The state of Texas is continuing its crackdown on healthcare fraud through 2026. Earlier in the year, Attorney General Ken Paxton announced over 180 indictments for healthcare fraud in 2025 and a focus on continuing the efforts through 2026. Three important things for those in the healthcare industry in Texas to know about these efforts are discussed below.
#1: Local focus with federal reach
These efforts are using a combination of local and federal resources. For example, in collaboration with federal agencies Attorney General Paxton’s Medicaid Fraud Control Unit played a significant role in the largest healthcare fraud action in history. The federal effort included more than a dozen healthcare fraud schemes in operation in Texas as well as hundreds of millions in fraudulent billing throughout the nation.
#2: These efforts will continue through 2026
Attorney General Paxton was very clear that the state is not slowing down these efforts. In a recent announcement, he stated his office will continue to “bring the hammer down on fraudsters.”
#3: Those under investigation have options
Healthcare professionals dedicate their careers to helping others. False accusations of fraud can devastate reputations built over decades. It is important for those who find themselves facing such allegations to understand the basics of the process so they can begin to structure a response to the allegations.
Healthcare fraud allegations often stem from billing errors, documentation issues or misunderstandings of complex regulations. A defense tailored to the case is important to help protect professional licensure, livelihood and reputation. When building a defense strategy, a review of the following can help:
- Intent: It is often helpful to demonstrate that any billing irregularities resulted from honest mistakes rather than deliberate deception. Prosecutors will look to establish that the fraud was intentional.
- Reasonable interpretation: Billing practices that reflect a reasonable interpretation of ambiguous regulations or coding guidelines can also serve as part of a defense strategy.
- Reliance on professional advice: Gather evidence of advice from billing specialists, consultants or legal advisors when making coding decisions.
- Inadequate evidence: Challenge the government’s case by exposing gaps in their documentation or flaws in their investigative methods.
- Good faith: A genuine attempt at honest billing practices that comply with applicable laws and regulations can also help.
Healthcare fraud defense requires attorneys who understand both medical practice and federal regulations. The right legal team can mean the difference between conviction and vindication. Your years of service to patients deserve protection from unfounded accusations.
Texas healthcare providers are practicing in a strict enforcement environment and healthcare professionals are wise to recognize the gravity of this situation. A single billing error could trigger an investigation that threatens a career. Early action matters. The moment you receive notice of an investigation, your response begins shaping the outcome. Documentation of billing practices, evidence of good faith efforts and proof of reliance on professional guidance can all become critical elements of your defense.
This enforcement wave will not subside in the near future. Healthcare providers should review their billing practices and ensure documentation supports every claim.
Attorney John Rivas is responsible for this communication.