Healthcare makes a lot of people in Texas grumble. Getting high-quality healthcare is not easy, and when you do get healthcare, your policy might not cover everything that you need.
Unfortunately, the healthcare industry has its own problems. Healthcare fraud is rampant throughout the United States and costs the country up to $68 billion each year.
Those numbers encourage law enforcement officers at the state and federal level to take a hardline approach in putting fraudsters behind bars.
Take three medical professionals in Houston, recently charged for racking up $16 million in fraudulent claims...
Two Texas Doctors and An Unlicensed Aid File $16 Million in Claims
That is what they are trying to do in Houston. In June 2019, two Houston doctors and an unlicensed medical aid from the Verimed Health and Medical Wellness Clinic were indicted on federal charges for conspiracy to commit healthcare fraud.
The Department of Justice claimed that the three filed fraudulent Medicare and Medicaid claims for eye procedures and home healthcare services -- $12 million-plus of which had already been paid.
While this trio surely faces many years behind bars for healthcare fraud, you don’t have to rack up millions of dollars in order to face serious healthcare fraud charges.
Even lying for $50 in reimbursements could result in criminal charges. False claims that involve over $2,500 of reimbursements may land you a felony.
Read up on how healthcare fraud is handled in Texas. If you are worried that you might face fraud charges, or you have already been charged with healthcare fraud, contact a Texas defense lawyer immediately.
What Is Healthcare Fraud - in Texas and Nationally?
Healthcare fraud seems like a crime that could only be committed by big corporations. In reality, any individual can face these kinds of charges. Defendants could face multiple fraud charges based on the nature of the crime and how it was committed, in fact.
Healthcare Fraud
Many healthcare fraud cases are tried at the federal level. If a case extends beyond state lines, involves a federal organization, or is particularly concerning to federal agents, you might find yourself in federal court.
Federal law says you commit healthcare fraud when you: “knowingly and willfully execute, or attempts to execute, a scheme or artifice
- to defraud any health care benefit program; or
- to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program in connection with the delivery of or payment for health care benefits, items, or services.”
Basically, any time you lie to in order to receive something from health care benefit programs, you could face serious penalties.
Insurance Fraud
Medical professionals can commit healthcare fraud, but so can individuals who have health insurance. Any attempt to defraud an insurance company may result in criminal charges.
Filing a claim for services that were never rendered or lying about the extent of your injuries and illnesses are two examples that may be considered insurance fraud.
Fraudulent Use or Possession of Identifying Information
There are many types of fraud. Credit card fraud, wire fraud, mail fraud - the list goes on. One of the more common charges, especially concerning healthcare fraud, is the fraudulent use or possession of identifying information.
Texas law defines this charge as an act in which “a person...with the intent to harm or defraud another, obtains, possesses, transfers, or uses an item of identifying information.”
What is identifying information?
- Another person’s name and date of birth
- Social security numbers, driver’s license numbers, or other identifying numbers
- Biometric data (fingerprints, voiceprints, retina images, etc.)
- Financial institution account number, routing code, etc.
Mere possession of any of the above could land you behind bars and owing thousands in fines.
Texas Healthcare Fraud Charges and Penalties
Healthcare fraud charges range from misdemeanors to felonies. Most cases look at the amount of money involved in the scheme.
For example, if the value of a claim involved in insurance fraud was less than $50, the defendant will only face Class C misdemeanor charges. If the value reaches $1,500, the defendant will face state jail felony charges.
Any type of “Fraudulent Use or Possession of Identifying Information” is a felony in the state of Texas. If just one piece of identifying information was used, defendants will still face up to two years in prison and up to $10,000 in fines.
Penalties for state healthcare fraud charges and federal healthcare fraud charges are different. If healthcare fraud charges reach the federal level, you could spend decades in prison.
Fight Your Texas Healthcare Fraud Charges
A charge is never a conviction. There are many defense strategies available for defendants who are facing healthcare fraud charges.
Do not let a fraud charge put you in jail (or in debt). A Texas criminal defense lawyer can help you build the best strategy and increase your chances of walking out of court without penalties.
About the Author:
Brandon Fulgham has an in-depth understanding of both Texas law and Texans themselves. Before practicing law here, he received his undergraduate degree from TCU, and his law degree from South Texas College of Law in Houston. After graduation, he worked in District Attorneys’ offices as a prosecutor, building cases designed to put people behind bars. Now, he uses that knowledge to protect the rights of people in and around Fort Worth, making sure they receive the strongest possible defense when they find themselves on the wrong side of the law. He has been recognized for his work by The National Trial Lawyers, Fort Worth Magazine, and others.