More than 600 people, including doctors, were charged in June with crimes in connection with health care frauds exceeding $2 billion and contributed significantly to the nation’s opioid crisis, according to the U.S. Department of Justice (DOJ0. In this post, we’ll detail the story and describe the laws that apply to these cases.
Biggest Healthcare Fraud Crackdown in History
The DOJ brought charges against an unprecedented 601 individuals for health care fraud. Of those charged, 162 doctors were charges with specifically over-prescribing opioids to get more money. Most of the cases are not related to one another.
The DOJ is cracking down due to the skyrocketing uses of opioids, which caused 42,000 deaths in 2016 alone.
One report from the U.S. Department of Health and Human Services’ Office of Inspector General states that nearly 460,000 Medicare patients were taking high doses of opioids in 2017, and about 71,000 of those patients could misuse or overdose on opioids.
The frauds at the core of the DOJ charges have caused over $2 billion in losses to insurers and government health care programs through illegal prescriptions and distribution. Most of the doctors charged, said the DOJ, are suspected of contributing to the current opioid epidemic with false or unnecessary prescriptions.
Among those charged in the crackdown are 48 individual from the southern district of Texas, including Houston, Laredo, and the Rio Grande Valley. Similar to the cases mentioned above, the alleged offenders filled bulk orders with false prescriptions.
Understanding Healthcare Fraud Laws in Texas and Beyond
Texas has a False Claim Act that specifically punishes false claims to Medicaid, and another Anti-Kickback Statute that punishes fraud. False claims can be made for treatments that are not medically necessary, were billed for but never provided, or for treatments not covered by the program.
If you are convicted under the Health Care Fraud Federal Statute for willfully and knowingly executing a scheme to defraud a health care program, you could face up to 10 years in prison and up to $250,000 in fines.
If you are convicted under the federal False Claims Act for knowingly presenting the government with a false claim for payment, or for making a false statement related to the false claim, you could face up to $11,000 in civil penalties for each false claim plus three times the amount of damages determined by the court. A conviction will also result in loss of participation in federal health care programs.
The government or private parties can file lawsuits against you under the federal False Claims Act. A conviction for knowingly filing a false claim will result in up to five years in prison and up to $250,000 in fines.
If anyone makes a knowing and willful offer to refer an individual to an item or service that is provided through a federal health care program, the Anti-Kickback Statute goes into effect. A conviction will result in up to five years in prison and up to $25,000 in fines. Civil penalties for infractions under the Anti-Kickback Statute are $50,000 per offense plus three times the amount of the kickback. If convicted, you may lose the right to be covered by federal health care programs.
Fight Your Charges with a Skilled Health Care Fraud Attorney
Since state and federal health care fraud cases can be complicated, you need a knowledgeable Texas criminal attorney to guide you through the process. We know what it takes to get results. Call us today for a free case review.