Medicare, Medicaid and Health Care Fraud in Texas

When you hear the word “fraud,” you might think about large-scale financial scams like a Ponzi scheme. But one of the most common types of fraud in Collin County and throughout Texas involves health care providers. Every year the federal government pays out millions of dollars in false and fraudulent billing claims submitted through Medicare and Medicaid.

This is not a small-time con: A Texas Senate investigation in 2012 revealed that over a two-year period, the state “spent $424 million on medically unnecessary orthodontic braces for Medicaid recipients alone.” And that was just a drop in the bucket: Overall, the Texas inspector general’s office “identified more than $6 billion” in Medicaid fraud dating back to 2004.

Justice Department Cracking Down on Medicare & Medicaid Overbilling

First, let us define what we mean by fraud in this context. Medicaid and Medicare are federal programs that help people pay for their health care. Medicare offers insurance coverage for people who are 65 and older. Medicaid provides benefits for low-income individuals regardless of age.

Individual health care providers in Collin County and throughout Texas sign contracts to treat Medicare and Medicaid patients. They are required to follow strict billing procedures established by the government. But in many cases, providers try to game the system. This can take the form of double billing–charging both Medicaid and the patient’s private insurer for the same service–or even billing for services that were never provided.

In other cases, a health care provider who is not properly licensed or otherwise qualified to treat Medicare and Medicaid patients will falsify their credentials to obtain reimbursements. And sometimes, health care providers bill for services they did provide but which they knew were medically unnecessary. All of these acts constitute fraud against the government.

For example, last June the U.S. Attorney’s Office in Dallas charged 12 defendants in north Texas with health care fraud. Nine of the 12 defendants were “charged in connection with three separate home health care schemes.” This refers to the practice of falsely billing Medicaid and Medicare for in-home services to patients. In one case, the Department of Justice (DOJ) said the defendant “hired a physician to apply for a Medicare number to allow him to bill Medicare for physician home visits and to sign false physician certifications for home health care.”

The Dallas cases were actually part of a larger nationwide crackdown against health care fraud. The June 2016 cases resulted in charges against 301 individuals residing in dozens of states. The DOJ said the total amount of fraud involved exceeded $900 million.

Fighting Health Care Fraud Accusations with a Frisco Criminal Defense Attorney

If you are facing fraud regarding health care in Texas, or any other type of white collar charge, and need assistance from an experienced Frisco, Texas criminal defense attorney, contact Rosenthal Kalabus & Therrian, today at (972) 369-0577.

Written by: Rosenthal Kalabus & Therrian Last Updated : August 14, 2023