The government built two successful cases against Texas physicians to start the New Year. The Justice Department’s Criminal Division along with the United States Department of Health and Human Services Office of the Inspector General (HHS-OIG) Dallas Region recently announced the sentences for the accused medical professionals.
First doctor: Charged with false and fraudulent claims to Medicare
The prosecution accused the first physician of conspiring to defraud Medicare by selling medical orders and other documents to home-health agencies in the Houston area. The physician allegedly made false claims about patients’ medical needs, leading to illegal payments from Medicare. The government claimed the physician was involved in this scheme from 2011 through 2015, costing the government over $17 million in false claims.
Due to these allegations, the court sentenced the doctor to 20 years imprisonment as well as a $20.928 million restitution payment and forfeiture of $250,000 in ill-gotten gains.
Second doctor: Charged with conducting tests that were not medically necessary
The government also accused another Texas doctor of falsely certifying patients for home-health services. These services were, allegedly, not medically necessary. The government claims Medicare paid over $10 million in false claims for unneeded home-health services.
The accused pled guilty to one count of conspiracy to commit health care fraud. Based on this deal, a U.S. District Judge sentenced the physician to a three-year prison term along with a required restitution payment of $1.875 million and forfeiture of $274,213.46.
Lessons for physicians in Texas: The government will scrutinize your claims
These cases were the result of collaborative efforts of various government offices. The government is working together to scrutinize claims to Medicare. As such, it is wise for those who are under investigation to take the process seriously. Contact an attorney experienced in this niche area of the law to better ensure your legal rights are protected.