What Are the Penalties for Medicare Fraud in Texas? - Federal Lawyer
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What Are the Penalties for Medicare Fraud in Texas?

Find Out (For Free) Why Texas Healthcare Providers Want Oberheiden, P.C. on Their Defense Team: 888-680-1745

It’s not easy to be a Medicare provider in Texas. Dallas, Houston, Sugarland, San Antonio, Amarillo, El Paso, Austin, and increasingly Tyler and Midland—all major Texan cities experience unprecedented levels of federal audits and investigations accusing doctors and business operators in Texas of healthcare fraud.

If this applies to you, you should know that Texas-based law firm Oberheiden PC has cleared hundreds of doctors across the country of healthcare fraud. We would be delighted to do the same for you. We have successfully represented, among many others:

  • Mobile Ambulance Transportation Cases
  • Mobile Radiology Services
  • Home Healthcare Agency (Form 485 Cases)
  • Hospice Care Representation
  • Illegal Kickbacks
  • Any Form of Medicare Fraudulent Billing
  • Mental Healthcare Providers
  • Cardiologists
  • Urologists
  • Dialysis Centers
  • Dentists
  • Family Medicine Doctors
  • Internal Medicine Specialists
  • Pain Management Doctors
  • Psychologists
  • Psychiatrists
  • Medicare Clinic Owners
  • Nurses

No matter what you do, avoid the mistake of underestimating a Medicare audit. Many inexperienced lawyers might tell you that it is not a big deal to be subject to a ZPIC audit, exposed to Medicare fraud allegations, or even under indictment. We disagree. We will be honest with you because honesty, derived from experience, is the way to work together and find a solution as we have for so many before you. Call 888-680-1745 today and speak to Texas Medicare Fraud Defense Lawyer Dr. Nick Oberheiden, free and confidential.

What Are the Penalties for Medicare Fraud in Texas?

What Are the Penalties for Civil Medicare Fraud in Texas?

Prosecutors in Texas may pursue a civil Medicare fraud prosecution if they see a rule violation but don’t claim criminal intent. The Civil Monetary Penalty Law (CMPL) and the False Claims Act are enforced throughout Texas and can impose severe penalties beginning at more than $ 10,000 per each violation. Civil violations of Medicare rules may include billing errors, false claims, kickback violations, and other violations to the detriment of CMS/Medicare.

Nick Oberheiden has avoided liability for clients across Texas (and the United States) in civil fraud cases. Call him directly and today at 888-680-1745 to hear what he would do to protect your business and your assets.

What Does the Government Have to Prove in a Texas Medicare Fraud Case?

Workers compensation fraud, in simple language, is a form of healthcare fraud that is often investigated by the FBI and the Office of Inspector General in combination with other state and federal agencies. The general statute applicable to workers compensation fraud is 18 U.S.C. 1347. Pursuant to this statute, a person is guilty of healthcare fraud if the following conditions are met:

  • The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare benefit program by means of false or fraudulent pretenses, representations, or promises;
  • The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the healthcare benefit program; and
  • The defendant acted with the intent to defraud the healthcare benefit program.

Because Medicare fraud is governed by federal law, Medicare Fraud is investigated by federal and not state agencies such as the U.S. Attorney’s Office, the Federal Bureau of Investigation, or the U.S. Department of Health and Human Services.

What Are the Penalties for Criminal Medicare Fraud in Texas?

A Texas defendant convicted of Medicare fraud at trial or a defendant who decided to plead guilty to 18 U.S.C. 1347 must expect severe penalties as calculated by the Federal Sentencing Guidelines. Pursuant to Title 18 of the United States Code, a defendant guilty of healthcare fraud will be ordered to not more than 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment. What follows are some recent Texas cases involving convictions for Medicare Fraud. Avoid these penalties. Call 888-680-1745.

  • A Houston hospital executive was convicted by a federal jury for his role in a Medicare fraud scheme. According to evidence presented at trial, the executive would pay kickbacks to home health agency owners in exchange for referrals of Medicare patients to the executive’s hospital. Evidence also showed that the executive knew that most of the patients referred did not qualify for hospital services under Medicare guidelines. Trial evidence further showed that the executive tried to conceal the kickback payments to the home health agency by claiming the kickbacks were salary payments. As a result of this scheme, Medicare paid out more than $16 million in fraudulent claims. The executive was convicted of one count of conspiracy to pay and receive healthcare kickbacks, two counts of violating the Anti-Kickback Statute, and one count of conspiracy to commit healthcare fraud.
  • A Texas patient recruiter was convicted by a federal jury in Houston for her role in a Medicare fraud scheme. According to evidence presented at trial, the patient recruiter gathered information from Medicare patients in the Houston area and then sold this patient information to various home health agencies. The home health agencies would then bill Medicare using the bought information for home health services that were not provided. The home health agency would pay doctors and nurses to sign the paperwork sent to Medicare in order to make the claim look legitimate. To try and conceal the illegal selling of patient information, the patient recruiter would make it look like she was paid an hourly salary. As a result of this scheme, Medicare paid more than $3.6 million in fraudulent claims. The patient recruiter was sentenced to 108 months in prison for her role in the offense.
  • Two Dallas based doctors and three nurses were convicted by a federal jury for their roles in a Medicare fraud scheme. According to evidence presented at trial, the doctors and nurses conspired together to certify patients for home health services that they otherwise would not be eligible for. The doctors would sign certification forms without ever seeing the patients and the nurses would write fake patient reports without ever seeing the patients. Evidence further showed that the doctors and nurses would bill Medicare for services that were medically unnecessary for certain patients. As a result of this scheme, Medicare paid out more than $11 million in fraudulent claims.
  • A mayor in Texas was indicted for his role in a Medicare fraud scheme. According to the indictment, the mayor was also a licensed physician who engaged in improperly certifying home health patients. The mayor was a medical director for various home health agencies and would pay bribes to doctors working at the agencies to certify patients for home health services when they otherwise not eligible to receive these services. The indictment further alleges that the mayor and other individuals would keep patients on home health services for months longer than they needed to be in order to increase billings to Medicare. As a result of this alleged scheme, Medicare paid more than $150 million.

Penalty calculation in Texas Medicare Fraud cases are complex and depend on many factors. If you have questions or need guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends.

What Is the Statute of Limitations for Medicare Fraud in Texas?

In Texas federal criminal healthcare fraud investigations, the Statute of Limitations is typically five years. However, 18 U.S.C. 3282 is subject to various exceptions that can prolong the allowable prosecution phase, in particular if the case is charged as a federal healthcare fraud conspiracy.

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