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Two Texas women accused of over $30 million in healthcare fraud

A sheriff’s department in Texas has charged two office administrators at medical clinics with healthcare fraud. The state has accused the women of conspiring with a doctor at the clinic to file fraudulent claims with the Office of Worker’s Compensation.

According to the government’s allegations, the scheme was set up to run as follows:

  • File the claims. The government claims the alleged scheme began when the two administrators started filling in and submitting false claims to the government agency. The administrators allegedly used various changes to increase the billed cost. Examples included increasing the appointment to claim it was reviewed by a nurse practitioner, a physician drafted the report or billing for lab tests that never occurred.
  • Grow the alleged scheme. As the scheme progressed, the women would allegedly train other workers on how to submit false claims to increase the number of claims submitted on their behalf.
  • Get a bonus. Finally, the women would receive bonusses as rewards for their work. One report claims the bonuses amounted to two percent of the total bill.

The government claims the women are responsible for $5.9 million in “false and fraudulent claims” to the government. The government has allegedly connected the woman who ran the office to additional false claims totaling over $30 million. The government has not yet filed any charges against the physician that was a part of the alleged operation.

The government takes allegations of these types of fraudulent billing practices seriously. It is wise to take prompt action if your organization is the subject of an investigation based on these types of allegations.