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Health Care Fraud And Potential Defenses In Texas

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Health Care Fraud And Potential Defenses In Texas


Health care fraud generally involves deceptive or abusive practices in the healthcare industry that redirects funds to those conducting various schemes or scams. All told, health care fraud costs billions of dollars each year and passes down these costs to other consumers through high insurance premiums and higher out-of-pocket expenses.

Because of these impacts across the nation and in Texas, health care fraud is a highly scrutinized criminal activity drawing strong attention from State and Federal prosecutors. For example, the FBI’s Health Care Fraud Strike Force has netted over 4,600 convictions nationwide for scams against private insurers and Federal health care programs. Texas also takes health care fraud claims very seriously, with both State and County agencies eager to investigate and prosecute health care fraud.

Some common areas for health care fraud include:

Medical Billing Fraud

  • Double billing for the same service;
  • Billing for supplies or service never given to a patient (also known as “phantom billing”);
  • “Upcoding” – billing for a more expensive service than the one actually performed;
  • Unbundling – submitting more than one bill for the same service.

Prescription Fraud

  • Forgery – using falsified prescriptions to obtain medications (for personal use or for sale on the black market);
  • “Doctor shopping” to obtain multiple prescriptions for the same drug. At times, the doctors themselves could be involved with a fraudulent scheme including financial kickbacks;
  • “Diversion” – obtaining valid prescriptions and “diverting” them for improper purposes. Selling prescriptions or trading them for other drugs (or cash) can be involved with this scheme.

Medicare and Medicaid Fraud

Medicare and Medicaid fraud is a type of improper billing scheme specific to these government benefit programs. When a health care provider claims bills to Medicare or Medicaid, claiming reimbursements they are not entitled to for services not rendered or equipment not sold, they can be charged with this type of fraud which naturally involves Federal penalties in addition to any other State and Federal charges they may face.

Health Care Fraud by Individuals 

  • False marketing to obtain personal information in order to steal identities, falsify enrollments, and bill for non-rendered services and supplies;
  • Identity swapping using an exchange personal information for insurance or billing purposes;
  • Impersonating health care professionals – this can involve providing services or supplies without a proper license to do so.

Prescription Fraud

  • Forgery – falsifying prescription information to obtain medications not prescribed by a doctor
  • “Doctor shopping” – scheduling appointments with more than one doctor or provider to obtain multiple prescriptions for the same drug. This often includes some level of unethical or illegal practice by the providers themselves.
  • Diversion – taking legal prescriptions and “diverting” them for improper purposes. This may include selling prescriptions or bartering them for other drugs.

Of course, the amount and types of health care fraud only seem to increase each year as criminals become more savvy in their methods. Unfortunately, due to the increased attention and prosecution of health care fraud, innocent people and health care workers can find themselves investigated or charged with some type of health care fraud. When this happens, they must contact a skilled Texas criminal defense attorney and mount a vigorous defense to the claims.

Our Pearland, Texas Criminal Defense Attorney Can Help You Defend Against Claims of Health Care Fraud in Texas

Whether you are affiliated with the health care industry or not, you can face serious criminal and professional consequences if charged and convicted of health care fraud. At Keith B. French Law, our Pearland criminal defense lawyers know the various legal approaches prosecutors may use against you in a health care fraud case, and what your potential defenses may be. We are eager to discuss options with you and review all aspects of your case. To learn more, don’t hesitate to contact the offices of Keith B. French Law, PLLC online or call 832-243-6153 today.


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