Health care fraud charges can turn your world upside down. This type of criminal offense involves making false claims to get money or benefits from health care programs, and getting convicted can mean heavy fines and serious jail time. Keep reading to learn about what Texas law considers health care fraud, the possible penalties associated with a conviction, potential defenses, and how a criminal defense lawyer can help fight the charges while protecting your rights.

What Is Health Care Fraud?

Health care fraud is a kind of illegal activity that involves cheating or lying in health care programs. According to Texas Penal Code Section 35A.01, one way of committing health care fraud is by making a false statement or lying about something important to get benefits or payments from a health care program when you're not supposed to. Another way is hiding information that lets you or someone else get these benefits or payments unfairly.

Also, if you get benefits or payments for someone else and use it for something else, that's health care fraud. This includes making false claims about a health facility's operations to meet certain standards, or not being honest about required information under the law or agreements related to health care programs.

Health care fraud also involves asking for or taking extra gifts or money beyond what the program pays for a service or product. It includes making claims for services or products provided by someone who's not properly licensed, or for services or products that don't meet the expected standards, or that are not approved by a health care practitioner.

Other actions like making a claim without showing the right license or ID of the health care practitioner, being part of a plan to cheat the government through health care programs, or trying to stop an investigation into health care fraud, also count as fraud.

If you're charged with health care fraud, the prosecutor must show that you knew what you were doing was wrong and that you did it on purpose.

What Are the Penalties for Health Care Fraud?

The penalties for health care fraud in Texas depend on how serious the fraud is. They range from smaller fines and shorter jail time to larger fines and longer jail time.

Specifically, if the fraud involves less than $100, it's a Class C misdemeanor which is punishable by up to a $500 fine. If it's between $100 and $750, it's a Class B misdemeanor which is punishable by up to 180 days in jail, a fine of up to $2,000, or both. For amounts between $750 and $2,500, it's a Class A misdemeanor which is punishable by up to one year in jail and a fine of up to $4,000, or both.

For fraud involving $2,500 to $30,000, it's a state jail felony which is punishable by 180 days to 2 years in jail and a fine of up to $10,000. For amounts between $30,000 and $150,000, it's a third-degree felony which is punishable by 2-10 years in prison and up to a $10,000 fine. If the fraud involves $150,000 to $300,000, it's a second-degree felony which is punishable by 2-20 years in prison and a fine of up to $10,000. For the most serious cases, where the fraud involves $300,000 or more, it's a first-degree felony which is punishable by 5 years to life in prison and a fine of up to $10,000.

Health Care Fraud on a Federal Level

Under 18 U.S.C. Section 1347, if someone knowingly and purposefully carries out or tries to carry out a plan to cheat any health care benefit program, they are breaking the law. This could be by lying, making false statements, or making promises to wrongly get money or property that's controlled by a health care benefit program. This program must be related to delivering or paying for health care services or items.

The punishment for doing this can be quite severe. You could be fined, sent to prison for up to 10 years, or both. If your actions cause someone serious physical harm, the prison time could go up to 20 years. And if it results in someone's death, you could face a life sentence in prison.

Also, the law makes it clear that you don't need to know about this specific law or have a specific plan to break it to be found guilty. So, even if you weren't fully aware that what you were doing was against this law, you could still be charged and convicted.

Potential Alternatives to Incarceration

If you're convicted of health care fraud in Texas, you might have options other than going to jail. One common alternative is community supervision, often called probation. This means you'd stay out of jail but must follow certain rules set by the court. These could include meeting regularly with a probation officer, not committing new crimes, and possibly doing community service. It's a chance to stay in your community while serving your sentence, but remember, breaking the rules can lead to jail time, and community supervision is not granted in every case.

Collateral Consequences

Being convicted of health care fraud can lead to more than just jail time or fines. It can affect your life in other big ways. With a criminal record, you might find it hard to get a job, especially in health care or other fields that require trust. If you're a licensed professional, you could lose your license. Also, your reputation could take a hit, making it harder to build relationships in your personal and professional life.

Criminal Process for Individuals Facing Health Care Fraud Charges

If you're facing health care fraud charges in Texas, here's what usually happens. First, the investigation starts when someone is suspected of fraud. This could be from a tip, audit, or other sources. Then, law enforcement looks into these claims to see if there's enough proof. If they think there's fraud, they'll bring charges against you.

After charges are filed, you'll go through several court hearings. The first one is the arraignment where you hear the charges and enter a plea (like saying you're guilty or not guilty). If you plead not guilty, the case might go to trial where both sides – the prosecutors and your defense – present evidence and arguments. A judge or jury will then decide if you're guilty.

During this time, you have the right to a lawyer. It's important to understand each step and your rights in the process, and a lawyer can help immensely in that area. Remember, being charged is not the same as being found guilty. A lawyer’s job is to defend you.

Potential Defenses in Health Care Fraud Cases

When you're accused of health care fraud in Texas, there are several defenses you can use. One key defense is lack of intent. This means showing you didn't mean to commit fraud. Maybe there was a mistake or misunderstanding about the rules of the health care program. If you can show you believed you were following the rules, it can be a strong defense.

Another defense is lack of knowledge. This is about proving you didn't know a false statement was made or that you were involved in a fraudulent claim. Sometimes in large organizations, you might not be aware of every detail. If you didn't know about the fraud, this can be a defense.

Also, you might argue that the accusations are false or exaggerated. This can involve showing that what you did was actually legal, or that the evidence against you isn't strong enough.

In some cases, you might challenge how the evidence was collected. If it was gathered in a way that broke the law, it might not be used against you.

Remember, each case is different, and what works in one situation might not work in another. It's important to work with a white collar crime lawyer to identify the best defenses for your case.

Frequently Asked Questions

What is health care fraud?
Health care fraud involves making false claims or providing misleading information to get payments or benefits from health care programs.

Can I accidentally commit health care fraud?
Mistakes or misunderstandings in billing or coding can still lead to charges.

What are the penalties for health care fraud?
Penalties range from fines and probation to significant jail time, depending on the fraud's severity.

Will health care fraud affect my professional license?
Yes, a conviction can lead to the loss of professional licenses, especially in health care fields.

Is it illegal to receive gifts for referrals?
Accepting gifts or payments for referrals in health care can be considered fraud.

Can I be charged for the actions of my employees?
You might be held responsible if your employees commit fraud under your supervision.

How can a defense lawyer help me?
A defense lawyer can develop a strong defense strategy, negotiate with prosecutors, and represent you in court.

Are there alternatives to jail for health care fraud?
In some cases, alternatives like probation or community service are possible.

What if I didn't know a claim was fraudulent?
Lack of knowledge can be a defense, but specific circumstances must be proven..

Contact Our Austin Health Care Fraud Attorneys

If you're facing health care fraud charges in Austin, Texas, it's important to understand your legal rights and options. The consequences of a conviction can be severe, impacting not just your freedom but also your future. You don't have to face this challenge alone. Contact Cofer & Connelly, PLLC by calling (512) 991-0576 or contacting us online for a consultation with an Austin health care fraud attorney. We’ll work towards the best possible outcome for your case.