Like many people in Texas, you may hear reports about health care professionals or health care facilities facing allegations of health care fraud. Some of these cases may center around billing practices and involve private insurance companies or the federal Medicare or Medicaid programs.
Anyone working in the health care field may find it interesting and important to understand the things that may lead to these types of assertions.
Recent cases provide a plethora of examples
In September of this year, Becker’s Hospital Review provided a recap of several relevant and recent cases involving allegations of some form of health care fraud. One involved a doctor from Houston. The case indicates he submitted bills to Medicare for a surgical procedure not reimbursable by Medicare. The physician paid $530,000 to settle the matter. Whether or not a mistake occurred in billing remains unknown, as does the plea entered by the defendant.
A Florida physician apparently entered a guilty plea in response to charges of Medicare billing fraud amassing an approximately $20 million. The maximum prison sentence for the charge extends 10 years but the actual sentence remains unknown at this time.
Three doctors in North Carolina had to pay $900,000 to settle a case in which they allegedly billed a federal payer for tests deemed unnecessary.
An error may lead to fraud allegations
Sometimes, mistakes happen in medical billing. When a mistake contributes to an accusation of fraud, defendants deserve help.
This information is not intended to provide legal advice but is instead meant to give people in Texas an overview of the types of situations that may contribute to allegations of health care fraud.