Dallas Healthcare Attorneys serving all of Texas
The healthcare industry is highly regulated to protect the interests of the public. Government regulation and oversight as well as industry watchdog groups have made operating in the health care industry without experienced legal counsel a very risky proposition.
The attorneys at the Health Law Group can help identify any potential risks, negotiate corporate transactions and to provide strategic representation and advocacy in complex litigations and potential criminal proceedings.
With experience in all aspects of healthcare law, the attorneys at the Health Law Group represent client interests in operational, regulatory and compliance and criminal matters. Our lawyers have helped many clients resolve some of the most complex legal issues including corporate structure, merger and acquisitions, government regulations and state and federal fraud abuse matters.
Our Dallas Health Law Group helps healthcare providers including hospitals, physicians, treatment centers, clinics, dental offices and more. We understand the unique challenges that pharmaceutical manufacturers and durable medical equipment manufacturers face. Our healthcare lawyers can assist advise you on a number of legal issues including but not limited to:
Internal audits and investigations
Health Care Fraud
Contract Disputes
Criminal Defense
Our healthcare fraud attorneys in Dallas, Texas have the knowledge and experience to handle any healthcare fraud case that comes their way.
Healthcare fraud cases can be complex and accusations may fall under either federal jurisdiction or the jurisdiction of the District Attorney for Dallas, Texas. This means there are two completely different sets of laws, punishments, and court systems potentially at play in any case.
Our Dallas healthcare fraud attorneys will ensure that your rights and interests are protected from the start of an investigation all the way through to the end of trial.
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Healthcare Fraud Law in Dallas Texas
Texas Penal Code §35 – Insurance Fraud.
Healthcare fraud law in Dallas, Texas is codified as “Insurance Fraud” under Texas Penal Code §35.
While this law penalizes defrauding, or attempting to defraud any type of insurance company, in this particular article we will only be discussing the pieces of the law that apply to healthcare fraud specifically.
Under Texas Penal Code §35(a), a person, who has the intent to defraud, commits insurance fraud if they, either:
Prepare, or cause to be prepared, a statement that the person knows to contain false or fraudulent information and it is presented to an insurer; OR
present, or cause to be presented, to an insurer a statement that the person knows to be false or knows to contain fraudulent information.
Under this code there are different “degrees” of severity to the offense. These degrees are separated as follows:
- If the value of the claim is less than $100 then the offense is a Class “C” misdemeanor.
- If the value of the claim is between $100 to $750 then the offense is a Class “B” misdemeanor.
- If the value of the claim is between $750 to $2,500 then the offense is a Class “A” misdemeanor.
- If the value of the claim is between $2,500 to $30,000 then the offense is a state jail felony.
- If the value of the claim is between $30,000 to $150,000 then the offense is a third degree felony.
- If the value of the claim is between $150,00 to $300,000 then the offense is a second degree felony.
- If the value of the claim is more than $300,000 or an act committed in connection with the offense places a person at risk of death or serious bodily injury then the offense is a first degree felony.
Federal Healthcare Fraud Law
Federal healthcare fraud is a bit more complicated than healthcare fraud law in Dallas. This is because there are several different statutes that, combined, make up what is referred to as healthcare fraud.
The one major difference between the federal statutes and the specific Dallas, Texas healthcare fraud laws is that the federal laws focus only on fraud in healthcare. The Texas laws cover most types of insurance fraud.
Each individual federal statute focuses on different actions or sets of actions. Each federal statute also carries with it a different set of possible penalties if you are convicted under it. We know that being accused of healthcare fraud can be terrifying.
If you have been accused of healthcare fraud in Dallas, Texas, contact one of our attorneys today.
The specific federal healthcare laws and regulations include:
Criminal healthcare Fraud
(18 U.S.C. §1347)
This is aimed to punish, criminally, those who purposefully execute, or attempt to execute, anything that would defraud a healthcare benefit program of any money, or other property, under that program’s control.
If you are found guilty of criminal healthcare fraud you could face up to 10 years in prison and up to 20 years if someone dies as a result of the fraud.
Additionally, you may face fines of up to double the amount of the property you received as a result of the fraudulent claims.
The False Claims Act
(31 U.S.C., Chp. 37)
This statute is used to prosecute, civilly, those professionals in occupational therapy offices who purposefully submit fraudulent or false claims to insurance companies in order to receive a payment.
For example, if a Dallas/ Fort Worth based occupational therapist bills a patient’s insurance company for therapy sessions that were never actually provided to that patient, that physical therapist can be charged with fraud under the False Claims Act.
If you are found guilty of a violation of the False Claims Act, you could face a fine of between $5,000 to $10,000.
In addition, a judge can order you to pay up to 3 times the amount that the government was defrauded of as a result of the scheme.
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The Physician Self-Referral law (Stark Law)
(42 U.S.C. § 1395nn)
The Stark Law is aimed at punishing those doctors who refer patients to receive specialized medical care from any facility or business that the doctor, or any member of the doctor’s immediate family, has some financial interest in.
For example, a Dallas based general practitioner, after seeing a patient, recommends that they need to consult a dermatologist about a skin condition the patient is suffering from.
If the physician refers the patient to a dermatology practice that the physician’s daughter has a stake in, then that referral would be a violation of the Stark law.
The Anti-Kickback Statute
(42 U.S.C. § 1320a-7b(b))
This statute looks to punish the purposeful payment made in order to reward people or companies for patient referrals, or the generation of business, involving any item or service payable by the federal healthcare programs.
