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What Forms Does HealthCare Fraud Take?

Medicare Fraud Charges

If you are under investigation for healthcare fraud, or if you have been arrested or charged with health care fraud under Texas state or federal law, it is critical to begin working with an experienced Dallas healthcare fraud attorney as soon as possible. There are many different forms of healthcare fraud, and it is important to understand the types of actions or situations that may result in healthcare fraud charges. Our firm can tell you more about healthcare fraud in Texas and can explain the different forms that this type of offense may take.

What Forms Does Health Care Fraud Take Under Texas Law?

To understand the different forms that health care fraud can take, you should gain a clear understanding of how both Texas state and federal law define health care fraud. Under the Texas Penal Code, health care fraud involves any of the following different actions or behaviors:

· Knowingly makes a false statement or misrepresents a material fact in order to receive a healthcare program benefit or payment;

· Knowingly conceals information that allows a person to obtain a benefit or payment;

· Knowingly applies for and receive a healthcare program benefit or payment for another person;

· Knowingly makes a false statement about the conditions of a healthcare facility;

· Knowingly charges, solicits, accepts, or receives payment for medical services even though they are being paid for by a healthcare program;

· Knowingly makes a claim for a healthcare program payment for health care services that have been provided by a person who is not actually licensed to provide those services;

· Knowingly makes a claim for a healthcare service or product that has not actually been approved by a physician or is not approved by the healthcare industry as adequate or appropriate;

· Knowingly fails to provide the healthcare license or identification number of the practitioner when making a claim;

· Knowingly conspires to help another person obtain an unauthorized healthcare benefit or payment;

· Knowingly obstructs a healthcare fraud investigation;

· Knowingly creates a false statement or record to avoid paying money for a health care benefit or payment; or

· A managed care organization that engages in fraudulent activity in a contract with HHS, the federal government, or a Texas state agency.

The penalties for healthcare fraud under Texas state law are largely based on the monetary value or amount of the payment or benefit obtained unlawfully. An offense can thus range from a Class C misdemeanor (for a benefit or claim under $100) to a felony in the first degree (for a benefit or claim of $300,000 or more).

What Forms Does Healthcare Fraud Take Under Federal Law?

How does federal law differ? The statute is not nearly as specific as state law. Instead, under 18 U.S. Code § 1347, the law says that healthcare fraud is defined as knowingly and willfully executing, or attempting to execute, a scheme or artifice that aims to do one of the following:

· “To defraud any healthcare benefit program”; or

· “To obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any healthcare benefit program, in connection with the delivery of or payment for healthcare benefits, items, or services.”

Accordingly, many of the specific forms of healthcare fraud listed out under Texas law can be prosecuted under federal law, but the federal penalties are much steeper.

Contact Our Texas Health Care Fraud Lawyers

If you are facing healthcare fraud charges, our Texas fraud defense lawyers can help. Contact the Law Office of Patrick J. McLain, PLLC today to get started on your defense.

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