Healthcare Fraud Attorney in Georgetown, TX
A Georgetown healthcare fraud lawyer is a criminal defense lawyer who provides legal representation to individuals who have been accused of engaging in fraudulent activity related to the billing of healthcare services, insurance claims, medical records, prescriptions, or other government healthcare programs.
These allegations can result in felony charges, issues with professional licensing, financial penalties, and long-term impacts on a person’s career and reputation. The Law Office of Lytza Rojas, PLLC, offers criminal defense representation to clients who are under investigation and charged with fraud crimes in Georgetown and other Texas communities.
Hire a Healthcare Fraud Lawyer
The Law Office of Lytza Rojas, PLLC, handles criminal defense cases in Texas. The firm defends people accused of white-collar crimes such as fraud. Criminal defense attorney Lytza Rojas has over 20 years of experience with misdemeanor and felony cases, and she has worked as a prosecutor as well as a criminal defense lawyer.
Lytza Rojas and her team work with clients throughout the course of investigations, negotiations, and court proceedings. The Law Office of Lytza Rojas, PLLC, focuses on preparing for trial, planning trial strategy, and carefully reviewing the facts and evidence of each case.
Healthcare Fraud Investigations and Federal Agencies
Healthcare fraud investigations can be performed by a combination of state and federal agencies that scrutinize billing, financial, and communication records of healthcare providers or medical businesses.
The Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), the Centers for Medicare & Medicaid Services (CMS), and the Texas Attorney General’s Medicaid Fraud Control Unit, among others, can be involved in a criminal investigation.
In some cases, investigations start once audits, whistleblower complaints, patient complaints, or peculiar billing patterns are flagged. Investigators may seek access to patient records, insurance claims, bank records, email accounts, or other internal business records as they work to establish allegations of fraud against Medicare, Medicaid, or private healthcare benefit programs.
Common Allegations in Healthcare Fraud Cases
Healthcare fraud prosecutions can be based on numerous types of billing, insurance reimbursement, prescription, and healthcare services allegations. Prosecutors may allege that a person or medical business has charged or billed for services that were not rendered, overstated the extent of care, submitted duplicate claims, or billed for medically unnecessary treatment.
Allegations can also include kickback schemes, false documentation, forged prescriptions, and Medicaid and Medicare fraud. Doctors, pharmacists, clinic operators, home healthcare providers, medical office employees, and many other individuals may become involved in an investigation. Since healthcare billing systems and coding practices are highly technical, sometimes arguments exist as to intent, record-keeping practices, and billing interpretation.
Professional License and Career Consequences
Allegations of healthcare fraud may result in adverse consequences that reach well beyond the criminal process. Doctors, nurses, pharmacists, therapists, clinic owners, and other healthcare professionals who are licensed may be subject to discipline by their licensing board while criminal charges are pending.
Individuals may also face suspension or revocation of their professional licenses, exclusion from Medicare or Medicaid, employment termination, or loss of their careers and professional reputations.
Healthcare organizations and medical practices may face business disruption, financial audits, and contract complications that arise from healthcare fraud investigations. In some cases, even prior to trial, allegations can impact a person’s ability to earn a living and be respected in the healthcare industry, so it is important to have legal counsel every step of the way.
Evidence and Defense Issues in Healthcare Fraud Cases
Healthcare fraud prosecutions also frequently involve large quantities of records, complex and technical billing data, and intricate financial information. Insurance claims, electronic health care records, prescription histories, internal documents, audits, or witness statements can all be used as a basis for the prosecution.
Alternatively, investigators may try to establish that fraudulent conduct was repeatedly committed over time through review of patterns in billing codes or reimbursement requests. In defense, an attorney may attack billing data interpretation, the intent behind coding or payment errors, the accuracy of the government’s calculations, or the methods used to gather evidence.
The complexity of health care laws and reimbursement regulations often requires an extensive review of records and business practices.
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FAQs
Can Healthcare Fraud Charges Be Filed as Felonies in Texas?
Depending on the allegations, the sum of money, and the prosecutors’ belief in intentional deception concerning a healthcare benefit program, healthcare fraud charges in Texas can be pursued as felony offenses.
Texas Penal Code § 35A.02 addresses healthcare fraud allegations involving false or deceptive claims and information related to healthcare services or reimbursements.
Felony convictions are punishable by prison or jail, financial fines, restitution to victims, and long-lasting impacts on career and business prospects.
How Much Money Is Recovered Through False Claims Act Cases?
False Claims Act enforcement has continued to be the primary focus of healthcare fraud investigations related to government healthcare programs and reimbursement claims. The U.S. Department of Justice announced False Claims Act settlements and judgments totaled over $2.9 billion in fiscal year 2024, with healthcare-related matters accounting for the largest portion of recoveries.
How Active Are Federal Healthcare Fraud Enforcement Efforts?
Government enforcement efforts to combat healthcare fraud are still prevalent nationwide. In fiscal year 2024, the U.S. Department of Health and Human Services Office of Inspector General reported 1,548 criminal actions and 1,041 civil actions related to fraud and abuse investigations.
These investigations included providers, business operators, and individuals accused of fraudulent activities involving federal healthcare programs. Federal agencies are continuing to prioritize healthcare fraud cases involving Medicare, Medicaid, and other government-sponsored healthcare benefit programs.
Can Electronic Medical Records Be Used as Evidence in Healthcare Fraud Cases?
Electronic medical records are often subpoenaed during healthcare fraud investigations. During such investigations, prosecutors and investigators typically review appointment histories, treatment notes, prescription records, timestamps, and communications found in electronic healthcare systems.
In some investigations, medical records are compared against insurance claims or financial records to identify alleged discrepancies. Healthcare providers and medical businesses often use these systems to such a large degree that electronic medical records can become a substantial part of an investigation or healthcare fraud case.
Contact a Georgetown Healthcare Fraud Lawyer
Healthcare fraud allegations can place a person’s career, finances, and reputation at risk. The Law Office of Lytza Rojas, PLLC, represents clients facing complex healthcare fraud investigations and criminal charges in Texas. Schedule a consultation today to hire a healthcare fraud lawyer.
