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TX physicians face healthcare fraud allegations for failure to provide meds

The United States Attorney’s Office from the Northern District of Texas recently announced the indictment of the two physicians for conspiracy to commit healthcare fraud, healthcare fraud, and unlawful distribution of a controlled substance.

The court documents state the two doctors sent fake claims to their patients’ insurance providers for corticosteroid injections that the patients never received. The details are particularly egregious, stating the physicians would place the needle near the injection site and pretend to provide the medication while never even piercing the patient’s skin. The government further claims that the group provided investigators with fake medical records to show that the patient received the injection.

How can my practice avoid similar allegations?

Allegations of a failure to provide care as billed like these are not uncommon. It is important to discuss these cases because they serve as a reminder of the need for careful record keeping and regular internal audits. These audits can help to better ensure that your staff is working in compliance with applicable regulations and reduce the risk of allegations of healthcare fraud.

What are the penalties for allegations of healthcare fraud?

Depending on the evidence, the government can push for repayment of the allegedly ill-gotten gains, additional financial penalties, and imprisonment.

In the case noted above, the government claims the physicians bilked the insurance companies of over $50 million in false claims. If the government can build a successful claim against the doctors, the physicians could face decades of imprisonment and millions in financial penalties.

What if I face similar allegations of wrongdoing?

It is important to look at the big picture. The allegations on their own warrant swift action but can also trigger a board investigation that may threaten your license. Take action to build a defense to the criminal allegations and the board investigation.

Attorney John Rivas is responsible for this communication.