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Federal Healthcare Fraud Lawyer

If you or your practice have been accused of healthcare fraud, you need a dedicated and aggressive Texas healthcare fraud lawyer to begin building your defense before it’s too late. Investigations for healthcare fraud move quickly and are prosecuted aggressively. If you don’t already have representation and do not act fast, you may not have time to catch up.

If you’re looking for the best federal criminal defense attorneys in Texas, you need to give Flanary Law Firm a call. Donald Flanary and the federal criminal lawyers for white collar cases at Flanary Law Firm know what it takes to aggressively defend fraud allegations in a federal court. They know what it takes to build an iron defense that will protect your practice, reputation, and life. For a free consultation and iron-clad defense, call Flanary Law Firm today at (210) 738-8383.


What is healthcare fraud?

Healthcare fraud is an umbrella term that encompasses any scheme to defraud a healthcare program like Medicare and Medicaid or any private insurance company or government insurance program. There are a few pieces of important legislation that can govern any healthcare fraud claim, including:

  • Federal Healthcare Fraud under 18 U.S.C. § 1347 is the broadest outline of federal healthcare fraud, it states that:
    • Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice—
      • to defraud any health care benefit program; or
      • to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury (as defined in section 1365 of this title), such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.
    • With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.
  • The False Claims Act (31 U.S.C. § 3729). Most cases that are filed under the False Claims Act are former employees or competitors whistleblowing to collect a monetary reward. If you have received a subpoena or a request for documents or information from a government agency, hire a lawyer before you comply. False Claims Act claims can easily turn into criminal cases if they are not handled correctly.
  • The Anti-Kickback Law (42 U.S. Code § 1320a–7b) prevents healthcare providers from gaining anything from referrals or use of products. Taking monetary payments, referrals, free equipment, or just about anything of value in an agreement with another medical provider could count as a kickback.
  • Federal Conspiracy cases under 31 U.S.C. § 1349 tend to get complicated. Essentially, federal conspiracy cases allege that a network of people have worked together to contribute to the success of a fraudulent scheme. This is most often invoked when working in connection to companies that either sell or market things like medical technology or pharmaceuticals.

The statutory language makes the crime out to be horrendous and obvious, but a healthcare fraud claim can often arise from simple actions and small mistakes. Common actions that can trigger an investigation for healthcare fraud include:

  • Billing for services not rendered or false service claims
  • Prescribing unnecessary medication or treatment
  • False diagnosis claims
  • Conditionally waiving fees
  • Ghost patients
  • Hiring unlicensed staff
  • Accepting or giving kickbacks for referrals

The Texas federal attorneys at Flanary Law Firm know fees get waived, misdiagnoses happen, and sometimes patients try out a medication that doesn’t work. This should never mean the loss of a medical license for someone that has dedicated their life to the well-being of their patients.


How do you prove healthcare fraud?

The burden of proof rests on the prosecution to prove that the provider engaged in a scheme of theft by deception in order to defraud Medicare or Medicaid, a private insurance company, or a government insurance program.

A central point of discussion in any healthcare fraud case is the intent of the defendant. The prosecution will need to prove that you “knowingly and willfully” executed, attempted, or planned to execute the fraudulent scheme or artifice in order to charge you with fraud. If they can’t, then they have no case.

Unsuccessful charges for healthcare fraud often originate in accounting errors, patient coding errors, or patient billing errors. Even if the accusations are baseless and the root cause was an honest mistake, which is often the case, you will still likely need the best federal criminal defense attorneys you can find in order to prove it.


Can I lose my medical license from a healthcare fraud case?

A healthcare fraud conviction will incur several penalties for the convicted, not limited to incredibly high fines, jail time, and loss of medical license. Significant personal and financial losses are on the table, not to mention the loss of life represented by felon status. If you want to continue working and living as you do now, hiring one of the best criminal defense attorneys in San Antonio is your best shot.

You’ve dedicated your entire life to your profession and to your patients, don’t let an over-scrutinized error in an over-regulated industry bring it all down.


Under investigation? Call the Texas healthcare fraud lawyers at Flanary Law Firm.

If you or your practice received an audit, a Civil Investigative Demand, or a subpoena, do not wait — arm yourself with an aggressive Texas healthcare fraud lawyer and protect your livelihood.

Don Flanary takes on high-stakes federal cases all over Texas. He knows how to stand up for his clients in a federal court and put the prosecution on their heels. Get Donald Flanary to fight for you, and call Flanary Law Firm at (210) 738-8383 or contact us online for a free consultation.

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