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Austin Texas Legal Issues Blog

Texas court sends ambulance operator to prison for fraud

A Texas court recently sentenced a 46-year old local man after he pleaded guilty to charges of conspiracy to commit health care fraud. The accused owned and operated the ambulance company in the Houston area from 2009 through 2012.

Outline of allegations: The ambulance company owner allegedly billed Medicare and Medicaid for ineligible or unprovided services. He also allegedly filed for payment of individual rides when the prosecution states he had multiple passengers in the vehicle.

Billing rules tightened for Texas labs

The Eliminating Kickbacks in Recovery Act of 2018 (EKRA) is part of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT). This new law will go into effect in October.

Doctor fights TMB's revocation of license, and wins

A doctor in Texas took issue with the Texas Medical Board’s (TMB) decision to revoke his license to practice medicine. He sued the board and could potential see reinstatement in the near future.

Two Home Health Care leaders in TX sentenced to prison time

April has proved a successful month for the Department of Justice (DOJ). The agency has already had two successful prosecutions against local leaders in the Home Health Care industry accused of health care fraud crimes.

Both will serve prison time for their alleged crimes. The cases serve as a reminder for those accused of health care crimes to take the allegations seriously. The DOJ can and will pursue serious penalties, including imprisonment.

Texas Medical Examiner's Office accused of fraud

The Texas Medical Board (TMB) has reportedly extended an investigation well past the usual 180-day limit. A forensic anthropologist serving on a contract basis at a local Medical Examiner's Office was one of many individuals who came forward with complaints about the facility's techniques.

What was the complaint? The complaint states that another physician had stated the previous chief medical examiner used the county facility to aid his personal practice and accepted bribes in exchange for changing the official cause of death. This led the TMB to call for a review of the accused physician's cases. The physician that allegedly made these accusations states he never made the claims provided within the complaints. He points to an ongoing investigation by the TMB of the facility and an attempt to put the blame on an innocent physician.

TX uses new tool to charge doctors with health care fraud

The medical profession's first concern should be the welfare of the patient. Most physicians, nurses and other medical professionals go into this field because they share a similar belief. However, as is true in any profession, there are some who stray and find the lure of financial rewards too much to ignore.

The government has various laws and regulations to help encourage a patient focus and deter financial motivation. One example is the Antikickback Statute. As a rule, those who practice must be very careful about financial partnerships with other physicians, hospitals or medical professionals. Although the partnership may have a focus on coordinated care efforts, the government could misconstrue the partnership as financially motivated and a violation of the Antikickback Statute.

Request for medical billing records can trigger payment problems

Health insurance companies may request a copy of billing records to substantiate claims for payment. If not provided in a timely manner, the company could report physicians who fail to comply to the state medical licensing board. Unfortunately, additional problems can arise if the requested records are provided but put together poorly.

TMB questions doctor's prescription methods, restricts license

The Texas Medical Board's (TMB) disciplinary panel announced the temporary restriction of a Houston physician. The group accused the physician of administering opioids at a high volume. The TMB further chastised the physician, stating he not registered as a pain management clinic as required due to the nature of his practice.

As a result of these alleged violations, the board temporarily and immediately restrained his medical license.

DOJ pursues healthcare fraud case, alleges billions in violations

The Department of Justice (DOJ) released the federal indictments for a group of individuals charged in one of the largest cases of healthcare fraud in recent history. The case is the result of a joint operation involving many agencies including the Federal Bureau of Investigation, U.S. Department of Health and Human Services Office of Inspector General and the Internal Revenue Service Criminal Investigation as well as various state agencies throughout the country.

Oncologist sues Texas Medical Board

The Texas Medical Board recently took away a local oncologist's medical license. Two former patients accused the physician of "improper behavior." As a result, the board severely restricted his ability to practice medicine.

The physician did not take the allegations lightly. He is proactively working to better ensure his license is fully reinstated. He has sued the board and three members, individually.

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