Health and Human Services Defense

Texas Health and Human Services Defense Lawyer

Under Investigation by the Texas HHS OIG? Call (713) 909-7323

Health care fraud and abuse is a top priority for regulators at both the state and federal level. The Texas Department of Health and Human Services (Texas HHS) is one of many state-based agencies tasked with identifying and investigating fraud involving Texas health care providers and medical businesses.

If you, your practice, or your medical business has received notice from the Texas HHS regarding potential enforcement action or a fraud investigation, taking timely and decisive action is critical. State-based fraud investigations can expose Texas providers to devastating penalties and exclusions, as well as potential referrals for criminal prosecution or investigation by the federal government.

As a firm recognized nationally for our work in health and medical law, Hendershot Cowart P.C. provides comprehensive and insight-driven counsel for a range of health care matters. This includes services for:

  • Proactive regulatory compliance to mitigate risks of violations and enforcement action; and 
  • Responsive defense representation against civil and administrative investigations.

To learn more about our services and how we may be of assistance, call or contact us online. Our Texas HHS defense attorneys serve clients statewide.

How the Texas HHS Investigates Health Care Fraud

The Texas HHS’ Office of Inspector General has many resources to identify events of waste, fraud, and abuse, and may initiate fraud investigations in one of several ways, including:

  • Referrals: The Texas OIG receives over 200 health care fraud referrals each day, and may initiative an investigation after being notified of potential fraud or overpayments by MCOs, providers, patients, public fraud reporting hotlines, contracted auditors, or other agencies.
  • OIG Initiatives: The Texas OIG may self-initiate cases based on patterns and trends identified by its investigators. This can involve multiple teams across the OIG, including the Intake Resolution Unit (preliminary investigation), Policy & Strategic Initiatives (policy clarifications), Medical Services (consultations), the Fraud, Waste, and Abuse Research and Analytics (certified paid claims analysis), Provider Investigations (case investigation) and Litigation (guidance and resolution).
  • Provider Self-Disclosure: Self-disclosing overpayments discovered through an internal review process may result in a better outcome for a provider than if the OIG had discovered the error independently. Benefits of self-disclosure may include forgiveness or reduction of interest payments, extended repayment terms, and waiver of penalties or sanctions.

Texas OIG investigations can subject providers to a range of adverse disciplinary actions and sanctions that threaten both their professional livelihood and personal freedom. Examples include:

  • Medical license suspension
  • Medicaid exclusion
  • Overpayment recoupment
  • Civil monetary penalty
  • Referrals to federal agencies
  • Criminal prosecution

With stakes as high as these, investigations brought by the Texas OIG demand the immediate attention of qualified and experienced attorneys. The same applies to audits or investigations conducted by private insurers, the federal government or other state agencies, including the Texas Attorney General’s Office, Texas AG’s Medicaid Fraud Control Unit (MFCU), and Texas Department of Insurance (TDI).

Read our blog: What Is Involved in a Health Care Fraud Investigation?

Texas Health Care Fraud Laws

Like federal health care laws, Texas law requires health care providers to abide by a complex patchwork of rules and regulations. Providers and health care entities that fail to comply, even unknowingly, can be held accountable through civil and / or criminal enforcement actions.

Below are a few important Texas laws on health care fraud you need to understand:

  • Texas Corporate Practice of Medicine Prohibition (CPOM): Texas law prohibits the corporate practice of medicine, which 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. Violations of the Texas Corporate Practice of Medicine Prohibition can result in significant penalties, including fines and medical license disciplinary actions.
  • Texas Patient Solicitation Act: Passed in 1999, Texas’ version of the Stark Law 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 into account, and adheres to a lower “knowingly” intent requirement than the federal AKS.
  • Texas False Claims Act: This is the Texas equivalent of the Federal 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 similar to the federal FCA, individuals may also be held liable for Medicaid claims for services or products rendered by an unlicensed provider, or services products which have not been approved by a health care practitioner. The Texas FCA further differs from 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 designed 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 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.

There is significant overlap in state and federal health care laws, and state and federal agencies commonly collaborate on investigations and fraud cases. Any attorney you choose to help you navigate the journey ahead should have experience representing clients before both state and federal agencies.

At Hendershot Cowart P.C., our award-winning attorneys draw from over 100 years of collective experience to counsel clients facing health care fraud investigations and other civil and administrative disciplinary actions involving the state of Texas and the federal government. Our comprehensive services offer support for matters involving:

Comprehensive Counsel. Proven Results.

Due to extensive regulation at both the state and federal level, health care providers need to ensure compliance before entering into any transaction. Any audit, enforcement action, or investigation also necessitates immediate intervention and the support of proven attorneys.

To speak with a lawyer about your potential case, contact us.

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