Houston Medicare & Medicaid Fraud Attorneys Providing Nationwide Defense

Healthcare fraud occurs when providers knowingly submit claims to Medicare or Medicaid for products or services that were never provided or were not medically necessary. Federal and state agencies aggressively investigate doctors, pharmacists, ambulance companies, hospitals, and clinics for possible fraud with a growing focus on criminal violations.

If you’re facing Medicare or Medicaid fraud charges, you need a dedicated legal team that understands the intricacies of these complex cases. Look no further than Hilder & Associates, P.C., a Houston, Texas-based law firm renowned for providing unparalleled defense representation against Medicare and Medicaid fraud allegations. With a proven track record and national representation capabilities, we are here to safeguard your rights, reputation, and future. 

Contact us today at 713-655-9111 to schedule a confidential consultation and discuss your case with our experienced fraud defense attorneys. Let us help you address the legal challenges ahead and work towards the best possible outcome for your situation.

Understanding Medicaid and Medicare Fraud

Medicaid and Medicare fraud involves dishonest actions to get money from these government healthcare programs without providing necessary services. At its core, this type of fraud involves intentionally misleading the system to obtain payments for services that were never rendered or were unnecessary. Common fraudulent activities include:

• Billing for services not provided
• Performing unnecessary medical tests
• Engaging in identity theft to procure benefits
• Falsifying patient records to justify unnecessary treatments
• Double billing for the same service or procedure

At Hilder & Associates, P.C., we have an in-depth understanding of the multifaceted realm of Medicare and Medicaid fraud cases. Our seasoned white collar defense attorneys offer a robust defense against a wide array of Medicaid and Medicare fraud-related charges, including:

• Billing Fraud: We provide an unwavering defense to healthcare professionals and organizations accused of submitting false claims or inflating billings to government healthcare programs.
• Kickbacks and Bribes: Our adept legal team represents clients facing allegations of illegal financial inducements, such as kickbacks and bribes, in connection with referrals or services.
• False Certifications: We advocate on behalf of individuals who have been accused of providing false information to qualify for Medicare or Medicaid benefits.
• Unnecessary Procedures: Our attorneys are skilled at defending against accusations of performing medically unnecessary procedures to boost reimbursement rates.
• Patient Identity Theft: We safeguard clients who are accused of wrongfully using patient identities to bill government programs for services that were never actually rendered.
• Healthcare Provider Fraud: Our strategic defense encompasses healthcare providers facing allegations that compromise the integrity of government healthcare programs.
  

At Hilder & Associates, P.C., we are dedicated to protecting the rights of medical professionals dealing with an investigation and facing possible criminal litigation over Medicaid and Medicare fraud charges.

Medicare and Medicaid Kickback Violations

Medicare and Medicaid kickbacks concerning fraud involve illicit practices within the healthcare industry that can defraud these government healthcare programs. These fraudulent activities often entail the exchange of unlawful financial incentives or remuneration in an attempt to manipulate patient referrals, medical decisions, or billing processes. Here’s how Medicare and Medicaid kickbacks relate to healthcare fraud:

• Referral Kickbacks: One common form of healthcare fraud involving these government programs is the offering or acceptance of kickbacks in return for patient referrals. For example, a healthcare provider might receive a kickback in exchange for referring Medicare or Medicaid patients to a specific laboratory, hospital, or pharmacy. These arrangements can lead to unnecessary medical services, inflated claims, and increased program costs, constituting fraud.
• Billing Fraud: Kickbacks can also be used to perpetrate billing fraud. Healthcare providers may engage in fraudulent practices such as upcoding (billing for more expensive services than provided) or unbundling (billing separately for services that should be billed together) to maximize reimbursement from Medicare or Medicaid. In some cases, kickbacks may be involved in orchestrating these fraudulent billing schemes.
• Improper Financial Relationships: Healthcare entities and professionals receiving improper financial incentives to order or prescribe certain medications, devices, or services can result in overutilization of Medicare and Medicaid resources, leading to financial losses and compromising patient care.
• Kickback Schemes: Complex kickback schemes can involve multiple parties within the healthcare industry, including physicians, hospitals, pharmaceutical companies, and patient recruiters. These schemes may be designed to exploit weaknesses in the system and defraud government programs.
• Whistleblower Claims: Medicare and Medicaid fraud, including kickbacks, are often exposed through whistleblower claims, where individuals with insider knowledge of fraudulent activities report them to authorities. These claims can lead to investigations, prosecutions, and the recovery of fraudulently obtained funds.
  

Medicare and Medicaid kickbacks, when used to manipulate patient referrals, billing practices, or financial relationships within the healthcare industry, can constitute healthcare fraud. 

Healthcare fraud not only results in financial losses to these government programs but also undermines the quality and integrity of healthcare services provided to vulnerable populations. It is crucial for healthcare providers and organizations to adhere to strict compliance standards and for individuals facing allegations of Medicare and Medicaid fraud, including kickbacks, to seek legal representation to navigate the complexities of these cases.

