Are you facing allegations or charges related to healthcare fraud? At Hilder & Associates, we understand the complexities and serious consequences associated with healthcare fraud cases. Our experienced team of healthcare fraud lawyers is based in Houston, Texas, and provides exceptional legal representation on a national scale. With a proven track record of success and an unwavering commitment to our clients, we are here to guide you through the legal process and vigorously protect your rights.
Hilder & Associates is a Texas based reputable law firm providing national representation with a primary focus on white collar crimes including healthcare fraud defense. Our skilled fraud attorneys have an in-depth understanding of the healthcare industry, coupled with extensive legal knowledge, allowing us to provide comprehensive representation to individuals and entities facing healthcare fraud allegations. With years of experience, we have successfully handled a wide range of healthcare fraud cases, earning us a strong reputation for our legal acumen and dedication.
Understanding Healthcare Fraud
Healthcare fraud refers to intentional deception or misrepresentation within the healthcare industry with the aim of gaining financial or personal benefits. This fraudulent activity can involve various parties, including healthcare providers, medical professionals, patients, and even healthcare organizations. The consequences of healthcare fraud can be severe, leading to legal actions, hefty fines, loss of medical licenses, and even imprisonment.
Title 18 U.S.C. §1347 makes it a federal offense to commit health care fraud. The prosecution of health care fraud allegations focuses on whether the medical provider knowingly defrauded a health care benefit program by submitting claims for services or products that were never provided or rendered services that were not medically necessary.
Oftentimes, federal and state agencies act jointly to ferret out fraudulently submitted claims by investigating and auditing doctors, ambulance companies, pharmacists, hospitals, clinics and other providers who are doing business with health care insurers.
Texas, like many other states, has implemented laws and regulations to combat healthcare fraud, which refers to deceptive practices aimed at obtaining unauthorized benefits from healthcare programs. Healthcare fraud can involve various activities, such as billing for services not rendered, submitting false claims, providing unnecessary medical treatments, or engaging in kickback schemes. Read about Healthcare Fraud FAQs.
Our Comprehensive Services
At Hilder & Associates, we recognize the intricate nature of healthcare fraud cases and provide a wide range of services to effectively address these complexities:
Healthcare Fraud Defense: Our team of experienced attorneys specializes in defending individuals and entities accused of healthcare fraud. We meticulously analyze the evidence, medical records, billing statements, and other relevant documentation to build a strong defense strategy. We understand the nuances of different types of healthcare fraud, including billing fraud, Medicare/Medicaid fraud, prescription fraud, False Claims Act/Kickbacks, Stark Law violations, and more. Our goal is to secure the best possible outcome for our clients, whether through negotiation or litigation.
Compliance Guidance: Staying compliant with constantly evolving healthcare regulations is a challenge. We provide proactive guidance to healthcare professionals, organizations, and entities to ensure that their practices align with legal standards. Our legal experts help clients implement robust compliance programs, conduct internal audits, and offer guidance on coding and billing practices to prevent unintentional violations.
Litigation and Appeals: In cases where litigation becomes necessary, our skilled trial lawyers are prepared to vigorously advocate for our clients in court. We have a proven track record of success in healthcare fraud litigation, with a deep understanding of the legal intricacies involved. If a conviction occurs, our appellate team is equipped to pursue appeals, striving to reverse or mitigate unfavorable outcomes.
Whistleblower Defense: Whistleblowers who expose healthcare fraud play a crucial role in upholding the integrity of the industry. Our firm represents both whistleblowers and defendants in whistleblower cases. For whistleblowers, we provide legal counsel on their rights and protections while guiding them through the reporting process. For defendants, we work diligently to protect their rights and reputation in the face of whistleblower claims.
Violation of Healthcare Fraud Laws
In Texas, healthcare fraud falls under both state and federal jurisdiction, as it often involves government-funded healthcare programs like Medicare, Medicaid, and the Texas Medicaid Managed Care Program. Violations of healthcare fraud laws can result in both civil and criminal penalties.
