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What constitutes healthcare fraud? And what should the accused do first?

The federal government is increasingly aggressive about prosecuting fraud and eliminating waste in the healthcare industry. Additionally, insurance companies have their guard up, and whistleblower suits are on the rise.

While many fraudulent healthcare schemes are rudimentary -- for example, using patients' identities to bill Medicare, Medicaid and insurers for services never provided -- other schemes are more sophisticated.

World of the whistleblower: often misunderstood by many

For many people in Texas and elsewhere, the goings-on that surround so-called whistleblowing can seem to be hyper-complex and more than a bit murky.

And that is certainly understandable, for these and additional reasons: Phrases like "qui tam" and "relator" pop up; there is the potential for the government to either intervene in a whistleblower suit or pass on the matter; questions can arise as to which party was first to file a claim (a key consideration); and financial incentives for stepping forward as a whistleblower can range widely.

Big-name medical care provider targeted in DOJ fraud probe

Most of our readers in Houston and across Texas have likely heard the adage, "The bigger they are, the harder they fall."

When it comes to companies suffering material downsides from the adverse fallout linked with a criminal and/or regulatory fraud-connected probe, a corollary might readily be tacked on to that maxim.

A look at algorithms: A slippery slope in criminal law?

A neural network, notes a recent media report, "creates connections on its own."

And that reality can be fundamentally troublesome when such networks -- better known in computer parlance as algorithms -- are used by courts in Texas and nationally to inform judicial decisions on things like flight risk, recidivism and the appropriate sentence to hand out to an offender.

6 points to consider regarding healthcare fraud

Healthcare fraud charges are very serious. These charges often come after lengthy and comprehensive investigations. People who are facing healthcare fraud charges must be ready to work hard on a defense. While this won't guarantee you a positive result, it does give you the best chance possible to have an outcome with minimized impacts on your life. Consider these points if you are facing charges for healthcare fraud. 

Is clock now ticking for FATCA offshore tax fraud law?

Any Texas resident who regularly reads business-related and legal news stories knows well -- and, indeed, is routinely reminded by a steady stream of reports -- that white collar criminal offenses and financial crimes generally are a top-shelf concern for law enforcers and prosecutors.

As we note on our criminal defense website at the Houston law firm of Hilder & Associates, P.C., "Federal and state governments have made the investigation and criminal prosecution of various frauds a high priority."

What you need to know about whistleblower protections

If you know there is an agency or company that is acting fraudulently and costing the government money or assets, you have the right to speak up. Your case, known as a qui tam case, is allowed by law.

The False Claims Act is a provision that allows individuals and entities with information on fraud being committed against the government to come forward and file a lawsuit on the government's behalf. With a qui tam action, the government retains the right to step in, to intervene and join the action. However, if the government decides not to do so, then you have a right to continue to sue on the government's behalf.

Derailing a medical career: a white collar crime conviction

The following story might be reasonably construed as a near-seamless companion piece to the subject matter we presented in a recent blog post.

That entry -- our April 7 post -- chronicled a recent large-scale Medicaid fraud case and conviction of a Texas resident. A particular focus of the post was on its underscoring of the vast resources devoted by criminal task forces these days -- with zealous prosecutorial zeal being manifestly on display -- to identify and convict individuals of white collar crimes in the health care sphere.

Recent Texas Medicaid fraud case underscores prosecutorial zeal

Just how serious -- that is, how ardent and uncompromising -- are state and federal officials when it comes to conducting investigative probes of individuals alleged to be involved in health care fraud?

And, following up on that, how adamant are they about subsequently bringing criminal prosecutions against alleged wrongdoers and pushing for flatly harsh sentencing outcomes?

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Contact Houston White Collar Lawyers for Experienced Representation

If you or your company is under investigation, charged or indicted for federal or state crimes, or you want to ensure future compliance, contact Hilder & Associates, P.C., for more information or to schedule an appointment with an experienced Houston white collar criminal defense lawyer.

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