Health Care Fraud

Health care fraud charges put everything on the line: your job, your medical license, you career, and your liberty. A federal health care fraud charge could close down your entire practice. With offices centrally located in McKinney, Texas, Keith Gore, Lawyer, is ready to take on the government and fight for your professional reputation.

Unlike some other types of fraud, health care fraud usually targets doctors, hospitals, and medical professionals. People in your industry spend years studying their profession and invest hundreds of thousands of dollars into running successful medical practices. But all that can go away if state or federal prosecutors believe you are guilty of health care fraud.

Texas Medical Fraud

On the state level, the Texas Insurance Fraud Unit is tasked with investigating all types of insurance fraud - including medical. State prosecutors will go after individuals they suspect are filing false injury claims, as well as medical providers they identify using fraudulent billing strategies. They look for:

  • Billing for materials or services not provided;
  • Deliberate performance of unnecessary medical services;
  • Billing by unlicensed medical providers;
  • Cross-border billing for services rendered in Mexico; and
  • Coding misrepresentations, where billers use codes for complex medical procedures even though simpler procedures were performed.

If state prosecutors press charges against you, or your staff, you could be looking at felony charges, time in a state jail, and thousands of dollars in fines and restitution.

Federal Health Care Fraud

Healthcare fraud is also a federal crime under 18 U.S.C. § 1347. This federal law prohibits medical providers from knowingly and willfully executing a scheme to defraud any health care benefit program. If convicted, you could face years in a federal prison.

The FBI's White Collar Crime unit investigates false statements made by medical providers. These high priority cases include false filings with government agencies (like Medicare or Medicaid), as well as private insurance companies. If the FBI suspects you of health care fraud, you could be facing investigation by several government agencies at once. You will need a health care fraud defense lawyer who is able to sort through the claims and the paperwork, defending you against federal criminal and regulatory challenges.

Federal health care fraud cases often include an element of identity theft. Prosecutors will identify individual complainants from among your own patient lists. Federal agencies often claim that medical providers use this stolen patients' information to fraudulently obtain medical payments from insurance providers. The federal government is aggressively investigating and prosecuting HIPAA violations, and an aggressive defense is the only way to respond.

Health Care Fraud Investigations

State and federal investigators often team up against medical providers to seek out health care fraud. They may use anything from a formal audit to an undercover agent to try to catch doctors and hospitals in the act. All these investigative strategies have weaknesses that may create defenses. You need a health care fraud attorney like Keith Gore who knows how to follow the investigative trail from agency to agency, and will do the work to track down all possible defenses.

Hire Health Care Defense Attorney Keith Gore

Your freedom is important. So is your professional reputation. If you have been targeted as part of a health care fraud investigation, you need a state and federal criminal defense lawyer you can trust. With offices in McKinney, Texas, in the heart of the Dallas/Fort Worth Metroplex, Keith Gore will stand beside you throughout the process, and fight for you against investigators, prosecutors, and the federal government. Don't wait until your case heads to court. Get Keith Gore, Lawyer, involved at the first sign of trouble. He'll help protect you and your medical career.