Texas Health Care Fraud Defense Attorneys
Prevention And Defense
Health care fraud is extremely serious. Individuals and organizations that are accused of committing health care fraud, either directly or indirectly, can be liable for civil and/or criminal penalties. The law firm of Hendershot, Cannon & Hisey, P.C., is here to help physicians, medical professionals and health care facilities defend or mitigate an accusation of health care fraud in Houston, throughout the state of Texas and across the nation.
Our health care fraud defense team has decades of experience in fraud-related matters, including:
- Civil investigative demands
- OIG investigations/subpoenas
- ZPIC (Zone Program Integrity Contractors) audits
- Texas Department of Insurance Audits
- Medicare, Medicaid and Tricare Fraud
- Compounding Pharmacy Fraud
- Prescription Fraud
- Novitas audits
- Department of State Health Services audits
- Health and human services investigations
- Federal False Claims Act violations / Quit Tam lawsuits
- Fraud and Abuse Statute violations
- RAC (Recovery Audit Contractor) audits
- Stark violations (self-referral)
- Anti-Kickback violations
- Violations of the 60-day rule
Early intervention and strategic defenses can help prevent a civil investigation from turning criminal. Even if you have been told you are not the target of the investigation, you should contact an attorney right away. The Office of Inspector General (OIG) employs a host of investigators and auditors who are exceptional at spotting inconsistencies and unusual patterns in purchasing and billing. If federal or state investigators come knocking on your door requesting documents or an interview, chances are these agencies have already invested significant time and resources investigating your case.
If this happens, you have the right to consult with a lawyer, you have the right to bring a lawyer to the interview, and you have the right to remain silent.
How Health Care Fraud Investigations Can Start
Health care providers that service the Medicare and Medicaid population are expected to know and comply with a complex and constantly evolving program. In today’s regulatory landscape – which closely scrutinizes waste, fraud, and abuse – errors in claims and billing practices can lead to audits and recoupment of overpayments. Violations of health care laws identified in these audits can also result in fraud investigations and substantial penalties, including hefty fines, exclusions from Medicaid and Medicare, the loss of a professional license, and even criminal prosecution.
Common Examples of Health Care Fraud Include:
- Upcoding: the practice of using a billing code that results in a higher reimbursement rate than the level of service justifies.
- Unbundling codes: The practice of using two or more Current Procedural Terminology (CPT) billing codes instead of one inclusive code.
- Double-billing Medicare or Medicaid and a private company for the same treatment. Double billing also occurs when a provider attempts to charge for the same service by billing using an individual code and again as part of a bundled set of tests.
- Billing Medicare for appointments the patient failed to keep
- Billing for services not furnished, supplies not provided, or both, including falsifying records to show delivery of such items
- Paying for referrals of Federal health care program beneficiaries
- Improper business arrangements designed to induce referrals
- Accepting or providing anything of value for referrals for Medicare or Medicaid services
- Business relationships where compensation is not set at a fair market value or charging excessively for services or supplies
- Certifying patients for unneeded services
- Failure to make timely repayment when an over payment is identified (60-Day rule)
For an initial consultation with an experienced health care fraud defense attorney, call (713) 909-7323.
Comprehensive Counsel from Premier Health Care Lawyers in Texas
At Hendershot, Cannon & Hisey P.C., we understand that a violation could not only mean legal penalties but could also jeopardize your medical license, certifications and your career. Avoiding audits and recoupment begins with proactively ensuring clear and executable billing practices, airtight documentation, and compliance that can be clearly demonstrated. We can advise you on the creation, implementation, and maintenance of compliance plans designed to prevent and resolve problems before they become investigations.
We also draft and review physician employment agreements and other medical contracts that help hospitals and physicians develop productive relationships that are in compliance with Stark, fraud and abuse prohibitions and Anti-Kickback Statutes. If state or federal government agencies do conduct investigations, we are well versed and experienced in handling civil investigative demands, subpoenas, interviews, document production, hearings and trial – and will prepare a strong and aggressive defense for you.
From establishing sound practices and compliance to handling overpayment audits, requests for recoupment, appeals, and investigations over fraud, waste, and abuse, our legal team at Hendershot, Cannon & Hisey is equipped with the experience, insight, and resources to effectively provide all medical practices and health care providers with the comprehensive counsel and tailored representation they need.
Contact us at (713) 909-7323 for an initial consultation. Our Houston-based lawyers serve clients throughout the state of Texas and across the nation.