Key Texas healthcare fraud laws include:
- Texas Medicaid Fraud Prevention Act (TMFPA): This state law prohibits fraud in the Medicaid program and establishes provisions for reporting, investigation, and prosecution of fraudulent activities. It empowers the Texas Attorney General’s Office to take legal action against individuals or entities engaged in healthcare fraud.
- Texas Penal Code, Chapter 35: This section of the Texas Penal Code addresses offenses related to healthcare fraud, including insurance fraud, false statements, false claims, and tampering with government records. Violations can result in criminal charges, ranging from misdemeanors to felonies, depending on the severity of the offense.
- Texas Occupations Code, Chapter 162: This chapter regulates licensed healthcare professionals, including physicians, pharmacists, dentists, and nurses. It outlines professional responsibilities, ethical guidelines, and penalties for fraudulent practices within the healthcare industry.
- Federal Laws: In addition to state laws, federal laws such as the False Claims Act (FCA), the Anti-Kickback Statute (AKS), and the Stark Law also apply to healthcare fraud cases in Texas. These federal laws provide additional avenues for prosecution and enforcement against fraudulent activities involving federal healthcare programs.
It’s important to note that healthcare fraud investigations and prosecutions often involve collaboration between state and federal authorities, including the Texas Attorney General’s Office, the Department of Justice (DOJ), the Office of Inspector General (OIG), and other relevant agencies.
If you are facing healthcare fraud allegations in Texas, it is crucial to seek legal representation from experienced healthcare fraud defense attorneys. They can help you navigate the complexities of Texas healthcare fraud laws, build a strong defense strategy, and protect your rights throughout the legal process.
At Hilder and Associates, our dedicated legal team understands the complexities of healthcare fraud cases and is committed to providing exceptional representation tailored to your specific needs.With our extensive experience and unwavering commitment to protecting your rights and reputation, we are prepared to offer strategic defense strategies tailored to your unique case.
Administrative Audits Of Health Care Providers
Criminal prosecutions may blossom from an administrative audit of the provider. For example, a Medicare auditor may look closely at a sample of patients and determine that their billed treatment was not medically necessary. An unsuccessful review could trigger a further inquiry, an appeal process, suspension of the provider’s Medicare or Medicaid number, reimbursement for loss or even criminal prosecution.
A provider receiving an audit letter or who is indicted for health care fraud should immediately consult with counsel adept at investigating and advising medical providers. A successful administrative review could remove the provider from the government’s radar, thus it is critical to follow the administrative process.
Severe Penalties for Healthcare Fraud
If indicted for and convicted healthcare fraud, a person can face severe penalties under the sentencing guidelines because the loss associated with medical claims is often steep. Thus, prosecutors may seek tens of millions in damages, years in prison and forfeiture of assets. If you’ve been accused of health care fraud in Texas, our Houston-based healthcare fraud lawyers are ready to fight for you.
Healthcare fraud can lead to a variety of criminal and civil convictions, each with its own legal consequences. The severity of the conviction depends on factors such as the nature and scope of the fraud, the amount of money involved, and the impact on individuals and government programs. Some possible convictions for healthcare fraud include:
False Claims Act Violations: Submitting false claims or making false statements to government healthcare programs (such as Medicare or Medicaid) for reimbursement can lead to criminal charges. Violations of the False Claims Act may result in fines, imprisonment, or both.
Wire and Mail Fraud: If fraudulent activities involve the use of electronic communications or the postal service, individuals may face charges of wire fraud or mail fraud. These charges can lead to substantial fines and imprisonment.
Conspiracy: Engaging in a conspiracy to commit healthcare fraud, whether with other healthcare professionals, patients, or third parties, can lead to charges of conspiracy. Conspirators can face penalties similar to those of the underlying fraud.
Anti-Kickback Statute Violations: Accepting or offering kickbacks, bribes, or incentives to refer patients or secure healthcare services can result in criminal charges under the Anti-Kickback Statute. Penalties may include fines and imprisonment.
Healthcare Fraud: Engaging in fraudulent activities, such as submitting false information, misrepresenting services, or inflating medical bills, with the intent to defraud healthcare programs or insurers can lead to charges of healthcare fraud.
