Health Care Fraud Accusations Are Rising – Seek Legal Help
Scrutiny of physicians and other medical professionals can lead to career-ending charges. A mere investigation can cause people to lose their professional licenses and face potential prison time.
Defending against health care fraud and protecting your reputation will require swift and immediate action. Lawyer Dan C. Guthrie Jr. is an accomplished white collar criminal defense attorney and has successfully defended numerous clients at the investigative, indictment and trial stages of health care fraud cases.
Understanding The Federal Health Care Fraud Statute
The United States health care system is founded on the presumption that providers act honestly and put the interests of their patients first. Under the federal health care fraud statute, 18 U.S. Code Section 1347, anyone who intentionally defrauds a health care benefit program or obtains money under false pretenses from a health care benefit program could be guilty of health care fraud.
Penalties for a federal conviction include fines and a sentence of up to 10 years in prison. If a person or patient was injured because of the provider’s fraudulent acts, a convicted provider could face additional fines and a sentence of up to 20 years in prison.
Understanding Texas’s Health Care Fraud Statute
While health care fraud is a federal crime, it can also be a crime under Texas state laws. Title 7 of the Texas Penal Code, Chapter 35A, addresses health care fraud. A person or provider could be charged and convicted of state health care laws if they:
- Knowingly misrepresent or falsely claim a material fact that results in a payment or benefit under a health care program
- Knowingly conceal or fail to disclose information that results in a payment or benefit under a health care program
- Knowingly receive a benefit for someone under a health care program and use that benefit for someone or something else
- Knowingly make misrepresentations about the conditions or nature of a health care facility in order to receive payment
Depending on the amount of money involved in the fraud, state health care fraud crimes can be charged as a misdemeanor or felony. Misdemeanor or felony convictions for health care fraud could result in fines and jail time.
How Are State Health Care Fraud Crimes Different Than Federal Crimes?
In the state of Texas, state and local authorities investigate allegations of state health care fraud violations. Federal health care fraud crimes are investigated by the FBI and prosecuted by the Office of the Attorney General. Any accusation of health care fraud should be taken seriously. If you suspect that you are under investigation for health care fraud by state or federal investigators, it is important to seek the advice of a criminal defense attorney who has experience with complex white collar crimes in both state and federal court.
Medicare And Medicaid Fraud Are The Most Common
Medicare and health care fraud allegations can involve many different types of conduct, including:
- Upcoding or using incorrect current procedural technology (CPT) codes to bill for more expensive procedures than those actually rendered
- Unbundling or charging medical procedures separately when they should be charged together
- Billing for services not rendered
- Performing unnecessary medical procedures to receive insurance payments
- Misrepresenting elective surgeries as medically necessary procedures
- Receiving or paying kickbacks
The fact is that billing procedures for Medicare and Medicaid are extremely confusing, even for people who work in these agencies. As a result, proving intent in these prosecutions can be difficult. If you have been accused of Medicare or Medicaid fraud, an experienced health care defense attorney can help protect your rights.
How Attorney Guthrie Can Help With Defense Efforts
The government’s goal in many health care fraud cases is to prove intent beyond a reasonable doubt. However, proving intent can be extremely challenging. Since Mr. Guthrie has worked as both a federal and state prosecutor, he knows what tactics government officials use to try and prove intent, and he can find fallacies in their arguments against you.
Don’t Put The Career You Love At Risk
Countless health care professionals are passionate about their work. Sadly, it can take only a simple error or misunderstanding to derail your career and lead to a career-ending investigation. However, by working with attorney Guthrie, you can improve your chances of fighting the charges made against you so that you can continue doing the work and living the life you love.
Call 214-953-1000 to get started on your case. You can also schedule an initial consultation via the firm’s contact form.
