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Austin Texas Legal Issues Blog

Two charged with health care fraud at mental health facility

The United States Department of Justice (DOJ) recently charged two individuals who worked with a mental health company with health care fraud and tax evasion. The DOJ has accused the two of diverting millions from the mental health agency into business bank accounts. The government alleges the individuals used the funds in these bank accounts to cover various personal expenses.

TX doctor’s wife arrested for knowledge of fraud scheme

The United States government recently accused a wife of criminal activity based on her husband’s alleged crimes. The government states the woman had knowledge of and knowingly participated in his alleged crimes. If convicted, she could face hefty fines and up to ten years imprisonment.

Husband accused, wife faces same fate: In this case, the husband is a physician who specializes in rheumatology and other degenerative diseases licensed to practice in Texas. The government has accused the physician of submitting false or fraudulent claims for care to health care benefit programs like Medicare. The government charged the physician with health care fraud conspiracy, health care fraud and money laundering conspiracy on May of 2018.

Patient sues for Anti-Kickback Statute violation

The False Claims Act is a federal law that allows the government or private individuals to file a claim against those who allegedly make false claims for payment against the United States. It is common for an individual to file suit and the government to join in at a later date. These cases can include physicians and health care providers that charge Medicare or Medicaid for services provided to patients.

In this case, a patient filed suit against a provider alleging a False Claims Act and Anti-Kickback Statute violation.

Study questions physicians' ability to report conflict of interest

It is not uncommon for physicians to receive compensation from pharmaceutical and medical device manufacturers. In many cases such compensation is legal. However, a misstep can lead to allegations of wrongdoing potentially including the illegal use of kickbacks to support the use of a medical device.

One area that can lead to mistakes in this niche of the medical world involves disclosure of conflicts of interest. A recent publication in the Journal of the American Medical Association (JAMA) Surgery discusses a study that delves into physicians' ability to report the presence of a conflict of interest with medical device vendors.

Physicians, when does your patient need a chaperone?

In some situations, physicians are allowed to offer the use of a chaperone for a patient during a physical exam. Generally, physicians will offer the use of these third parties in an effort to provide a patient with additional comfort. A patient may agree to a chaperone in an effort to maintain their dignity.

But when should a physician offer the use of a chaperone to a patient during an exam? The Texas Medical Board recently provided some guidance on this question. Key takeaway lesson from the publication include:

TX Medical Board clarifies mandatory reporting requirements

The Texas Medical Board (the Board) recently released a publication designed to offer guidance on required reporting obligations from hospital staff and other medical professionals. The piece specifically focused on required reporting efforts by individual physicians as well as medical peer review committees.

Am I required by law to report? Yes, the Medical Practice Act requires medical doctors, medical students and resident or medical peer review committees to report certain offenses to the Board.

FBI ramps up investigations of physician kickbacks in Dallas

The United States Federal Bureau of Investigation (FBI) has ramped up investigations of allegations of illegal medical kickbacks to physicians and health care businesses in the Dallas area. Since May, the agency has raided at least four separate, local health care businesses.

These raids can disrupt a practice and lead to false allegations of wrongdoing. Ultimately, the FBI uses these raids in an effort to gather evidence to support claims of criminal activity. With the right evidence, these allegations can grow to criminal charges and potential lead to a conviction.

Texas Doctors: Two tips to protect your online reputation

A doctor’s reputation is extremely valuable. Patients will take this reputation into consideration before deciding upon pursuing treatment. In this digital age, it is important to take proactive steps to help build your online reputation.

Why do I have to worry about my online reputation? Use of Internet rating sites is growing in popularity. Not only are these sites popular, but they impact a patient’s choice. As noted in a recent study published by the United States National Library of Medicine’s National Institutes of Health, 28.1 percent of patients surveyed “strongly agreed” a positive physician review alone would cause them to seek care from that doctor.

CMS extends temporary moratorium on home health agencies in Texas

The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) recently announced it will extend a statewide, temporary moratorium on enrollment of new non-emergency ambulance providers and home health agencies in Texas. The agency intends the freeze to cut down on the risk of fraud, waste and abuse within the system.

Why did the CMS decide to issue a moratorium on home health care agencies? The agency based the decision on a review of various qualitative and quantitative factors. In addition to a review of its own data, the CMS also took into consideration data gathered from the Department of Health and Human Services’ Office of Inspector General and the Department of Justice to support the decision. This evidence indicated the likelihood for fraud in this area of healthcare was dangerously high. As such, the agency has frozen the ability to start up a new practice in these specific fields.

TX Medical Board disciplines eighty doctors

The Texas Medical Board disciplined eighty physicians in June. The group stated the violations included issues with quality of care, unprofessional conduct, nontherapeutic prescribing, inadequate medical records and impairment infractions. The violations resulted in various penalties including the revocation, suspension or voluntary surrender of the alleged offender’s medical license.

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