Civil Monetary Penalties: Individuals or entities found liable for healthcare fraud in civil cases may face significant monetary penalties, which can be assessed per false claim submitted.
Treble Damages: Under the False Claims Act, defendants can be required to pay three times the actual damages caused by the fraud, in addition to fines.
Exclusion from Government Programs: Convictions for healthcare fraud can result in exclusion from participating in government healthcare programs, which can have significant financial and professional consequences.
Whistleblower Lawsuits: Individuals who report healthcare fraud and initiate whistleblower lawsuits may be entitled to a portion of the recovered funds as a reward.
It’s important to note that healthcare fraud cases can be complex and involve a combination of criminal and civil proceedings. The specific charges and penalties an individual or entity might face depend on the jurisdiction, federal or state laws, and the details of the case. If you’re facing allegations of healthcare fraud, it’s crucial to consult with experienced legal counsel who can provide guidance tailored to your situation.
Comprehensive Defense for Healthcare Fraud Allegations
At our firm, we understand the gravity of healthcare fraud allegations and the potential impact they can have on your personal and professional life. Our skilled fraud attorneys possess in-depth knowledge of healthcare laws and regulations, allowing us to develop effective defense strategies for a wide range of healthcare fraud cases.
Why Choose Hilder & Associates?
Experience: Our attorneys possess a deep understanding of healthcare laws, regulations, and industry practices, giving us a unique advantage in healthcare fraud defense.
Strategic Approach: We craft customized defense strategies tailored to the specific circumstances of each case, ensuring that our clients receive the attention and representation they deserve.
National Representation: While based in Houston, Texas, our legal services extend nationwide. We have successfully represented clients across the United States, bringing our exceptional legal advocacy to various jurisdictions.
Client-Centered: We prioritize open communication with our clients, keeping them informed at every step of the legal process. Our compassionate approach underscores our commitment to achieving the best possible outcomes.
When you choose our Houston-based healthcare fraud defense attorneys, you can expect a comprehensive and personalized approach to your case. We will conduct a thorough investigation, analyzing complex financial records, medical documents, and relevant evidence to build a strong defense strategy. Our legal team will also work closely with you, keeping you informed throughout the process and ensuring that your concerns and questions are addressed promptly.
Protecting Your Rights and Reputation
Safeguarding your rights and reputation is our top priority. We are well-versed in the intricacies of healthcare fraud defense and will diligently pursue the best possible outcome for your case. Our fraud attorneys will challenge the prosecution’s evidence, negotiate with government agencies, and, if necessary, aggressively litigate your case in court. Our goal is to secure a favorable resolution that minimizes the potential consequences and protects your professional standing.
Our Houston-Based Lawyers Fiercely Defend Accusations of Health Care Fraud
If you are facing healthcare fraud allegations in Houston, don’t delay in seeking the skilled legal representation you need. Contact our experienced healthcare fraud defense attorneys today for a confidential consultation. We are ready to listen to your concerns, assess your case, and provide you with the guidance and defense strategies necessary to navigate this challenging legal landscape. Your rights and reputation are worth protecting, and we are here to help you every step of the way. For a confidential discussion of your case, call Hilder & Associates, P.C., at 713-234-1416 or toll-free 888-659-8742.
As part of Lawyer Monthly’s Legal Focus on Fraud and Financial Crime, we benefit from an exclusive article from Philip H. Hilder from Hilder & Associates, P.C. in Houston, Texas, on Medicaid fraud, waste
Houston Chronicle By Philip H. Hilder December 11, 2010 Constitutional protections are being hastily overlooked in our government’s zeal to crack down on Medicaid fraud. But even that worthy cause
If more evidence was needed to make the following even clearer than it already is, it came courtesy of the U.S. Department of Justice last Thursday. To wit: If you
As a medical provider, you want what’s best for your patients. You never want to file claims for services they don’t receive. Not only would it be unethical, but it’s
“[P]utting folks on notice that it’s a big deal.” So notes a recent national media piece on clear indications signaling the progressively heightened focus of government regulators and law enforcers