Understanding Health Care Fraud in Dallas, TX

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Health Care Fraud Defense Attorneys Serving the Dallas Area

Health care fraud is a major problem in the United States. Each year, scams targeting Medicare, Medicaid, Tricare, and other health care benefit programs cost the government billions of dollars, impacting consumers insurance rates and creating an enormous burden on federal law enforcement. In the words of the National Health Care Anti-Fraud Association (NHCAA), “Don’t be fooled into thinking that health care fraud is a victimless crime. There is no doubt that health care fraud can have devastating effects.”

But, the government’s focus on combating health care fraud also means that innocent providers are getting caught in the crosshairs. Indeed, despite the scope of the problem in terms of government and societal costs, the vast majority of losses from health care fraud are the result of intentional acts by a relatively small number of illegitimate providers. These individuals and companies make their money by defrauding the system, and many of them are very good at what they do.

Then, there are the practices and companies that make honest mistakes. They do their best to keep pace with the complex and constantly-changing program regulations (such as those in the Medicare Claims Processing Manual); but, for one reason or another, they fall short of meeting their onerous obligations. Unfortunately, with government agencies’ increasing reliance on data analytics to identify possible instances of health care fraud, these honest mistakes look just like intentional fraudulent acts.

Aggressive Health Care Fraud Enforcement in Dallas, TX

All of this means that an extraordinary number of health care providers are being targeted in federal audits and investigations. The Medicare Fraud Strike Force, which has a field office in Dallas, and other federal authorities have a mandate to reduce government waste due to health care fraud, and as a result, they have little choice but to aggressively pursue any cases involving potentially-significant fraud. This often means launching an investigation without the information needed to differentiate between intentional fraud and honest mistakes. Auditing contractors working with the Centers for Medicare and Medicaid Services (CMS) – which get paid to recover fraudulent disbursements – often overreach in their scope of work, in many cases aggressively pursuing reimbursements when none are owed.

So, if your practice or company is being targeted in a federal health care audit or investigation, the first thing you need to know is this: Being investigated does not mean you are guilty. We have resolved numerous health care audits and investigations with no civil or criminal charges, helping providers around the country protect their businesses and their federal benefits program eligibility.

Resources for Health Care Entities Under Investigation in Dallas, TX

What else do you need to know if your physician-owned entity, pharmacy, medical facility, or other health care business is under investigation or facing an audit? These resources provide important information to help get you started:

1. Has Your Business or Practice Been Contacted by a Recovery Audit Contractor (RAC)?

Recovery Audit Contractors (RACs) are often health care providers’ first introduction to the Medicare fraud enforcement system. While RACs are private contractors and not officially arms of the government, they have been empowered by CMS to take action against providers suspected of fraud, and they can report cases of suspected fraud to the U.S. Department of Justice (DOJ) for investigation and prosecution. Learn what you can expect if someone in your office has been contacted by an RAC.

2. Is Your Business or Practice Facing a ZPIC Audit?

Like RACs, Zone Program Integrity Contractors (ZPICs) are private contractors that get paid to help the government recover fraudulent disbursements under Medicare. Health care providers must take ZPIC audits extremely seriously, as, due to CMS’s “fee-for-service” recovery program, ZPICs will often go to great lengths to find ways to charge providers with accepting fraudulent payments. Find answers to common questions about ZPIC audits.

For additional information about defending against ZPIC audits, you can read:

3. What Should You Do When You Are Under Stark Law Investigation?

The Stark Law is one of the federal government’s primary tools for combating health care fraud involving physician referrals. Physicians in Texas and around the country are subject to strict prohibitions on so-called “self-referrals,” with penalties including denial of Medicare billings, recoupment request, and steep fines.

4. What Should You Do When You Are Under False Claims Act Investigation?

The False Claims Act is a federal statute that provides for both civil and criminal penalties and allows for actions initiated by the government as well as private citizens (so-called “whistleblower” claims). False Claims Act investigations can target a wide range of forms of alleged fraud, from accepting kickbacks to upcoding and billing for services that were never performed.

5. Facing Investigation by Various Health Care and Law Enforcement Agencies

While HEAT is certainly one of the federal government’s strongest weapons against health care fraud in Dallas, it is by no means the only authority with its sights set on prosecuting health care providers. Several agencies maintain their own health care fraud enforcement programs, and responding to each requires a clear understanding of the specific agency policies, practices, and authority involved:

Contact The Criminal Defense Firm for a Free Consultation

If your practice or company is facing an audit or investigation, we encourage you to contact us for a complimentary case assessment. Our team of experienced health care fraud attorneys and former federal prosecutors will be happy to sit down with you to discuss your situation in confidence. To schedule an appointment at our offices in Dallas, TX, please call 214-251-4238 or contact us online today.

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