Houston Health Care Fraud Lawyer

Health care fraud is a serious issue that can have devastating consequences for individuals and organizations involved. Whether you’re a medical professional accused of fraudulent activities or a patient victimized by fraudulent schemes, understanding the intricacies of health care fraud is crucial. Health care fraud can take many forms, including billing for services not provided, falsifying patient diagnoses, or accepting kickbacks for patient referrals. These fraudulent activities not only undermine the integrity of the health care system but also place an enormous financial burden on the industry, costing billions of dollars each year.

At Mary E. Conn & Associates, we understand the complex nature of health care fraud cases and the significant impact they can have on your professional and personal life. Our team of highly experienced health care fraud lawyers in Houston, TX  is dedicated to providing robust defense strategies tailored to your unique situation. With extensive knowledge of both state and federal laws governing health care fraud, we are well-equipped to protect your rights and fight for the best possible outcome. If you are facing health care fraud allegations, call us now to discuss your case and explore your legal options.

Understanding Health Care Fraudin Houston

Health care fraud encompasses a wide range of illegal activities aimed at obtaining unwarranted financial gain from health care programs. Common types of health care fraud include submitting false claims, upcoding, unbundling, and performing unnecessary medical procedures. False claims involve billing for services that were never provided or were not medically necessary. Upcoding is the practice of billing for a more expensive service than the one actually performed. Unbundling refers to billing separately for procedures that should be billed together to receive higher reimbursement. Performing unnecessary medical procedures not only defrauds the system but also endangers patients’ health.

The entities most often involved in health care fraud include health care providers, such as doctors, nurses, and medical institutions. However, patients and employees of health care facilities can also commit fraud. For instance, patients might engage in doctor shopping to obtain multiple prescriptions for controlled substances. Employees might falsify records or misrepresent the level of care provided to increase reimbursements. Insurance companies and government programs like Medicare and Medicaid are frequently targeted by these fraudulent schemes, leading to increased scrutiny and enforcement efforts by regulatory agencies.

Health care fraud is prosecuted under various laws, including the False Claims Act, the Anti-Kickback Statute, and the Health Care Fraud Statute. The False Claims Act allows the government to hold individuals or entities liable for defrauding governmental programs. The Anti-Kickback Statute prohibits the exchange of remuneration for referrals for services covered by federal health care programs. The Health Care Fraud Statute criminalizes schemes to defraud any health care benefit program. Violations of these laws can result in severe penalties, including fines, imprisonment, and exclusion from participating in federal health care programs.

Defending Against Health Care Fraud Allegations

When facing health care fraud allegations, it is crucial to have a strong defense strategy. A thorough investigation is the first step in building a robust defense. This involves reviewing all relevant documentation, interviewing witnesses, and consulting with experts in the field. The goal is to identify any weaknesses in the prosecution’s case and gather evidence that supports the defendant’s position. For example, demonstrating that billing errors were accidental rather than intentional can significantly impact the outcome of the case.

Another key aspect of defending against health care fraud allegations is understanding the intent behind the actions. Prosecutors must prove that the accused knowingly and willfully engaged in fraudulent activities. By challenging the intent element, health care fraud attorneys in Houston can argue that the actions were the result of misunderstandings, administrative errors, or lack of proper oversight. This approach can be particularly effective in cases involving complex billing systems or ambiguous regulatory guidelines.

Negotiating with prosecutors is often a critical component of the defense strategy. Experienced Houston health care fraud lawyers can engage in plea negotiations or work towards a settlement that minimizes the potential penalties. In some cases, it might be possible to enter into a deferred prosecution agreement, which allows the defendant to avoid a criminal conviction by complying with certain conditions. This can be especially important for medical professionals who risk losing their licenses and livelihoods if convicted of health care fraud.

The Role of Regulatory Agencies in Health Care Fraud Cases

Several regulatory agencies play a pivotal role in investigating and prosecuting health care fraud. The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) is tasked with identifying and combating fraud, waste, and abuse in federal health care programs. The OIG conducts audits, investigations, and inspections to detect fraudulent activities and enforce compliance with federal laws. The agency also works closely with other federal and state entities to coordinate efforts and share information.

The Centers for Medicare & Medicaid Services (CMS) is another key player in the fight against health care fraud. CMS administers the nation’s major health care programs and implements various initiatives to prevent and detect fraud. These initiatives include data analysis to identify suspicious billing patterns, provider education to promote compliance, and collaboration with law enforcement agencies. CMS also imposes administrative sanctions on providers found to be engaging in fraudulent activities, such as exclusion from participating in federal health care programs.

The Department of Justice (DOJ) plays a crucial role in prosecuting health care fraud cases. The DOJ’s Health Care Fraud Unit is dedicated to investigating and prosecuting complex fraud schemes involving health care providers, pharmaceutical companies, and other entities. The DOJ often collaborates with the OIG, CMS, and state Medicaid Fraud Control Units (MFCUs) to build strong cases against those suspected of health care fraud. Successful prosecutions can result in significant recoveries for the government and serve as a deterrent to others considering engaging in fraudulent activities.

Why Choose Mary E. Conn & Associates for Your Health Care Fraud Case in Houston, TX?

When facing health care fraud allegations, having a highly experienced legal team on your side can make all the difference. At Mary E. Conn & Associates, we have a proven track record of successfully defending clients against health care fraud charges. Our team understands the complexities of health care regulations and the aggressive tactics used by prosecutors. We are committed to protecting your rights and providing you with the best possible defense. Our personalized approach ensures we tailor our strategies to your specific situation, maximizing your chances of a favorable outcome.

Our firm offers a comprehensive range of legal services to address all aspects of your case. From the initial investigation to courtroom representation, we handle every step with the utmost professionalism and dedication. We pride ourselves on being responsive and accessible, ensuring that you are informed and supported throughout the legal process. If you are facing health care fraud charges, do not hesitate to contact us. Call us now at (713) 357-4190 or visit our contact form. Let Mary E. Conn & Associates help you navigate this challenging time with confidence and expertise.