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The changing scenery of the healthcare practice has seen numerous changes in state and federal regulations. Hospitals and individual practitioners have to stay updated on the ever-changing legislation. Failure to do so exposes them to a myriad of litigation issues. Medicare fraud and abuse have become a subject of significant tension among healthcare providers. The recent crackdown in Texas has led to the closure and loss of license of many practices. Healthcare providers who have been charged with fraud violations suffer serious consequences. When faced with a fraud or abuse charge, it is best to consult with Texas Medicare fraud lawyers. It is important for healthcare providers to understand the law. The following are some of the issues that warrant legal aid and expertise.
Medical Identity Theft
Medical identity theft mainly involves the use of a patient’s medical identity to obtain services, healthcare goods or funds for fraudulent purposes. Patient’s medical identifiers can be used to obtain supplies or unnecessary services. They can also be used to bill for services that the patient did not receive. Medical identity theft also involves impersonating a beneficiary of a particular services or good. Healthcare providers must employ strict security measures to protect the identity of their patients. Any fraudulent exposure can create legal issues for the entire practice. If you are being investigated on fraud charges, you risk losing your license and your practice. As such, you need the legal counsel of Medicare fraud lawyers.
Self-referral is a common Medicare fraud issue. This happens when a healthcare provider orders tests and refer himself with the intention of receiving financial compensation for the test. For instance, a surgeon is prohibited from encouraging a surgical procedure to a patient that he or she would perform. If found in violation, health care providers can face criminal penalties. In addition to this, the Medical Board may order the clinic to be shut down. The anti-kickback statute is harsh on those who solicit, or willfully offer money for inducing services that are payable by Medicaid or Medicare. Doctors and other health care providers must be keen when it comes to business relationships. Self-referral is prohibited so as to avoid unnecessary procedures. Medical bills can be inflated in such referrals, and this is why it considered a serious fraud offense.
Fraud vs. Mistake
It is crucial to establish the difference between healthcare fraud and errors or omissions. The law defines fraud as knowingly engaging in an activity, a plan or a scheme with the intention of misleading for financial gain. For instance, fraud does not equate to making a mistake that leads to incorrect billing. However, when a healthcare giver knowingly offers treatment to a patient who does need it and then bills the insurance provider with the intention of making a financial gain, then such conduct is considered fraudulent. When you receive an inquiry from Medicare officials, it is important to hire a medical fraud attorney. If not handled properly, a mistake can be interpreted as a fraudulent act.
The federal law gives provisions for both criminal and civil penalties for health care fraud. A criminal penalty can attract a prison sentence, fines or monetary restitution. Civil penalties, on the other hand, do not include any jail time. The healthcare provider is only expected to compensate the victim for damages. Criminal fraud charges have dire consequences both at the federal and state level. It is wise to seek legal counsel when faced with a fraud charge. A conviction could mean the end of your hard earned career as a medical practitioner.
The need for a fraud defense attorney
Health care fraud is treated seriously. Most of the fraud allegations may seem minor, but they have the potential to damage the credibility and reputation of a health care provider and their business. If you are approached by Medicare officials about a fraud allegation, you need to contact health care fraud lawyers immediately. It is very easy for a health care giver to incriminate themselves when speaking to an investigator. You need legal counsel and guidance when responding to fraud allegations. The stakes are very high in such cases, and the best way to protect your profession is to consult with a Texas Medicare fraud lawyer.