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Texas officials crackdown on Medicaid fraud and healthcare marketing

The medical profession relies on integrity. We trust physicians, nurses, and other healthcare providers to focus on helping their patients get well. Since this is also their profession, physicians and medical professionals profit from their service — but how do they balance making a profit and meeting patient needs?

The public needs to trust that the needs of the patients take priority over financial gain. Laws are present at federal and state levels to help ensure physicians maintain this balance and not lean too heavily towards making a profit.

How do these laws work?

A recent investigation out of the Texas Attorney General’s Medicaid Fraud Control Unit provides an example. The unit gathered evidence to build a case against a healthcare marketer. This evidence included:

  • Kickbacks. The prosecution had evidence the healthcare marketer received payment for referring patients to Grace Healthcare Services and Ebra Health Care Services facilities for home health services.
  • Failure to provide services. The government also established that the patients never received the services stated in claims to Medicare and Medicaid.

A federal jury reviewed this and other evidence and convicted the healthcare marketer of conspiracy to pay and receive healthcare kickbacks. He now awaits sentencing and could face up to five years imprisonment and a $250,000 fine.

What if I face similar accusations?

It is important to note that the threat of criminal prosecution is just one potential consequence of these allegations. The state board may also investigate, risking your license to practice. You can build a defense to the allegations on both fronts, and you have the right to legal counsel. It is important to find an attorney experienced in this niche area of healthcare law to help better protect your rights and mitigate the risk of a negative outcome.

Attorney John Rivas is responsible for this communication