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HINTON & BAILEY LLP

Healthcare Fraud

Houston Healthcare Fraud Defense Lawyers

Healthcare fraud is on a substantial up-rise in Texas and across the country. It is often committed by medical practitioners with the aim to deceive legitimate healthcare providers. In some cases, these misrepresentations are on an overwhelming scale and profits can result in millions of dollars of unlawful gains over short periods of time based on often sophisticated schemes. The offenders often face extremely severe penalties. Potential allegations against violators frequently are:

  • Providing false information to an insurance company. For example, billing for services actually not provided or for more serious services than were actually provided.
  • Offering, receiving, and/or soliciting benefits in the form of kickbacks for referring patients who may, in some cases, require no medical services or home healthcare at all.

1. Texas false claims act (Texas Medicaid Fraud Protection Act)

The Federal False Claims Act (FCA) is created to protect individuals from fraud. It is said to be the primary weapon in fighting fraud against the Government, as it covers combating deceitful claims against any government agency, grant, contract or program.

Due to the increasing number of complaints against inflated and fraudulent billings done by medical practitioners and pharmaceutical companies in Texas, the state created the Texas Medicaid Fraud Prevention Act (TMFPA). Teams of Federal and State Prosecutors and Law Enforcement Agents are very active in Texas, especially in metropolitan areas.

Similar to the FCA, TMFPA is also geared towards fighting fraudulent claims; however, the latter only covers fraud against the Texas Medicaid Program -- a program that is aimed to help and “provide healthcare and prescription drug coverage” to low-income families and individuals.

A person violates the TMFA if:

  • A managed care organization contracted to provide healthcare benefits to eligible individuals but fails to cater the required medical assistance to the individual, fails to provide the Texas government the required details under the law, running double bills on medical supplies and equipment that was never purchased, and conduct of similar nature.

2. Texas Anti-Kickback Statute

To eradicate fraudulent malpractice in the healthcare industry, the federal government used enormous resources by launching specialized audits and investigations, continuously creating laws and harsher penalties for those at fault. Aside from the Texas Medicaid Fraud Prevention Act, the Anti-Kickback Statute (AKS) is considered as one of the most important fraud laws created to eliminate the increasing abuse of physicians and healthcare providers.

The AKS makes it unlawful to deliberately provide and/or accept payments or remuneration in exchange for “influence referrals of federal healthcare program business.” While business referrals are technically acceptable, paying for referrals is a different story. Under the statute, both payer and recipient are liable and can be prosecuted.

If found guilty, an accused can expect the following:

  • Criminal fine of up to $25,000 per violation
  • Loss of medical license
  • Exclusion from any of the federal healthcare service programs
  • Civil charges of up to $50,000
  • Maximum federal imprisonment of 5 years for a single violation

If an individual is accused of fraud, the first step is to get help from defense lawyers who know and understand the laws in this area. Cases related to healthcare fraud can be overwhelming and can have extremely harsh penalties. That’s why Hinton & Bailey is here to defend you and your professional reputation. We will make sure that you don’t go through this alone.