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What Houston Medical Providers Should Know About Medicare Fraud

Categories: Health Care Law

Medicare Fraud Word Wall

Medicare Fraud Defense Attorneys Serving Medicare Providers in the Houston, TX Area

Oberheiden, P.C.
Former Prosecutors & Defense CounselEffective Defense Strategies for:
Physicians, Business Owners, Marketers, Health Care Providers, Home Health & Hospice Agencies, DME Companies, Laboratories, Pharmacies, and Hospitals.Call Attorney Dr. Nick Oberheiden Directly: (214) 469-9009

The Investigative Process

It is an unavoidable fact for all participants in the medical field that health care is one of the most heavily regulated industries in the United States.  While all medical providers are subject to some level of regulatory oversight, those providers who accept reimbursement from federal health care programs, such as Medicare, Medicaid, Tricare and the Department of Labor, face much stricter regulations regarding their business practices.  As such, medical providers who service federal beneficiaries receive greater scrutiny from federal health care fraud investigators and are subject to steep penalties if they run afoul of federal health care laws.  Therefore, those medical providers who participate in federal health care programs must be extremely conscientious of federal health care laws and proactive about complying with them.

Houston, as a national epicenter of the medical industry, is one of the most highly monitored geographical regions by federal health care fraud investigators.  In recent years, health care fraud investigations and prosecutions in Houston have greatly increased.  In fact, Houston is one of nine American cities that the federal government has declared to be a “hot spot” for Medicare fraud.

The United States Departments of Justice (DOJ) and Health and Human Services (HHS) have recently teamed up to place Medicare Fraud Strike Forces in hot spot regions, including Houston.  The local Medicare Fraud Task Forces are supervised by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), another joint project of DOJ and HHS tasked with fighting health care fraud on a national scale.

Any health care provider in Houston that services Medicare patients or other federal health care beneficiaries is at risk for being targeted by a federal health care fraud investigation.  If you have received a notice of investigation from a federal investigator, you should contact an experienced health care attorney immediately.  Oberheiden, P.C. represents clients facing health care fraud investigations in the Houston area.

Once federal investigators have initiated a Medicare fraud investigation, Medicare may either demand a recoupment of any overpayments it made to the provider or it may request that the United States Attorney’s Office pursue charges against the provider.  The U.S. Attorney’s Office may bring civil charges, criminal charges, or both against the medical provider, at its discretion.

The best way to avoid a health care fraud investigation is to make regulatory compliance an ongoing priority.  However, once an investigation has begun, the best thing a provider can do is immediately hire legal counsel that is experienced in Medicare fraud investigations.

Not Every Mistake Constitutes Health Care Fraud

Health care regulations are complicated and confusing, and they are constantly changing.  Even the most conscientious health care provider may make a mistake from time to time.  Simple human errors, such as clerical mistakes, inadequate staffing, of lapses in organizational oversight, can result in a well-meaning practitioner coming in violation of health care laws.  While such mistakes may look suspicious to federal investigators, they do not amount to health care fraud.

To commit Medicare fraud, a medical provider must intend to defraud Medicare.  Including a typo in a billing document submitted to Medicare that results in an overpayment does mean that the provider committed Medicare fraud.  In order to convict a medical provider of Medicare fraud, the prosecutor must prove that the provider knowingly and intentionally cheated Medicare.  Demonstrating to investigators and prosecutors that suspicious looking inaccuracies resulted from inadvertent oversights and not fraudulent intent can be a helpful tool for a provider facing allegations of health care fraud.

Medical providers who proactively institute compliance regimes for their practices are much more likely to avoid making the unintentional mistakes that could lead to a health care fraud investigation.  Practices like routine internal audits and ongoing employee training may help prevent mistakes from occurring in the first place.  Moreover, if a mistake does happen, a provider who can demonstrate ongoing efforts to maintain regulatory compliance will have an easier time convincing investigators that any mistakes resulted from human error as opposed to fraudulent intent.

Oberheiden, P.C. regularly advises medical providers on health care compliance issues.  As former health care fraud prosecutors and investigators, we know what federal investigators are looking for, and we can help you implement policies that will prevent the red flags that could provoke a health care fraud investigation.  We can help you avoid an investigation before it starts.

Oberheiden, P.C.

The Oberheiden, P.C. brings together former federal health care fraud prosecutors and experienced health care defense attorneys to provide doctors, pharmacies, hospitals and other medical providers with a full-service law firm dedicated to protecting their interests before, during and after a health care fraud investigation.

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