Category Archives: Health Care Fraud

Medicaid Fraud in Texas: Federal and State Prosecutions

First things first, it’s important to understand exactly what is involved in the Medicaid program here in Texas.  Bottom line, Medicaid is free or low-cost health insurance provided by the government for those that meet its eligibility requirements. The majority of Medicaid coverage is provided to those with no income or have a low income,…


Safe Harbor Defenses to Health Care Fraud Kickback Charges

Evolving Safe Harbor Provisions to the Federal Anti-Kickback Law can form the Basis for a Defense to Health Care Fraud Charges Kickbacks are illegal activities that can happen in all sorts of endeavors, from construction and real estate development to banking or politics.  The term is broadly defined by Cornell Law School, citing Fischer v….


Elder Crimes: Federal Prosecutions and the Elder Justice Initiative

According to federal and state statute, anyone age 60 years or older is legally considered to be elderly. See, 42 U.S.C. § 1397j(5) and Texas Human Resources Code §102.001(5).  In some Texas criminal laws, elderly is defined as anyone who is age 65 or older. It is easy to imagine an elder as a grey-haired…


Health Care Fraud Arrests for Violation of Federal False Claims Act: Criminal Defense Overview

Schemes to take government money through nefarious means are far from new.  Over 150 years ago, as the Civil War was raging in this country, Congress passed its initial landmark false claims law “…in the wake of a spate of frauds upon the government.” United States v. Bramblett, 348 U.S. 503, 504, 75 S. Ct. 504,…


Texas Health Care Fraud Arrests: The Physician Self-Referral Law aka Stark Law, a Criminal Defense Overview

Health care is an almost incomprehensibly big business in this country.  According to the Centers for Medicare and Medicaid Services (CMS), spending in the U.S. health care industry accounts for almost a fifth (19.7%) of our Gross Domestic Product (GDP) with $4.1 Trillion (yes, trillion) spent in health care during the calendar year 2020 alone….


Texas Physicians’ Risk of Arrest: Criminal Defense Overview of Federal Anti-Kickback Statute (AKS)

All physicians understand that practicing medicine in Texas today involves continuing, widespread governmental oversight at every level, including extensive regulation by the federal government through a variety of federal statutes. Failure to comply can have devastating results.  Doctors, clinicians, hospital administrators, and others can face damage to their professional and personal reputations with even the…


Medical Identity Theft: Texas Criminal Defense of Health Care Fraud Charges

In Texas, both state and federal law enforcement are keenly focused upon the investigation and prosecution of all varieties of health care fraud, which can result in serious prison time upon conviction.  From a criminal defense standpoint, this investigatory zeal into the medical industry is of serious concern in part because of its impact long…


Doctor’s Risk of Arrest: Popular Bases for Texas Health Care Fraud Prosecutions

Law enforcement is more likely to investigate Texas health care providers for certain activities known to be targeted by prosecutors.   Health care is big business in this country.  The U.S. medical industry is defined as not only involving (1) those providing medical services, but also (2) manufacturers of medical equipment or drugs; (3) providers of…


Health Care Fraud Defense: Arrests Based Upon Medicare, Medicaid, or TriCare Insurance Claims

Defending Against Allegations of Fraudulent Billing to Federal Benefit Programs Health care providers in the State of Texas seeking reimbursement or payment for services rendered to persons in their care or charge must understand they are vulnerable to investigation and prosecution by either federal or state law enforcement for health care fraud crimes.  Suspicion can…


Loss Amounts in Federal Sentences: Calculating Economic and Financial Losses in Federal Felonies

Federal Sentencing Guideline 2B1.1 explains how to calculate monetary loss in a variety of crimes, such as tax evasion, structuring, wire fraud, money laundering, and mortgage fraud. Financial crimes prosecuted by the federal government usually involve a lot of money that builds into a large economic loss for its victims.  Criminal creativity being what it…