You dedicated your career to helping others. But now, a healthcare fraud accusation threatens everything you’ve worked for. It feels unfair. Maybe it was a billing oversight, a coding error, or a misunderstanding of complex regulations. Yet, the system is treating you like a criminal.
The stigma is heavy. The financial burden is crushing. And the fear of losing your license and reputation is overwhelming. You’re fighting to protect your name, your livelihood, and your future. But here’s the truth: not every accusation holds up in court. Many healthcare professionals have been where you are and have successfully defended themselves.
With the right criminal defense attorney you can fight back. Our Houston, TX Health Care Fraud Lawyer, John T. Floyd, has the experience to protect your career and reputation.
This occurs when healthcare providers submit claims for medical procedures, treatments, or services that were never actually performed. It usually involves fabricating patient records, falsifying dates of service, or even using the identities of unsuspecting patients to generate fake bills. In some cases, providers may exploit the identities of deceased individuals or inactive patients to file fraudulent claims. This defrauds insurance companies and compromises the integrity of patients’ medical records, potentially affecting their future healthcare needs.
Upcoding: Billing for a more expensive service than what was actually provided. For example, a doctor may provide a routine check-up but bill it as a comprehensive examination, leading to higher reimbursement rates. This practice is deceptive because it misrepresents the level of care provided, resulting in overpayment by insurance companies and higher out-of-pocket expenses for patients.
Unbundling: Separating services that are typically billed together to increase reimbursement. Instead of charging a single fee for a comprehensive service, each component is billed individually. For example, a surgery might typically include anesthesia, post-operative care, and follow-up consultations as part of a single package. However, unscrupulous providers may separately bill each component as if they were independent services, significantly inflating the total cost.
Some providers may intentionally misdiagnose patients to justify expensive treatments or tests that aren’t medically necessary. This exposes patients to potential harm and results in significant financial losses.
Kickbacks and bribes in healthcare occur when financial incentives are offered to influence medical decisions. This includes pharmaceutical companies offering bonuses to doctors for prescribing specific medications or medical device manufacturers providing gifts to encourage the use of their products. For example, a physician may prescribe a costly brand-name drug over a cheaper, equally effective generic alternative because of incentives received from the pharmaceutical company.
This encompasses activities like forging prescriptions, overprescribing medications, or diverting drugs for illegal sale. Such actions contribute to issues like the opioid crisis and place patients at risk of addiction and other health complications.
Medicare and Medicaid fraud involves exploiting government-funded healthcare programs through billing for non-existent services, inflating costs, or misrepresenting patient information. For example, providers may bill for home healthcare visits that never occurred or misclassify services to receive higher reimbursements.
● Criminal Penalties: Individuals may face substantial fines and imprisonment. For example, under the Health Insurance Portability and Accountability Act (HIPAA), those convicted of healthcare fraud can be penalized with up to 10 years in prison, or up to 20 years if the fraud resulted in serious bodily injury.
● Loss of Medical License: Healthcare providers found guilty may lose their licenses, effectively ending their medical careers.
● Exclusion from Federal Programs: Convicted individuals or entities can be barred from participating in federal healthcare programs like Medicare and Medicaid, which can be financially devastating.
● Civil Penalties: Beyond criminal charges, perpetrators may face civil lawsuits, with the government or private insurers seeking to recover damages. The False Claims Act allows for civil penalties of up to three times the amount defrauded, plus additional fines.
An accusation of healthcare fraud can feel like a punch to the gut. It’s confusing, stressful, and overwhelming. But you don’t have to go through it alone. John T. Floyd understands what’s at stake. He knows the fears you’re facing and the pressures weighing you down. More importantly, he knows how to fight back. With years of experience defending healthcare professionals, he’s seen it all—from billing disputes to allegations of false claims. He digs deep into the details, challenges the accusations, and builds a defense strategy that tells your side of the story.
You’ve worked too hard to let one accusation define your future. It’s time to take control. Contact John T. Floyd Law Firm at 713-224-0101 or message online for a free consultation with a Houston, TX criminal defense lawyer.
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