Austin Medicaid & Medicare Fraud Lawyer
Facing a Medicare or Medicaid fraud charge can be deeply troubling. The consequences of a conviction are serious and can include heavy fines and prison time. Understanding your legal situation is crucial.
Facing Medicare or Medicaid fraud charges? Get a tough defense from Cofer & Connelly, PLLC. With 200 years of combined experience and over 300 trials, we know how to fight for you. Call (512) 991-0576 or contact us online to consult with a Medicare/Medicaid fraud attorney in Austin.
What Is Medicare and Medicaid?
Medicare is a health insurance program primarily for people aged 65 and up, although it also covers younger people with certain diseases or disabilities. It consists of several parts: Part A covers hospital stays and some home health care, Part B covers doctor visits and outpatient services, and Part D helps with prescription drug costs. Additionally, Medicare Advantage (Part C) plans, offered by private companies approved by Medicare, often include extra benefits and can be a good choice depending on your needs. Understanding Medicare is crucial as you age because it can significantly impact your health care options and expenses. It’s important to review your options annually, as your health needs might change.
In Texas, Medicaid provides health coverage to lower-income adults, pregnant women, children elderly adults, and those with disabilities. Administered by the Texas Health and Human Services Commission, it helps cover medical costs for those who may not afford health care otherwise. Additionally, the Texas Health Insurance Premium Payment Program (HIPP) helps Medicaid recipients pay for private health insurance when it’s cost-effective, reimbursing the cost of premiums if this option is cheaper than direct Medicaid coverage. These state programs are designed to ensure Texas residents have access to affordable health care, supplementing the federal Medicare program, especially for those with lower incomes or specific health needs.
What Is Medicare Fraud?
Medicare fraud in Texas refers to actions where someone dishonestly claims Medicare health care reimbursements they are not entitled to. This can be done by providing false information, such as billing for medical services that were never provided or inflating the cost of services. It also includes using someone else's Medicare information to receive medical services or equipment.
Medicaid fraud occurs when individuals or healthcare providers dishonestly claim Medicaid funds or services they're not entitled to. Imagine a doctor charging Medicaid for X-rays or blood tests that were never performed, or diagnosing a patient with a condition they don't have to justify unnecessary tests. Or consider an ambulance company that transports patients who can easily walk on their own but uses an ambulance unnecessarily. Other examples include an individual lying about their financial status to obtain benefits, or a nursing home bookkeeper stealing money from resident trust funds, a pharmacist dispensing a cheaper generic drug but billing for a more expensive brand-name medication, a home health agency billing for care not provided or for patients who are no longer eligible, an orthodontist claiming payment for braces never fitted, or a health clinic charging patients for services already covered by Medicaid.
What Are the Penalties for Medicare Fraud?
The penalties for Medicare fraud in Texas vary based on the amount involved. For smaller amounts, less than $100, the charge is a Class C misdemeanor, which could result in a fine of up to $500. If the fraud involves $100 to $750, it becomes a Class B misdemeanor, punishable by up to 180 days in jail, a fine of up to $2,000, or both. For amounts ranging from $750 to $2,500, you could face a Class A misdemeanor, which could lead to a year in jail and a fine of up to $4,000.
As the amounts increase, so do the penalties. Fraud involving $2,500 to $30,000 is classified as a state jail felony that is punishable by 6 months to 2 years in jail and up to a $10,000 fine. If the amount is between $30,000 and $150,000, it's considered a third-degree felony, which can result in 2 to 10 years in prison and a fine up to $10,000. For $150,000 to $300,000, the charge is a second-degree felony that is punishable by 2 to 20 years in prison and up to a $10,000 fine. The most severe cases, involving $300,000 or more, are first-degree felonies, which could lead to 5 years to life in prison and up to a $10,000 fine.
Investigation of Medicare Fraud Charges
When you are facing Medicare fraud charges, it's important to understand how these cases are looked into, both on a federal level and a state level.
Our Impact
The Experience and Proven Track Record Your Case Needs
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200+ Years' Combined Experience
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95% of Cases Dismissed, Acquitted, or Reduced
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Thousands of Cases Handled
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Award-Winning Legal Representation
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Voted Best Lawyer Five Years in a Row by the Austin Chronicle
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Former Felony Prosecutors and Judge Defending You
More experience. More strategy. More dedication. At Cofer & Connelly, our team
of seasoned trial lawyers, including former prosecutors and award-winning advocates,
brings over 200 years of combined experience to every case. When everything’s on
the line, we don’t settle—we do more.