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Medical Fraud

Houston Medical Fraud Lawyer

Medical care fraud in the United States is estimated at $80 billion a year according to the Federal Bureau of Investigation. Insurance fraud charges have become the focus of attention of federal, state and local law enforcement agencies and prosecutors. With so much money at stake, prosecutors regard defrauding the health care system as a serious white-collar criminal violation, and they aggressively prosecute those suspected of committing it.

State and federal laws and regulations governing the delivery of health care services and the billing practices of providers are complex and prone to ambiguities in their application. If you are under investigation by one or more law enforcement agencies, you should speak to a Houston medication fraud attorney before responding to requests for information from investigative agencies.

Investigations of Medical Staff

Rand Mintzer, Attorney at Law knows that prosecutions usually focus on certain categories of conduct. A case frequently begins when one or more of the following activities of an individual or group practice come to the attention of investigators:

  • Fraudulent billing practices
  • Submitting duplicate claims
  • Unbundling, in which tests or procedures normally billed as a single item are billed separately
  • Receiving or paying kickbacks for business or patient referrals
  • Billing services that are not medically necessary

Fraudulent Billing Practices

Medicaid and Medicare regulations governing billing practices and procedures can be complicated and confusing even to trained investigators and prosecutors. Most prosecutions for health care fraud frequently rely upon patient records, billing statements and other documents generated by the medical provider or the third-party insurance company handling the claim to prove wrongdoing on the part of the health care professional.

Every document that supports the criminal case against a medical provider must be examined to determine if the documentation supports the charges that have been filed. Defense attorneys know that a gap in the documentation can be enough to lead to a dismissal or reduction of the charges due to insufficient evidence of criminal activity.

Penalties for a Conviction

Many of the prosecutions brought against doctors, hospitals and other medical providers are for violations of established federal laws. Federal sentencing guidelines place an accused person at risk of a prison sentence or probation if found guilty. Judges routinely impose substantial fines as part of the sentence and require the convicted party to pay restitution.

Medical Insurance Fraud Defenses

Insurance fraud lawyers know that the complexities and ambiguities of some of the laws can work in favor of a person accused of violating them. For example, safe-harbor provisions added to the Medicare and Medicaid statutes protect individuals from criminal charges unless prosecutors prove that payments were willfully made or received.

Meet With a Medical Fraud Attorney in Houston, TX

Houston criminal defense attorney Rand Mintzer has the knowledge and skills to take on the most complicated fraud cases while protecting your rights and freedom. Dial 713-862-8880 to schedule an appointment with Rand Mintzer, Attorney at Law.