Category Archives: Health Care Fraud
What is a Federal Deferred Prosecution Agreement?
Here in Texas, federal investigations may target organizations and businesses in their various forms as well as individuals for violations of federal criminal statutes. For instance, in health care fraud investigations, potential defendants include all sorts of practitioners, from doctors or pharmacists, to pharmacy retailers; medical supply distributors; hospital operators; clinic operators; group practices; nursing…
HealthCare Fraud Prosecutorial Trends in 2024: Predictions Based Upon Latest OIG DOJ Enforcement Report
Money and health care and crime: the topics are intertwined. The amount of money spent in the health care industry here in the United States is almost impossible to comprehend. It is reported that in 2021, 17.8% of the entire gross domestic product (GDP) of our country was spent on health care. This is two,…
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…
