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Healthcare Fraud

El Paso Healthcare Fraud Defense

Although the U.S. healthcare system is strictly regulated, healthcare fraud and abuse is prevalent in the state of Texas. Healthcare fraud may result in state and federal charges and a conviction can result in serious penalties, including imprisonment, fines, and restitution. The best way to defend yourself against healthcare fraud charges is to consult an experienced criminal defense attorney.

Benjamin Law Firm, located in El Paso, has extensive experience defending clients against white-collar crimes, including healthcare fraud. If you have been charged with healthcare fraud, you should not go up against state and federal authorities on your own. When you become our client, we will carefully weigh the strength of the evidence against you, choose the best line of defense, and help you fight the charges. Above all, we are committed to protecting your rights, your freedom, and your future. 

What is healthcare fraud?

Healthcare fraud is a white-collar crime involving the submission of false or misleading information to a health insurer, Medicare, or Medicaid to recover payment for healthcare services. Healthcare fraud is not a victimless crime since it results in significant financial losses for health insurance carriers that subsequently pass those losses on to consumers in the form of higher insurance premiums.

Healthcare fraud can be committed by individuals, medical providers, and insurance companies with either the goal of obtaining medical care without valid insurance or to profit financially. Different types of healthcare fraud include:

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Federal Healthcare Fraud Penalties

Both criminal and civil penalties apply to federal healthcare fraud. These penalties include:

  • Prison — Healthcare fraud can lead to lengthy prison sentences. For example, submitting a false Medicare or Medicaid claim can result in a 5-year prison sentence for each offense, while a violation of the Criminal Healthcare Fraud Statute is punishable by up to 10 years for each offense. If the violation causes bodily injury, such as when a medical provider performs an unneeded medical procedure, the penalty can be a prison term of up to 20 years. If the violation causes a patient’s death, the provider can be sentenced to life in prison.
  • Fines — A conviction for healthcare fraud will also result in significant fines. An individual who makes a false statement in a Medicare or Medicaid claim, for example, may be fined up to $250,000 for each offense, while organizations making false claims face up to $500,000 in fines for each offense.
  • Restitution — Defendants can be ordered to pay back the amount of money they improperly obtained as a result of their fraudulent acts. A doctor who improperly billed and received payment from an insurance company for services not performed may be required to pay back the insurance company. Restitution is in addition to a fine paid to the government.
  • Exclusion — A healthcare provider who has been convicted of Medicare fraud may be excluded from federal healthcare programs, and failing to comply with the terms of exclusion can result in additional fines. 

Texas Laws on Healthcare Fraud

In Texas, healthcare fraud is vigorously prosecuted under a number of applicable state laws, including:

  • Texas Patient Solicitation Act — Texas’ version of the federal Anti-Kickback Statute prohibits physicians from directly or directly paying someone remuneration for patient referrals. Violations of this state law can be charged as a Class A misdemeanor or a felony of the third degree, depending on the circumstances.
  • Prohibition on Corporate Practice of Medicine – Under this law, physicians are prohibited from being employed by individuals who are not licensed to practice medicine, or by business entities run by individuals who do not have medical licenses. Violations can result in significant penalties, including fines and medical license disciplinary actions.
  • Texas False Claims Act – Texas’ version of the False Claims Act (FCA) holds individuals and entities liable for (1) submitting false or fraudulent claims for healthcare services paid by the government (Medicaid) or (2) submitting Medicaid claims for services or products rendered by an unlicensed provider, or one which has not been approved by a healthcare practitioner. Enhanced civil penalties apply if the misconduct results in harm to the elderly, disabled individuals, or minors.
  • Texas Medicaid Fraud Prevention Act — This law establishes a cause of action for submitting false claims to the Medicaid program. Violations can result in civil penalties ranging from $5,500 to $11,000 per violation which can be elevated if the unlawful conduct causes harm to the elderly, disabled or minors. 
  • Improper Billing Practices — The Texas Medical Board is authorized to discipline practitioners for improper billing practices and conduct intended to deceive or defraud the public, such as knowingly submitting improper or fraudulent claims to patients or third-party payers. Violations can result in significant penalties and medical license suspension.
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Contact Our Experienced Healthcare Fraud Attorneys

Benjamin Law Firm has a proven track record of successfully defending clients against healthcare fraud charges in both state and federal court. Well-versed in the state and federal laws governing healthcare fraud, we have successfully defended a wide range of clients against a variety of healthcare fraud allegations, such as:

  • Healthcare providers billing insurers, Medicare and Medicaid for services not provided
  • Insurers, pharmacists, and therapists for submitting false claims for reimbursement
  • Consumers charged with providing false or misleading information on government program applications

The penalties for a healthcare fraud conviction can be severe, especially for medical providers who are subject to license forfeiture if convicted. While being charged with healthcare fraud can be overwhelming, you can rest assured we will fight to protect your freedom and your future. Although we are committed to winning an acquittal, we will be honest with you about your prospects at trial. Depending on the circumstances, we may seek to have the charges and penalties reduced. Above all, we will work strategically to defend you from healthcare fraud charges and make sure your rights are protected.  

Please contact our office today to schedule a consultation.

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    Excellent attorney!! The staff is outstanding. The intake coordinator is someone you can truly count on for almost anything you might need and a great person to have on your side!
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