In Texas, health care fraud is considered a serious crime because it has the potential to affect hospitals and their patients. Some of the most common forms of health care fraud include doctors billing their patients for procedures that were never performed, conducting additional and unnecessary tests to increase bills and paying others for referrals.
Not only does health care fraud lead to massive financial losses for patients, but it also has the potential to destroy a hospital’s reputation. As a result, the consequences of committing such crimes can be severe.
What are the penalties for committing health care fraud?
Chapter 35A of the Texas Penal Code outlines the consequences of committing health care fraud. The level of the offense varies depending on how much the offender gained as a result of their crime:
- Class C misdemeanor if the value of the claim does not exceed $100.
- Class B misdemeanor if the value of the claim exceeds $100 but does not exceed $750.
- Class A misdemeanor if the value of the claim exceeds $750 but does not exceed $2,500.
- State jail felony if the value of the claim exceeds $2,500 but does not exceed $30,000.
- Third-degree felony if the value of the claim exceeds $30,000 but does not exceed $150,000.
- Second-degree felony if the value of the claim exceeds $150,000 but does not exceed $300,000.
- First-degree felony if the value of the claim exceeds $300,000 or if the crime kills or severely injures another person.
If the payment or the value of the benefits is too difficult to determine, the judge will likely consider the crime a state jail felony. Medical professionals who commit health care fraud are also at risk of having their medical license suspended or revoked and may also be required to serve time in jail.
Watching out for health care fraud
Health care fraud can happen to anyone in the profession and can threaten your career and even your freedom.
Attorney John Rivas is responsible for this communication.