented with the appropriate evidence. At The Criminal Defense Firm, we are dedicated to helping medical professionals, home health care centers, pharmacies, rehabilitation centers, and others defend against claims and charges of fraud across Texas.

Our Texas Medicare fraud defense lawyers accept calls seven days a week and are ready to help you immediately by providing you with information about Medicare fraud, by finding out as much as possible about your fraud investigation, and by ultimately working with you and the system to secure the optimal outcome for your case.

Medicare Fraud in Texas

In 2015, over 3.6 million Texans took advantage of Medicare benefits more than any other state except for California and Florida. Because of the large number of beneficiaries as well as the large number of medical professionals and medical suppliers, it is no surprise that the state is also among those that lead the nation in Medicare fraud.

In fact, the largest known case of home health care fraud by a single doctor in the United States took place in Texas in April 2016. According to the Dallas News, Former Rockwall doctor Jacques Roy was found guilty of Medicare fraud by a federal jury, resulting in the loss of his medical license as well as up to 80 years in federal prison. The doctor along with several cohorts was convicted of bribing 11,000 patients with food stamps, money, and groceries as part of a Medicare scam that resulted in over $400 million in stolen funds.

Like many of those under investigation today, Roy was caught from data analysis by the Department of Health and Human Services (HHS), which found that Roy had far too many patients for a single practitioner. HHS is just one of many organizations that conduct Medicare fraud investigations, including:

• The United States Department of Justice (DOJ)
• The United States Department of Defense (DOD)
• The Federal Bureau of Investigation (FBI)
• The Drug Enforcement Administration (DEA)
• The Office of the Inspector General (OIG)
• The Medicaid Fraud Control Unit (MFCU)
• The Medicare Fraud Strike Force (MFSF)
• The Internal Revenue Service (IRS)
• The Health and Human Services Centers for Medicare & Medicaid Services
• Texas State Police

The fight against Medicare fraud in Texas has also been strengthened by the passage of Senate Bill 8 in 2013. This bill improved health care fraud investigations by establishing the data analysis team at the Health and Human Services Centers for Medicare & Medicaid Service, making the consequences of health care fraud more severe, and strengthened the laws against health care fraud across the state.

Understanding Texas Medicare Fraud

Legally, Medicare Fraud is the deliberate submission of false or fictitious claims to the Medicare health care program in order for financial gain. Because Medicare is a trust-based system, some doctors, medical facilities, and medical supply/equipment companies may attempt to defraud the government through false billing, bribing patients, and scams.

While Medicare fraud can take on an almost unlimited number of forms, the most common types of Medicare fraud include:

• Phantom billing.
• Billing for medically unnecessary services, supplies, or equipment.
• Billing for medical supplies that were never ordered or returned medical supplies.
• Billing services that are not covered by Medicare as services that are covered by Medicare.
• Certification for services or supplies that were medically unnecessary
• Double billing, unbundling of services, or inflating bills.
• Up-Coding.
• The offering of or accepting of kickbacks.

Medicare fraud laws are outlined in a number of legal codes and acts, including:

• The False Claims Act
• The Anti-Kickback Statute
• The Physician Self-Referral Laws (Stark Law)
• The Social Security Act
• The U.S. Criminal Code

What Are the Consequences Of Medical Fraud Conviction?

The penalties associated with Medicare fraud are significant and can have lifelong consequences. Four of the major consequences include:

• Restitution. First and foremost, those convicted of Medicare fraud are often required to pay back the money that was wrongfully taken from the Medicare program. Restitution amounts depend on the scope and scale of the fraud and are collected in addition to other fines.

• Heavy fines. Because of the financial nature of these crimes, the fines for health care fraud can be astronomical. For example, the fine for making a false statement regarding Medicare fraud is $250,000 for an individual and $500,000 for an organization. Those associated with Medicare large scams and schemes can be fined millions of dollars in total.

• Federal prison. Making a false statement regarding Medicare fraud can result in five years in a federal prison, while one count of Medicare fraud can result in ten years in federal prison. Fraud that results in the injury or death of a patient is associated with even longer sentences.

• Professional consequences. Medical professionals like doctors may have their license to practice medicine suspended or revoked, depending on the charges. In addition, according to Senate Bill 8 in Texas, medical professionals may lose their ability to participate in government health care programs in the future.

Finding The Right Medicare Fraud Defense Attorney

Being investigated for health care fraud does not mean that the above consequences are inevitable. In fact, a significant number of investigations do not result in charges because authorities find a lack of evidence or a lack of intent. Working with an experienced, knowledgeable legal team during the investigation can be vital in:

• Preventing charges.
• Getting charges dismissed.
• Getting charges reduced.
• Fair sentencing.

Many people and organizations are unsure of where to turn when it appears they may be charged with Medicare fraud. Some may believe that turning to a general criminal defense attorney is the best choice, while others may find a lawyer with general experience with cases involving health care law. However, finding an attorney or firm that has specific experience with health care fraud and Medicare fraud are best suited to secure the optimal outcome for your case.

It is always recommended to speak to potential attorneys during an initial consultation before making your decision. During these meetings, it is imperative to ask the following questions:

• Have you handled a Medicare case similar to mine? How many and how often?
• What is your background in handling these cases?
• What is your process for handling these cases?
• What are my best defenses from what you know so far about my case?
• How much trial experienced do you have relating to Medicare fraud?
• How do you charge for your legal services?

The Criminal Defense Firm Medicare Fraud Case Results

• Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• 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.

• Defense of Medicare laboratory 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.

• Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• 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.

• Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
  Result: No civil or criminal liability.

• 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.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• 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.

• Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

Our Health Care Fraud Defense Attorneys

The above case results could not be possible without the hard work, knowledge, and passion of our Medicare fraud defense attorneys.

Contact The Criminal Defense Firm Today

One of the single best actions you can take when confronted with a Medicare fraud investigation is to act quickly and to mobilize with experienced and knowledgeable attorneys at your side. At The Criminal Defense Firm, we understand the importance of early intervention and will immediately begin to take action on your case.

We offer private consultations to individuals, businesses, and groups who may need our legal services. Call us today to schedule a meeting or simply to ask a question.