Anti-Kickback vs Stark Law

Penalties for Violating the Anti-Kickback Statute

Penalties for Medicare or Medicaid Fraud

Penalties for Medicare or Medicaid fraud can be severe, reflecting the serious nature of the offense and the potential financial harm to government healthcare programs. These penalties can vary depending on factors such as the specific charges, the amount of financial loss, the defendant’s criminal history, and the jurisdiction where the case is prosecuted. Here are some common penalties associated with Medicare or Medicaid fraud:

1. Criminal Charges: Individuals or entities charged with Medicare or Medicaid fraud can face various criminal charges, including healthcare fraud, wire fraud, mail fraud, conspiracy, and making false statements.
2. Fines: Fines are a common penalty for Medicare and Medicaid fraud convictions. The fines can range from thousands of dollars to millions, depending on the extent of the fraud and the financial losses incurred by the government programs.
3. Restitution: Courts often order convicted individuals to pay restitution to the government programs for the amount of money that was fraudulently obtained. This is meant to compensate the programs for the financial losses suffered due to the fraud.
4. Imprisonment: Individuals convicted of Medicare or Medicaid fraud can face substantial prison sentences. The length of imprisonment depends on the severity of the offense. Sentences can range from a few years to several decades in federal or state prison.
5. Exclusion from Programs: Convictions for healthcare fraud can result in exclusion from participating in Medicare, Medicaid, and other federal healthcare programs. This can have significant professional and financial consequences for healthcare providers.
6. Asset Forfeiture: Courts may order the forfeiture of assets that were gained through fraudulent activities. This can include money, property, or other assets acquired using the proceeds of the fraud.
7. Civil Monetary Penalties: In addition to criminal penalties, individuals and entities found liable for healthcare fraud may also face civil monetary penalties imposed by the government. These penalties are meant to deter future fraudulent activities.
8. Professional Consequences: Healthcare professionals convicted of Medicare or Medicaid fraud may face license suspension or revocation, as well as damage to their professional reputation.
9. Legal Fees: Defendants are typically responsible for covering the legal fees associated with their defense. Legal representation in healthcare fraud cases can be complex and costly.
10. Impact on Reputation: Convictions for Medicare or Medicaid fraud can lead to damage to personal and professional reputation, making it difficult to secure future employment in the healthcare industry.

It’s important to note that federal and state laws can vary, and penalties can be influenced by a range of factors. If you’re facing charges of Medicare or Medicaid fraud, it’s necessary to get an experienced lawyer to help you understand the legal process and protect your rights. An experienced defense attorney can assess your case, develop a strong defense strategy, and work toward the best possible outcome given the circumstances. Secure the advocacy you need and the protection of the rights you deserve.

Immediate Steps to Take if Accused of Fraud

If you find yourself accused of Medicaid or Medicare fraud, swift action is key to protect your interests. Here are the immediate steps you should take:

1. Seek Qualified Legal Advice: The first and most important step is to seek qualified legal advice immediately. Engaging a dedicated Medicare fraud investigation attorney from Hilder & Associates, P.C. as soon as you are aware of the investigation can help you avoid disastrous consequences and criminal charges. Early consultation allows us to understand the specifics of your case and prepare a strong defense strategy.
2. Comply with Investigation Requests: Compliance with investigation requests is another key aspect. If approached by state or federal investigators, it’s imperative to cooperate fully while ensuring that your rights are protected. This includes complying with requests for medical records and other documentation, as failure to do so can result in further legal complications and even exclusion from federally funded healthcare programs. A thorough investigation of these records by your attorney can be instrumental in building your defense.
3. Demonstrate Early Intervention: Early intervention not only helps in leveling the playing field against the government’s case buildup but also demonstrates your commitment to addressing the allegations. Consulting with an experienced healthcare fraud attorney from Hilder & Associates, P.C. can mitigate the risks of severe penalties, including lengthy prison sentences and hefty fines.

The Legal Process for Defending Fraud Charges

Defending against healthcare fraud charges involves a multifaceted legal process. Medicaid Fraud Control Units (MFCUs) play an important role in these investigations, operating independently to investigate and prosecute fraud cases. These units have the authority to use subpoenas or search warrants to access a provider’s records, and healthcare providers are legally obligated to comply with these requests. Obstructing an MFCU investigation can lead to additional criminal charges.

The government’s burden of proof in these cases is significant. To secure a conviction, federal prosecutors must demonstrate that the defendant knowingly and intentionally committed fraud. This involves proving beyond a reasonable doubt that a fraudulent claim was submitted with criminal intent. Experienced attorneys, like those at Hilder & Associates, P.C., leverage our understanding of prosecutorial tactics to expose cracks in the government’s case and argue that mistakes do not equate to criminal actions. Common defense strategies include:

