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What Is A Violation Of The False Claims Act In Healthcare In Texas?

What is the False Claims Act?

Under the federal False Claims Act it is a crime for any person or organization to “knowingly’ submit a false or fraudulent claim for payment under any federal health care program. You do not actually have to “know” you are submitting a fraudulent claim to break the law. If you “should have known” that your claim was unlawful, you could face federal criminal and civil penalties.

Texas law similarly makes it unlawful for a person to knowingly present a false claim, solicit or receive kickbacks for referrals, or to fail to maintain documentation to support claims for healthcare payments.

Healthcare Fraud Billing Practices Include

  • Billing for services or products not provided
  • Billing for the same service more than once
  • Making false statements about a patient’s condition or the altering dates of service
  • Unbundling services: billing tests individually that are routinely part of a test panel
  • Billing for unnecessary services or services above what the patient needs, including tests
  • Split billing: dividing the billing into multiple days when the patient was treated in one visit
  • Billing Medicare at a higher fee schedule than that used for non-Medicare patients
  • Inflating costs related to patient care, supplies, equipment, and non-covered services

What are the Potential Penalties Under the False Claims Act?

Under the False Claims Act, providers can face both civil and criminal penalties.

  • Civil penalties include recovery of three times the amount of the false claim(s), plus an additional penalty of $5,500.00 to $11,000.00 per claim.
  • A provider may face criminal penalties if the government alleges that a provider “knowingly” submitted a false or fraudulent claim. Intentional fraud can bring prison terms, depending on the amount of the false claims for benefits.

Texas False Claims Statutes Penalties

Fines levied under Texas False Claims Statutes include a penalty of up to three times the Government’s damages and inflation adjusted civil penalties up to $21,916 per false claim. Defendants also face payment of the costs of the civil action.

Are You Under Investigation for Healthcare Fraud?

If you are under investigation or think you may be facing fraud charges, you need a proven negotiator and litigator on your side. Former Federal Prosecutor Michael J. Wynne knows how prosecutors build cases against his clients. He spent 12 years doing just that. He uses his knowledge and decades of experience to defend individuals and companies from fraud allegations.

Federal criminal defense attorney Michael J. Wynne’s priority will be to help you avoid criminal charges by thoroughly investigating the relator’s claims and credibility and doing everything possible to demonstrate why the case may not be worth pursuing.

If civil liability is unavoidable, you will need a skilled negotiator with years of experience and the proven skill to negotiate a settlement resulting in the least possible penalties and fines.

Attorney Michael J. Wynne has nearly 30 years’ experience navigating complex litigation, including high-profile white-collar criminal charges and commercial fraud allegations. If you are under investigation or think you may be facing civil or criminal fraud charges, call (832) 390-6244 today to speak with federal criminal defense and white-collar criminal defense attorney Michael J. Wynne.

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