Houston Texas Business Lawyer

Medicare and Medicaid Fraud in Texas Hurts Taxpayers

Medicare and Medicaid fraud has long been a costly offense for taxpayers across the Houston area. Recently, the Department of Justice has uncovered a systemic Medicare fraud ring that generated $1.3 billion in false billings. The Washington Post reports that prosecution of this scam is “the largest ever health care fraud enforcement action”. This latest bust only shows how widespread, pervasive, and costly the problem of fraud has become.

Medicare and Medicaid FraudSuch law enforcement actions benefit immensely from reports of medical employees who suspect their employers are committing billing fraud. A Texas Medicare or Medicaid fraud lawyer can help you report any suspected fraud in order to protect the taxpayers of Texas, which ensures medical coverage for those who genuinely need it.

Texas Medicare Fraud Cases Are Costly

Numerous federal laws to deter and punish those who fraudulently seek to obtain improper payments from Medicaid. Federal laws include:

  • The Health Care Fraud Statute;
    • The False Claims Act;
    • The Anti-Kickback Statute;
    • Exclusion Provisions; and
    • The Civil Monetary Penalties Law.

But Medicare and Medicaid fraud cases are not just limited to federal tax dollars. Texas cases directly impact taxpayers in Houston and across the state. Such was the case of Dallas Home Health Care. Dallas News reports that the company provided Parkland Memorial Hospital patients with services meant for home-bound patients. Investigators discovered that many of these supposedly bedridden patients were able to drive, mow their lawns, and complete other everyday activities. The owners of Dallas Home Health Care, Viju Mathew and Mariamma Viju, stole patient lists from Parkland and Baylor University Medical Center (where they worked) in order to get Medicare billing information. Mathew was fired from Parkland, and Viju from Baylor, when the employers discovered that they had stolen patient records. Both defendants have been sentenced to thirty months in federal prison.

What To Do if You Suspect Medicare or Medicaid Fraud

White collar crimes (such as fraud) can be difficult to identify. It can be even more difficult to know what to do when you suspect such a crime.

  • Keep your eyes open for any suspicious behavior in your workplace. Look for such practices as: phantom billing for services that were not provided; double billing for the same service; upcoding to bill for a more expensive service than was actually provided; unbundled billing for multiple services that should only be billed once; kickbacks from medical companies; or falsifying of time sheets for in-home services.
  • Collect and retain your own copies of any documentation of the suspected fraud. Your employer may take action to destroy those documents, so it’s important to have proof. Make your own copies of billing invoices; ads for free healthcare in exchange for Medicare information; recommendations for unnecessary treatment; and other such documentation to help prove that fraud occurred. A Medicare fraud attorney can help you determine what documentation is needed, and how to obtain it.
  • Consult with a Houston Medicare fraud attorney. Under the False Claims Act, whistleblowers who report Medicare fraud can be entitled to financial compensation. However: many employers try to combat claims of fraud. They might even try to claim that you were the one who perpetrated the fraud. For this reason, it is important that you be represented represented by counsel who can protect your legal interests.

Medicare and Medicaid fraud is a problem that affects all Americans. It costs taxpayers huge sums of unnecessary expenses - not just for the services themselves, but also for the prosecution of the perpetrators of fraud. It reduces the ability of Medicare and Medicaid to provide medical coverage to those who genuinely need it. By reporting any suspected fraud, you can protect the most vulnerable residents of Texas.