Houston Medicare Fraud Defense Attorneys

Providing Experienced Legal Defense for Health Care Fraud Charges in the Houston, Texas Area

The Criminal Defense Firm is a health care law defense firm that works cases in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Among our diverse and tested group of attorneys is the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force. Our lawyers have years of relevant experience, and many studied at the country’s top law schools. We serve clients in Houston and throughout the state of Texas.

According to a recent article in the Houston Chronicle, almost 200 people in the greater Houston area have been charged with health care fraud in the past seven years and 136 have been convicted. All in all, the convictions account for a staggering $650 million in fraudulent Medicare and Medicaid billing. Clearly, Medicare fraud is a serious problem in Houston, in Texas, and across the country and a number of authorities are cracking down on scammers, from the United States Department of Justice to the Federal Bureau of Investigation (FBI).

At The Criminal Defense Firm, we understand the serious implications of Medicare fraud. We also understand that some practitioners, organizations, and businesses may wrongly be investigated for or charged with Medicare fraud. Our Houston Medicare fraud defense attorneys are dedicated to studying health care law, understanding the issues surrounding health care fraud, and helping their clients successfully navigate Medicare fraud cases from beginning to end.

We assist clients with:

• Health care fraud defense
• Medicare fraud defense
• Compliance programs
• Internal investigations
• Qui Tam (whistleblower) defense
• Asset protection
• Licensure & disciplinary proceedings
• Jury trials

We offer private consultations, in which you can answer your legal questions, tell you more about our legal services, and discuss a strategy for your case. To learn more, call us seven days a week at 713-454-7814.

Understanding Houston Medicare Fraud Investigations & Charges

In recent years, the fight against Medicare and health care fraud has intensified, both on the state and national level. As government organizations fight to keep taxpayer money from being stolen, new task forces and laws are making it more difficult for individuals and entities to take advantage of Medicare’s largely honor-based billing system.

Specifically, two recent actions have led to a recent crackdown on Medicare fraud in the Houston area:

• The Health Care Fraud Prevention and Enforcement Action Team (HEAT). The HEAT task force, also known as the Medicare Fraud Strike Force, has hubs in nine areas across the country, including the Southern District of Texas (which includes Houston). This task force was formed in 2007 by the Department of Health and Human Services (HHS) and Department of Justice (DOJ) in order to prevent waste, fraud, and abuse related to government health care programs.

• Senate Bill 8. Passed in 2013 by Texas lawmakers, this bill took a number of actions to improve the prevention of and response to health care fraud. For example, the bill created a data analysis team at the Texas Health and Human Services Commission that detects suspicious trends that could flag fraud and strengthened already-existing laws that make it illegal for parties to directly solicit Medicare patients.

Medicare Fraud: The Basics

Medicare fraud occurs when false claims are made on behalf of a Medicare beneficiary by a physician, medical professional, medical facility, or medical supply company. The following people and entities may commit Medicare fraud:

• Doctors
• Nurses
• Hospitals
• Health care centers
• Hospice care centers
• Nursing homes and assisted living facilities
• Rehabilitation centers
• Registered care facilities
• Pharmacies
• Toxicology laboratories
• Medical devices companies
• Medical supply companies
• Physician syndications
• DNA testing centers
• Cancer treatment centers
• Durable medical equipment companies

Federal laws governing Medicare fraud and abuse include:

• The False Claims Act (FCA)
• The Anti-Kickback Statute (AKS)
• The Physician Self-Referral Law (Stark Law)
• The Social Security Act
• The United States Criminal Code

Medicare fraud takes on a number of different forms and happens on a number of different scales. One example of small-scale fraud could simply be a doctor’s office that occasionally bills Medicare for more services than it actually provides. An example of large-scale fraud could be a medical supply company that offers money to Medicare patients in order to provide them with large numbers of unnecessary medical services, from diagnostic tests to wheelchairs.

The most common forms of Medicare fraud include:

• Billing for services that weren’t performed, also known as phantom billing.
• Billing for medically unnecessary services.
• Billing for medically unnecessary supplies or equipment.
• Billing for medical supplies that were never ordered.
• Billing for services that are not covered by Medicare as services that are covered.
• Certification for services that were medically unnecessary
• Certification for supplies that were medically unnecessary.
• Double Billing.
• Upcoding.
• Inflating Bills.
• The offering of or accepting of kickbacks.

The Consequences of Medicare Fraud

In the act, it may not seem that Medicare fraud is particularly harmful to anyone money is simply taken from a government coffer and funneled to a health care provider or medical business. However, Medicare fraud not only steals billions of dollars from taxpayers each year, it can also harm patients and the medical profession at large. Because of these implications, the consequences of committing health care fraud are very severe:

• Retribution. In almost all cases, those found guilty of fraud are required to pay back all money that was taken.

• Prison. For each count of Medicare fraud, those convicted can face 10 years in federal prison. If the count of Medicare fraud involved the injury or death of a patient, those convicted can face up to life in prison.

• Fines. On top of retribution payments, those convicted of health care fraud face large fines that range from tens of thousands of dollars to millions of dollars, depending on the details of the case and the charges.

• Professional restrictions. Doctors and dentists who are convicted on health care fraud may no longer be able to practice or could have their license suspended temporarily. In addition, medical professionals convicted of health care fraud could lose their right to bill Medicare in the future.

• Probation. In less serious cases, individuals may be sentenced to probation, in which a person’s movements and freedoms are limited over a certain period of time. Probation may one or more years and involves regularly meeting with a probation officer, maintaining employment, and avoiding association with known felons.

Our Recent 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.

Medicare Fraud Defense Lawyers Serving Houston

Our team consists of a unique blend of knowledge, talent, experience, and passion for the law.

Request A Confidential Meeting With A Houston Medicare Fraud Defense Attorney

If you or your business is being investigated for Medicare fraud, don’t wait for formal charges. If you or your business is undergoing a Medicare billing audit, don’t wait for an investigation. Whether or not you believe illegal or negligent actions have taken place, a Houston Medicare fraud defense attorney can help answer your legal questions, tell you more about your case, and help you understand your options for taking action. To speak to one of our attorneys, call us or use our online contact form today.