A civil investigation into the Texas Center for Orthopedic and Spinal Disorders commenced after a whistleblower, represented by Hilder & Associates, P.C., filed a Qui-Tam lawsuit alleging that a doctor committed fraud through his clinic. The complaint alleged that...
Penalties for healthcare fraud
Healthcare fraud is an intentional false claim about a healthcare service or procedure that results in payments. It is most often committed by physicians. Individuals or groups commit healthcare fraud when they reap financial gain from an insurer or government...
What pharmacists should know about prescription fraud
The opioid epidemic in the United States has led to an increase in cases involving prescription fraud. As a pharmacist, one may be at risk of facing criminal charges if state and federal laws are not carefully followed for distributing controlled substances....
Doctors accused of ordering more tests to increase medical bills
America has a shortage of doctors and other health care professionals. Professionals in the education system and health field believe this trend may worsen over time. From difficult courses to high student loan debt and constant lawsuits, doctors have their work cut...
The Anti-Kickback Statute and how it differs from Stark Law
The Medicare system has several rules and regulations in place to safeguard against healthcare fraud and protect federal funds. Two such laws are the Anti-Kickback Statute and Stark Law. It is important that healthcare providers intimately understand both laws and...
Breaking down the Stark Law
Past posts on this blog touched upon the fact that you (as a healthcare provider) cannot receive compensation for referrals made to other practitioners in Texas. At the same time, most people understand the need to refer patients to other doctors in order for them to...
Reviewing the anti-kickback safe harbor for space rentals
As a healthcare provider in Houston, you understand that your conduct is often highly scrutinized in order to ensure that no one is making attempts to influence your practices or judgments. You might think that the regulations governing activity that some may view as...
Are there different types of healthcare billing fraud?
Any time you visit a doctor for an appointment or undergo a medical procedure, the healthcare clinic or office you visit must bill your insurer for payment. This is a process known as healthcare billing and coding, which entails the use of codes to identify different...
Investigating health care fraud schemes takes a team approach
You may believe that no one in your office would engage in health care fraud. However, if you have a busy medical practice or pharmacy, it is not always possible for you to keep an eye on the activities of your staff. A little background One reason health care...
Genetic Testing Healthcare Fraud
The Department of Justice (DOJ) charged 35 individuals with federal crimes arising from allegations involving fraudulent genetic cancer testing in September 2019. According to the charges, the defendants included medical professionals, telemedicine companies, and...
