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Thorough Record Keeping Is Your Best Defense Against Accusations of Healthcare Kickbacks

Medical record

If you have ever received a medical bill, then you know that the way that healthcare providers charge money to patients and to insurance companies is anything but transparent. The insurance billing codes make no sense to anyone except insurance company employees and medical office billing staff. When you call the insurance company to ask why you have to pay so much for just a doctor’s office visit and some lab tests, you get the impression that the insurance companies just make up the prices on the spot, as if healthcare were a souvenir shop in a tourist town where employees make up individualized prices based on how much they think they can get each customer to pay. 

Somehow, all of this fancy math is legal, but it is not legal for doctors to bill insurance companies for medically unnecessary tests, treatments, and medical devices or for services that the doctors did not perform. Healthcare fraud is usually not the case of a doctor filing as many fraudulent claims as he or she can before getting caught; often, lab testing companies or medical device companies offer financial incentives for fraudulent insurance claims. 

If you are being accused of participating in a healthcare kickback scheme, contact a Texas white-collar crime lawyer.

Healthcare Kickbacks in Texas

In the past two years, criminal investigations have led to allegations of healthcare kickback schemes against three Laredo physicians and three laboratory diagnostic companies. Two physicians received prison sentences of two-and-a-half years. A third physician pleaded guilty in February 2024 and is awaiting sentencing; he could face a maximum of five years in prison. News sources did not include information about any charges filed against employees of the lab testing companies.

Texas follows the Anti-Kickback Statute, which makes it illegal for physicians to receive compensation from outside companies for billing insurance providers for medical treatments that use the products or services of these companies.  Since physicians use a variety of commercial products in the course of their work, can a physician get in legal trouble for, for example, recommending that a patient buy and take a certain over-the-counter medication. Therefore, the Anti-Kickback Statute contains detailed rules, known as “safe harbor” provisions, detailing when it is legal for physicians to promote the products of private companies.

If you are being investigated for healthcare fraud, you are in a position of strength if you have detailed records of all of the transactions you have made in the context of your medical practice and why you made them. You have the right to have a lawyer present when investigators question you or take a deposition, and you have the right not to answer questions until after you have consulted a lawyer about your rights and, if applicable, your defense strategy.

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

Dallas criminal defense lawyer can help you if you are facing charges of healthcare fraud or receiving kickbacks in your work in the medical profession. Contact the Law Office of Patrick J. McLain, PLLC, in Dallas, Texas, to discuss your case.

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