Large and small health-care providers across the country-and particularly in Texas-are under increasing levels of scrutiny in every area of their businesses. Nowhere is this truer than in regard to billing practices. Your organization could easily be the target of a government investigation, even if you had no intent to commit fraud.
If the Office of Inspector General (OIG) or State Attorney General (AG) has contacted you about a fraud investigation, speak with an experienced healthcare fraud lawyer at Hendershot, Cannon, Martin & Hisey before you respond. Even if investigators say you are not the target of the investigation, you may inadvertently make an admission that jeopardizes your practice or organization. Our job is to protect your interests from the time you suspect a problem through the conclusion of your case.
Have you been contacted by the Attorney General or Office of Inspector General? Contact us right away at (713) 909-7323. We emphasize early and thorough preparation with Medicaid or Medicare matters. We serve clients throughout Texas.
Allegations of Medicare or Medicaid fraud may stem from either billing problems or improperly inducing referrals for Medicare or Medicaid services.
Common violations include:
Medicare and Medicaid fraud investigations can have serious consequences, including criminal charges, disenrollment from Medicare and Medicaid, fines, and sanctions against you or your practice. The earlier you contact us, the sooner we will begin investigating and preparing your case.
We will represent you at every step of a fraud investigation-beginning before allegations arise. We can advise you on the creation, implementation, and maintenance of compliance plans designed to prevent and resolve problems before they become investigations. If state or federal government agencies do conduct investigations, we will prepare a strong and aggressive defense. We handle civil investigative demands, subpoenas, interviews, document production, hearings and trial.
Our services to your organization may go beyond billing or fraud allegations. We are a full-service business and healthcare law firm. Because of this, we routinely advise healthcare clients on matters as varied as:
In any legal matter we are involved with, you will find that we get to know you personally, so that we can better protect what matters to you and your case.
We regularly advise defendants on the most complex health care regulations affecting providers in Texas, including:
To combat the risk of money influencing a patient's health care, the federal government enacted an anti-kickback law called the Fraud and Abuse Statute. In addition, Texas has the Patient Solicitation Act. These laws make it illegal to knowingly and willfully receive or offer payment to influence referrals of state or federal healthcare program business. Violations of this law can lead to both criminal and civil penalties. We help care providers and professionals set up transactions that comply with fraud and abuse regulations, and we provide immediate, comprehensive advice and guidance when allegations surface that a transaction may be in violation of the statute.
The Stark Law, otherwise known as the self-referral law, governs medical professionals' conduct regarding the referral of Medicare or Medicaid patients to another provider. Doctors are prohibited from referring a Medicare or Medicaid patient for designated health services to a provider in which the doctor or an immediate family member has a financial interest. Doing so is deemed to be a conflict of interest under the rules of the law.
The OIG and Texas AG are conducting an increasing number of investigations into possible violations of the federal False Claims Act by healthcare professionals and facilities. Frequently focusing on much broader issues than improper billing practices, these investigations can include tainted claims, which are claims that are fraudulent in any respect or the result of a kickback or an improper referral or relationship. If the OIG or AG has requested information or an interview or has served a notice or subpoena, our healthcare attorneys will help protect you and your organization. We draft compliance programs and advise clients on the law. We handle civil OIG and AG investigations as soon as you receive a call or letter.
The RAC program was created by the Medicare Modernization Act of 2003. Its purpose is to efficiently detect and recover improper payments to medical care providers. As part of the program, private contractors assess health-care records for signs of wrongdoing. Investigators may look for things like improperly coded services, duplicate services, billing for services not covered, and incorrect payments of other kinds. If you have been notified that your practice or organization is the target of an RAC audit, you should consider working with an experienced healthcare attorney right away. You can better protect yourself by bringing in legal counsel as soon as possible.
Zone Program Integrity Contractors (ZPICs) oversee the Medicare Benefit Integrity program, including Parts A and B, home health care services, hospice care and durable medical equipment (DME). The purpose of the program is to identify and eliminate Medicare fraud. In most instances, contractors use a sampling of statistical data for a particular time period. ZPIC audits are typically initiated based on rate analysis or information provided by a whistleblower. Depending on the findings of the audit, the ZPIC can choose to initiate a fraud investigation. We will counsel you on how to respond to demands for audits and develop strategies to challenge the contractor's extrapolations and grounds for seeking an audit. If an audit does commence, we are prepared to support you at every stage of the process.
Novitas Solutions Inc., formerly Highmark Medicare Services Inc., is an administrative services processing company that, among other things, serves as the Medicare Administrative Contractor (MAC) for Jurisdiction H-which includes Texas. In addition to its handling of enrollment and claims processing, Novitas handles the review of past payments to providers. If it finds patterns of coding errors or overbilling, it can initiate an audit of the providers in question. If the audit findings warrant it, Novitas can recommend additional pre- or post-payment reviews. If your practice is the target of a Novitas audit, we will pursue every available option in an effort to protect your interests.
The Texas Department of Insurance oversees the insurance industry in order to protect patients from unethical or unfair behavior. The TDI has a law enforcement arm (the Fraud Unit) with full police powers to conduct criminal investigations and make arrests. The process, whether you're at risk for losing licensure, receiving a fine, or worse penalties, begins with an audit of your billing practices. If they find that you've committed insurance fraud, they have the resources of the state's investigative forces behind them. Get an attorney on your side before that happens-we can help you prepare for an audit and affirm your rights while remaining compliant throughout the process.
Accused of Medicare or Medicaid fraud? Contact our Houston office to discuss your Medicaid fraud case and defense needs with a dedicated Houston health law attorney. Fill out a simple online consultation form or call (713) 909-7323 to get started.