For example, an in-home healthcare service pays a patient recruiter to refer patients, specifically those who are Medicare or Medicaid beneficiaries, to become home healthcare patients even though they do not qualify.
The payments made in this example would make this a violation of the Anti-Kickback Statute.
If you are found guilty of violating the Anti-Kickback statute, you could face fines of up to $25,000, a prison sentence of up to 5 years, or a combination of both.
Examples of healthcare Fraud Taking Place in Dallas, Texas
Dallas Doctor Convicted of healthcare Fraud
In August 2017, Jacques Roy, a doctor from the Dallas area, was sentenced to almost 35 years in federal prison and was ordered to pay $268,147,699.15 million in restitution.
Roy, along with his 6 co-defendants, defrauded Medicare and Medicaid through the companies each defendant personally owned or controlled.
As a part of the conspiracy, some of the co-defendants would recruit individuals with Medicare coverage to sign up for home healthcare services.
In addition, they would falsify medical documents to make it appear as though those beneficiaries qualified for the home healthcare services but were not medically necessary.
The reports were then delivered to Dr. Roy without a physician performing an exam. Dr. Roy instructed his employees to then certify the reports as if he had reviewed them.
After being approved and certified for home service visits to patients, documents were falsified to make it seem as if skilled nursing services were visiting the patients.
This was done in an attempt to bill Medicaid and Medicare for additional services.
The scheme involved somewhere near 11,000 patients and over 500 home healthcare agencies.
For more information or for the full Department of Justice (DOJ) press release, click this link or copy and paste the following URL.
https://www.justice.gov/usao-ndtx/pr/dallas-doctor-sentenced-health-care-fraud-conviction
Last Defendant Sentenced in healthcare Fraud Scheme
In October 2017, Cynthia Stiger was involved in a Dallas area healthcare fraud scheme and sentenced to 10 years in prison. In addition, she was ordered to pay $23,630,777.26 in restitution, jointly and severally from her co-defendants.
Stiger worked as one of the patient recruiters and would help falsify documents in order to bill Medicare and Medicaid for home health services. These services were unnecessary and most of the time never even provided to the patients.
For more information or for the full DOJ press release, click this link or copy and paste the following URL.
https://www.justice.gov/usao-ndtx/pr/last-defendant-sentenced-health-care-fraud-scheme
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Bushland Man Sentenced on healthcare Fraud Conviction
In November 2017, Thomas Roy Clark was sentenced to almost about 3.5 years in prison for fraud. In addition, he was ordered to pay over $500,000 in restitution with his co-defendant.
As a part if his plea agreement Clark was also ordered to forfeit over $84,000.
It was found that from 2012 through 2015, Clark operated a chiropractic clinic without a license. The license was suppose to have been issued by the Texas Board of Chiropractic Examiners.
Clark’s co-defendant was also implicated for assisting him in billing insurance companies for services that were only properly billable by a licensed chiropractor.
The two would also bill for:
services that were never provided; and
services that were rendered in lesser qualities than billed.
Further, the two would intentionally exclude Clark’s name or national provider in the itemized billing statements.
By omitting this information, the providers were unable to determine that they were being improperly billed for services that were being provided by a chiropractor without a license.
For more information or for the full DOJ press release, click this link or copy and paste the following URL:
https://www.justice.gov/usao-ndtx/pr/bushland-man-sentenced-health-care-fraud-conviction
Woman Running a healthcare Fraud Scheme From Prison Gets Indicted
In July 2017, Alexis C. Norman was indicted on charges that she was able to submit more than $800,000 worth of fraudulent claims to Medicaid from prison.
In August 2015, Norman pled guilty to one count of healthcare fraud in connection with a false billing scheme that she ran via two companies she had owned and operated.
As a part of that scheme, Norman used the names and licenses of counselors and Medicaid beneficiaries without their consent or knowledge.
She would use this information to submit claims to Medicaid for psychotherapy services that had never actually been provided.
As a result of this scheme, Norman was sentenced to over 8 years in prison and ordered to pay over $2,000,000 in restitution.
Presently, Norman is accused of having continued to run the same scheme while she was awaiting sentencing and while she was incarcerated.
It is alleged that Norman and a co-conspirator opened and operated two new health companies outside of the Dallas-Fort Worth area in order to hide from the watchful eyes of the DFW law enforcement.
Further, it is alleged that they then applied for, and obtained, Medicaid provider numbers. They would then use Craigslist to get the Medicaid provider numbers of other licensed medical professionals. It is further alleged that they would then use these those provider numbers and the information of medicare beneficiaries – mostly minor children – to submit false claims to Medicaid.
For more information or for the full DOJ press release, click this link or copy and paste the following URL.
https://www.justice.gov/usao-ndtx/pr/woman-indicted-running-health-care-fraud-scheme-prison
North Richland Hills Physician Admits Role in healthcare Fraud Conspiracy
In June 2016, Byron Felton Conner pleaded guilty to one count of conspiracy to commit healthcare fraud.
From 2012 through 2015, Conner worked as a contract physician serving patients throughout the Dallas-Fort Worth area. As a part of the scheme, Conner would sign physician orders that he knew contained false information on behalf of Medicare beneficiaries.
Additionally, Conner stated that he knew that these false claims would be used to support and justify fraudulent claims submitted to Medicare.
For more information or for the full DOJ press release, click this link or copy and paste the following URL.