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Understanding Texas Health Care Fraud Laws

Health care fraud has become a top priority for regulators and law enforcement at both the state and federal level. Because allegations have the potential for substantial civil and criminal penalties that can jeopardize a practice and the personal and professional futures of practitioners, ensuring regulatory compliance on a proactive basis, and taking decisive action following audits, investigations, and formal civil complaints, is critical to mitigating or avoiding devastating repercussions.

As a law firm recognized throughout Texas and the U.S. in matters involving health and medical law, our team at Hendershot, Cannon & Hisey, P.C. has a proven record counseling health care providers in fraud avoidance, as well as representing providers facing investigations and allegations brought by state and federal agencies, including specialized task forces created specifically to root out waste, fraud, and abuse. In Texas, various state agencies can be involved in a health care fraud case. These commonly include:

  • Texas Attorney General’s Office
  • Texas AG’s Medicaid Fraud Control Unit (MFCU)
  • Texas Department of Insurance (TDI)
  • Texas Medical Board

Texas Laws on Health Care Fraud

Texas laws, like federal laws, require health care providers to abide by a complex set of regulations. When they fail to do so, providers can be held accountable – through civil and / or criminal means. Below are a few important Texas laws on health care fraud you need to understand:

  • Texas Patient Solicitation Act – Passed in 1999, this state law is often known as Texas’ version of the Anti-Kickback Act, and it regulates physician referrals at the state level. Although the Patient Solicitation Act is a criminal provision similar to the federal Anti-Kickback Statute, Texas has not yet enacted a civil provision, does not take the value of remuneration obtained into account, and adheres to a lower “knowingly” intent requirement than the federal AKS.
  • Prohibition on Corporate Practice of Medicine – Texas law prohibits the corporate practice of medicine, which generally means physicians are not to be employed by individuals who are not professionally licensed to practice medicine, or by business entities governed by individuals who do not have medical licenses. Practitioners can face significant penalties for violations, including fines and medical license disciplinary actions.
  • Texas False Claims Act – This is the Texas state version of the False Claims Act (FCA), and it holds individuals and entities liable for submitting false or fraudulent claims paid by the government. While the Texas FCA is substantially similar to the federal FCA, individuals may also be held liable for Medicaid claims for services or products rendered by an unlicensed provider, or which has not been approved by a health care practitioner. The Texas FCA further differs from the federal law by imposing enhanced civil penalties when misconduct results in harm to the elderly, disabled individuals, or minors.
  • Texas Medicaid Fraud Prevention Act– Texas has adopted a number of other false claims laws design to prevent abuse and fraud within the Texas Medicaid program. Generally, these laws make it illegal to file fraudulent documentation / claims paid by the state Medicaid program.
  • Improper Billing Practices– The Texas Medical Board has an authority to discipline practitioners for improper billing practices and unprofessional and dishonorable conduct likely to deceive or defraud the public. This includes improper or fraudulent claims submitted to patients or third-party payers, provided the physician knew the claim was improper. Violations can result in substantial sanctions and medical license suspension.

Because there is significant overlap in state and federal health care laws, and because state and federal agencies commonly collaborate on investigations and fraud cases, our team also has extensive experience with federal laws, federal agencies, and third-party contractors commonly involved in health care fraud cases. This enables our legal team to provide the immediate and effective representation providers need in a range of situations, including those involving:

Our firm has represented a diverse range of physicians and health care providers in matters related to audits, investigations, Civil Investigative Demands, medical board complaints, and litigation at the state and federal level. Regardless of how fraud is identified or investigated, or which agencies are involved, the stakes and exposure to risks are tremendous, and can include civil fines, damages, provider exclusion, adverse medical license consequences, and, in some cases, criminal charges. Defending against or mitigating these penalties demands immediate action.

Work with Experienced Texas Health Care Fraud Defense Attorneys

Due to extensive regulation at both the state and federal, health care providers need to ensure compliance before entering into any transaction. With serious penalties, any audit or investigation also demands immediate intervention led by proven attorneys. At Hendershot, Cannon & Hisey, P.C., we have the experience and resources to assist health care practitioners in a range of proactive and responsive measures related to health care fraud. Our goals in these cases focus on using our insight to ensure compliance, keep investigations civil, and open the door to effective negotiations or defense strategies that help clients mitigate risks and penalties.

To discuss health care fraud or any medical / health care law matter, call (713) 909-7323 or contact us online to request an initial consultation.

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