• Challenging the Evidence: Scrutinizing the evidence presented by the prosecution to identify inconsistencies, errors, or lack of credibility. For example, questioning the accuracy of billing records or the validity of witness testimonies can weaken the prosecution’s case.
• Proving Lack of Intent: Demonstrating that the defendant did not knowingly or intentionally commit fraud, which is crucial for a conviction. For instance, if a healthcare provider can show that an administrative error led to incorrect billing, this may negate the intent to defraud.
• Mistake of Fact: Arguing that any inaccuracies or discrepancies were honest mistakes rather than deliberate attempts to defraud. An example might be a clerical error where a procedure was coded incorrectly, leading to an overpayment.
• Compliance with Regulations: This shows that the defendant adhered to the complex regulations governing Medicare and Medicaid billing and documentation. This could involve providing documentation that proves the services billed were necessary and properly documented according to regulatory standards.
• Absence of Financial Gain: Establishing that the accused did not financially benefit from the alleged fraudulent activities. For example, if a physician can demonstrate that any overpayments were promptly refunded to Medicare or Medicaid, it may indicate a lack of financial motive.
• Third-Party Liability: Pointing out that another party, such as an employee or contractor, may be responsible for the fraudulent actions. For instance, if an office manager was responsible for billing and committed fraud without the physician’s knowledge, the physician might not be held liable.
• Good Faith Defense: Demonstrating that the defendant acted in good faith, believing their actions were lawful and appropriate. An example might be a healthcare provider who followed advice from a billing consultant, believing it to be correct, but later found out it was not.
• Statute of Limitations: Arguing that the charges are time-barred because they were not filed within the legally prescribed period. For example, if the alleged fraud occurred more than five years ago and the statute of limitations for the specific charge is five years, the defense can seek dismissal of the case.
• Whistleblower Motives: Questioning the credibility and motives of whistleblowers who may have reported the fraud for personal gain or retaliation. For instance, if a former employee who was terminated for cause reports the fraud, their motives and credibility could be scrutinized.
• Procedural Errors: Highlighting any procedural errors made during the investigation or prosecution that could undermine the case. This might include improper handling of evidence or violations of the defendant’s legal rights during the investigation process.

Throughout this process, our legal team at Hilder & Associates, P.C. is committed to providing a vital defense. We work tirelessly to gather evidence, challenge the prosecution’s claims, and demonstrate your compliance with healthcare regulations.

Why You Need a Health Care Fraud Attorney

Understanding the legal intricacies of healthcare fraud requires more than just a general knowledge of the law; it demands specific skills. Healthcare fraud attorneys play a pivotal role in defending the rights of medical professionals and ensuring that their interests are protected amidst rigorous federal investigations. When facing allegations of Medicare or Medicaid fraud, the consequences can be severe—ranging from severe financial penalties to the potential loss of your medical license and livelihood.

Specific attorneys bring an in-depth knowledge of both federal and state legal systems, essential for mounting an effective defense. They are skilled at understanding the details of fraud laws and creating defense plans that fit your situation. Early involvement of a dedicated healthcare fraud attorney can help mitigate potential liabilities and prevent the escalation of charges.

At Hilder & Associates, P.C., we understand the importance of immediate legal intervention. With over a decade of experience in healthcare fraud cases, our team is well-equipped to handle the complexities of your case.

Why Choose Hilder & Associates, P.C.

At Hilder & Associates, P.C., we provide strong legal defense against fraud charges, particularly for health care providers. Our firm understands the unique challenges faced by medical professionals accused of Medicaid fraud and Medicare fraud and is dedicated to offering personalized legal solutions tailored to your specific needs. We pride ourselves on our commitment to clear communication and personalized attention throughout your legal journey.

1. Proven Success: The history of successful outcomes achieved by our firm in Medicare and Medicaid fraud cases is a testament to our legal acumen and innovative defense strategies.
2. Knowledgeable: Our attorneys possess an intricate understanding of the healthcare industry, including the intricate regulations surrounding Medicare and Medicaid programs. We tailor our defense strategies to suit the unique circumstances of each case.
3. Nationwide Representation: Though headquartered in Houston, Texas, we extend our legal representation to clients across the nation. Our attorneys are well-equipped to handle cases in federal and state courts throughout the United States.
4. Comprehensive Investigations: We collaborate with experts in healthcare regulations, accounting, and digital forensics to conduct thorough investigations, unearth critical evidence, and expose vulnerabilities in the prosecution’s case.
5. Strategic Negotiation: While we are always prepared for trial, our negotiation skills are adept. We strive to secure favorable settlements whenever possible, with the ultimate goal of minimizing the impact of the legal process on your personal and professional life.
6. Client-Centered Approach: At Hilder & Associates, P.C., we prioritize your well-being. With personalized attention, transparent communication, and steadfast support, we ensure you are guided through every step of your legal journey.

Facing allegations of Medicare or Medicaid fraud can be an overwhelming experience. Our team of dedicated attorneys is ready to listen, thoroughly assess your case, and provide the strategic legal guidance needed to address these allegations. Your rights, reputation, and future are our top priorities.

Committed to Protecting Your Future

A simple administrative audit can grow into a complex criminal case, requiring you to have an experienced Houston healthcare fraud attorney at your side. Contact Hilder & Associates, P.C. online or over the phone at 713-655-9111.

Frequently Asked Questions

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