Dallas Healthcare Fraud Attorney

Defending Those Who Are Facing Healthcare Fraud Charges in Texas

Healthcare fraud encompasses a number of accusations involving both healthcare professionals, hospitals, and individuals. Any attempt to defraud a health insurance plan or company to gain money or services may be considered fraud. In addition, healthcare companies and insurance agencies have many resources to actively go after perceived instances of fraud, which is why it is vital that you have an experienced Dallas fraud defense lawyer from the Law Office of Patrick J. McLain, PLLC, on your side.

Have you been accused of healthcare fraud? Call the Law Office of Patrick J. McLain, PLLC, today at (214) 238-9392 or contact us online to schedule a consultation with our healthcare fraud lawyers in Dallas.

What is Healthcare Fraud?

Healthcare fraud involves the intentional deception or misrepresentation of information by an individual or entity for financial gain within the healthcare system. This illegal activity can occur in various settings, including hospitals, clinics, and insurance companies. Perpetrators of healthcare fraud can include healthcare providers, patients, and even insurance companies.

The consequences of healthcare fraud are significant, leading to increased healthcare costs, compromised patient care, and a loss of trust in the healthcare system. Legal penalties for those found guilty of healthcare fraud can be severe, including fines, imprisonment, and the revocation of professional licenses.

Common examples of healthcare fraud include:

• Billing for Services Not Rendered: This occurs when healthcare providers bill for medical services, procedures, or equipment that were never actually provided to the patient.
• Upcoding: Upcoding involves billing for a more expensive service or procedure than what was actually performed. This leads to higher reimbursements from insurance companies or government programs.
• Unbundling: Unbundling is the practice of billing separately for procedures that should be billed together as a single comprehensive service, thus inflating the overall cost.
• Performing Unnecessary Services: This type of fraud occurs when healthcare providers perform and bill for medical procedures or services that are not medically necessary, solely to increase revenue.
• Falsifying Diagnoses: Providers may falsify patient diagnoses to justify tests, surgeries, or other procedures that are not needed, thereby receiving payment for unnecessary services.
• Kickbacks and Referral Fees: This involves offering, soliciting, or receiving any form of payment or incentive for referring patients to a particular provider, service, or product, which is illegal under anti-kickback statutes.
• Prescription Fraud: This can include writing unnecessary prescriptions for medications, particularly controlled substances, or altering prescriptions to obtain higher doses or quantities.
• Double Billing: Double billing occurs when the same service is billed multiple times to either the same or different insurance plans, resulting in overpayment.
• Misrepresentation of Services: This includes misrepresenting the type or level of service provided, such as claiming a higher level of care was given than what was actually provided.
• Identity Theft: In this scenario, someone uses another person's insurance information to obtain healthcare services or prescriptions fraudulently.
• Overutilization of Services: This involves ordering excessive tests or treatments that are not medically necessary, often driven by the desire to increase billing.
• Non-Compliance with Regulations: Failing to adhere to state and federal regulations in billing practices, record-keeping, and reporting can also be considered fraudulent if done intentionally to mislead or gain financially.

A common cause of insurance fraud charges and accusations is healthcare fraud through misleading or misrepresenting Medicare and Medicaid claims.

If you’ve been charged with healthcare fraud for government health coverage, you need to call a Dallas fraud lawyer immediately.

What are the Penalties for Healthcare Fraud in Texas?

Penalties for healthcare fraud in Texas can be severe and include both civil and criminal consequences. Criminal penalties may include imprisonment, fines, restitution, and probation. Civil penalties can involve substantial financial fines, exclusion from participating in federal healthcare programs like Medicare and Medicaid, and the loss of professional licenses.

Additionally, individuals and entities found guilty of healthcare fraud may face lawsuits and be required to pay significant damages. The exact penalties depend on the nature and severity of the fraudulent activities and the amount of money involved.

Who Investigates Healthcare Fraud in Texas?

Healthcare fraud in Texas is investigated by several agencies, including the Texas Attorney General's Medicaid Fraud Control Unit (MFCU), the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, and the Federal Bureau of Investigation (FBI). These agencies work together to identify, investigate, and prosecute individuals and organizations involved in fraudulent healthcare activities. They use various methods, such as audits, data analysis, undercover operations, and whistleblower tips, to uncover fraud and hold perpetrators accountable.

Contact Our Dallas Healthcare Fraud Lawyer Today

When you’ve been accused of healthcare fraud, trust our Dallas federal criminal defense attorneys for the comprehensive legal guidance your case requires. With more than 30 years of experience, Patrick McLain has a reputation for winning or getting a dismissal in thousands of complicated federal cases, including healthcare fraud. These effective results are reflected in our past clients’ satisfaction and our high standards of professional legal care.

Additional Reading:

• Frequently Asked Questions About Healthcare Fraud
• How Can I Defend Against Healthcare Fraud Charges?
• What Forms Does Healthcare Fraud Take?
• 5 Things To Know About Healthcare Fraud

Contact the Law Office of Patrick J. McLain, PLLC, today to get started on your defense with our Dallas Healthcare Fraud attorney.