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Pain Clinics and Healthcare Fraud Cases

Healthcare Fraud

Pain is one of the most difficult symptoms to treat. Even with the most advanced medical technology, today’s diagnostic images and lab tests cannot always accurately show where it hurts and how much. As a result, treating chronic pain is often a matter of trial and error. Therefore, pain management is a much-needed and sought-after medical specialty. Despite this, pain clinics sometimes get a bad reputation, especially since, before current regulations went into effect, some unscrupulous ones acted as “pill mills,” prescribing large quantities of prescription opioid painkillers to patients who were likely to resell the pills on the street. This month, two physicians who operate a pain management clinic in the Dallas area are facing charges of healthcare fraud, not only because they are accused of prescribing controlled substances that were not medically necessary but also because they are accused of billing patients’ medical insurance for services that the patients did not receive. If you are being accused of making false statements for your own financial gain in connection with your work in the healthcare sector, contact a Texas white-collar crime lawyer.

What Is Healthcare Fraud, and Why Are Pain Clinics at Risk?

You can face charges of healthcare fraud if, in the context of your work as a physician, pharmacist, doctor’s office employee, or other worker in the healthcare sector, you knowingly make false statements so that you can benefit financially. Because Medicare, Medicaid, and private health insurance companies contribute so much money toward the income of doctors’ offices and hospitals, healthcare fraud often takes the form of fraudulent insurance claims. For example, doctors’ offices may bill insurance companies for treatments that they never performed or for treatments, medications, and medical devices that patients did receive but that were not medically necessary.

As patients with chronic pain know, it is common for doctors to disagree about the most appropriate interventions for pain management. The same patient may visit several doctors about the same complaint of chronic pain, and one will recommend physical therapy, the second will recommend corticosteroid injections, the third will recommend prescription opioids and the fourth will recommend surgery. Investigators may become suspicious when pain management clinics consistently submit insurance claims for treatments with a higher rate of reimbursement when less expensive treatments are also available.

Defending Yourself Against Charges of Healthcare Fraud

Accurate record-keeping and medical expertise are your best defenses against accusations of healthcare fraud. The more detailed your records are, the easier it is to show that you filed the insurance claims in good faith and that you believed that the treatments you ordered for patients were medically necessary. If you are being investigated for healthcare fraud, you should contact a criminal defense lawyer before providing information to investigators, even if you are sure that you have nothing to hide.

Contact the Law Office of Patrick J. McLain, PLLC About Criminal Defense Cases

Dallas white-collar crime defense lawyer can help you defend yourself against allegations of healthcare fraud. Contact the Law Office of Patrick J. McLain, PLLC, in Dallas, Texas, to discuss your case.

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