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Hinton & Bailey LLP

Healthcare Fraud

Health Care Fraud Legal Defense Team Serving Houston and the Surrounding Area

Hinton & Bailey is a Texas law firm providing health care fraud defense to clients in Houston, Texas and the surrounding areas. Many of our attorneys have previous experience as health care auditors and as health care fraud prosecutors with the Department of Justice. Our clients gain valuable insight for their health care fraud defense cases.

The Definition of Health Care Fraud

Health care fraud can be defined as an attempt to receive reimbursement from a federal government health care program for medical services or equipment. Federal health care programs include Medicare, Medicaid, Tricare, or federal workers’ compensation. It includes at least one of the following elements:

  • Violation of the Anti-Kickback Statute – Federal health care law prohibits receiving money or other valuables in exchange for patient referrals. Any person (including doctors, marketing professionals, and business owners) may be prosecuted for violating the Anti-Kickback statute for offering or providing payment or other valuables in exchange for patient referrals.
  • Violation of Stark Law – This is also referred to as the Self-Referral Law. It prohibits doctors from referring patients to certain health care service entities if the doctor or a member of the doctor’s immediate family has an ownership or investment interest in it, or if there is some compensation arrangement. There are statutory exceptions to this law.
  • Violation of the False Claims Act – If you submit a claim to a federal health care program, you must ensure that your claim is accurate. Otherwise, it is a violation of the False Claims Act. The federal government may begin an investigation into your billing practices under the criminal provisions of this act.
  • Prescription Fraud – The federal government watches health care practices that prescribe an unusually high number of narcotics. If you’re suspected of running a “pill mill,” you may be investigated for insurance fraud and for violating DEA dispensing rules.
  • Billing Fraud – One of the most common instances of billing fraud is when claims are upcoded. Upcoding means that the next higher code is used when the federal government is billed. The federal government also investigates phantom billing (billing for services that were not provided), ghost patients (billing for patients who don’t exist), and billing for services or equipment that aren’t medically necessary.
  • Certification Errors – The federal government pays close attention to the home health care and hospice industry. One of the most common allegations includes fraudulent certifications for care.

What Are the Penalties of Health Care Fraud?

Health care fraud is extremely serious. An allegation could be civil or criminal. Both include severe penalties. Civil penalties include repayment of claims, non-payment of future claims, and you may be excluded from federal health care programs. You may also face your state disciplinary board and lose your license or hospital privileges.

Criminal penalties can include fines in the hundreds of thousands of dollars, a criminal record, or even federal prison time.

Federal prison time can be sentenced as:

  • Up to 10 years for each count of health care fraud
  • Up to 20 years for each count of fraud that resulted in serious bodily injury to the patient
  • Life sentence if the health care fraud resulted in the death of a patient.

Often, we’re asked about the worst-case scenario for health care fraud in Houston, Texas. Facing criminal charges or a prison sentence will depend on several factors, including the severity of an injury suffered by a patient, whether the prosecutor is interested in pursuing criminal charges, and the reason why the federal government initiated the investigation. If you’re being investigated for health care fraud, contact the Hinton & Bailey today. Initial consultations are free of charge and confidential.

Health Care Fraud Defense

Immediate legal advocacy. Our main objective for each Houston, Texas client is to help them avoid criminal charges. Experience has taught us that the best way to advocate for our clients against the possibility of criminal prosecution is to immediately contact the federal government. This gets answers to important questions, and also stops the government from having much uninterrupted time to investigate you. We work to protect your freedom and your career. Usually, we get answers to the most important questions within just a few hours:

  • What is the investigation about?
  • What is the purpose of it?
  • How long will the investigation take?
  • What is the most likely outcome?

Testing Constitutional standards. The U.S. Constitution has a high standard of proof that requires the federal government to prove beyond a reasonable doubt that you committed a crime. It must also prove that you acted with criminal intent. In cases where criminal charges may be brought, we test these standards. The federal government will often try to use billing inaccuracies to prove that you acted with criminal intent. Hinton & Bailey has learned from experience that mistakes happen by our clients. Those mistakes should not equate to being treated like a criminal. We have provided successful legal defense for clients across the United States by proving that the inaccuracies are a result of human or organizational error, and were not a result of criminal intent. We’ve noted that the use of unqualified workers, delegation errors, outsourcing errors, lack of oversight, insufficient supervision, and the constantly changing laws and rules that are involved in health care are the most common errors that cause these investigations. Although these issues should be corrected, they should not lead to criminal liability.

The use of strategic health care fraud defense. Hinton & Bailey has substantial experience in developing strategic defenses. Many of our cases were successful because of statutory loopholes and exceptions. For instance, in the context of Stark Law which involves medical necessity certifications, we’ve been able to use exceptions to either mitigate or entirely resolve a health care fraud case.

Defending your professional reputation. Hinton & Bailey is committed to more than health care fraud defense. We’re also fully committed to defending your professional reputation. Allegations of health care fraud can be extremely damaging. Many of our clients are concerned about how these allegations may affect their future. The media has a lot of power. Your reputation could be destroyed by rumors spread by the media. Our attorneys routinely address concerns about slander, and book news spots and other opportunities to correct misinformation about our clients.

Hinton & Bailey has helped clients across the country who were accused of health care fraud. Call us today at 713-864-4477 to learn more about your legal options.