What Are the Penalties for Healthcare Fraud in Texas?

medical instruments in doctor's office

Previously referred to in Texas as Medicaid fraud, any scams involving health insurance are not taken lightly. As such, understanding what constitutes this crime and the penalties associated with it is vital to protecting yourself. If you’re accused of healthcare fraud, it’s essential to contact an experienced Houston white collar crimes defense attorney as soon as possible. Keep reading to learn more about this offense and what you can expect if charged.

What Is Healthcare Fraud?

Healthcare fraud is a type of insurance scam commonly committed by hospitals, doctors, and patients. However, providers most commonly engage in this illegal activity. Generally, any time someone falsifies or misrepresents a claim to receive benefits of any kind in relation to health insurance or medical treatment constitutes healthcare fraud.

There are a number of ways that doctors and facilities like nursing homes or rehabilitation centers commit healthcare fraud. The most common is via billing inconsistencies. For example, if you bill a patient’s insurance for a service you did not perform, “upcode” or make a procedure seem more expensive than it actually is, or falsify records to justify performing medically unnecessary testing, you would be committing healthcare fraud. Similarly, accepting kickbacks for referring a patient to another doctor or facility also constitutes healthcare fraud.

What Penalties Can I Face for This Offense?

Generally, the penalties you face for this offense will depend on the monetary value of the benefit, as follows:

  • Class C Misdemeanor: Payment is less than $100
  • Class B Misdemeanor: Payment is more than $100 but less than $700
  • Class A Misdemeanor: Payment is more than $700 but less than $2,500
  • State Jail Felony: Payment is more than $2,500 but less than $30,000
  • Third-Degree Felony: Payment is more than $30,000 but less than $150,000
  • Second-Degree Felony: Payment is more than $150,000 but less than $300,000
  • First-Degree Felony: Payment is more than $300,000

It’s essential to understand the severity of these crimes. Misdemeanors and felonies can result in jail time and hefty fines. For those who work in pharmaceuticals, you also run the risk of facing additional drug-related charges. Unfortunately, it’s likely that you could face a medical license suspension or revocation, making it illegal for you to practice medicine.

Are There Any Possible Defenses for This Crime?

If you are facing this crime, understanding the possible defenses you can use is crucial. In some instances, it may simply be a miscommunication. There may have been an error in billing in which a patient was charged twice or for the wrong service, the billing team misunderstood how to process the payment, or you believed the patient needed the tests performed.

Whatever the case may be, the Gonzalez Law Group is here to help. Our dedicated legal team understands how crucial healthcare providers are to the community, and we will do everything possible to help you achieve the best outcome possible for your unique circumstances. Contact us today to schedule a free consultation with our competent firm.