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How Health Care Fraud is Prosecuted

Posted by Dan Cogdell | Nov 09, 2015 | 0 Comments

According to the FBI, health care fraud is estimated to cost the U.S. more than $3 trillion every year. Also known as Medicaid or Medicare fraud, health care fraud typically occurs when a health care provider — either an individual or a company — attempts to collect illegitimate reimbursements from federal health care programs by overcharging for services, charging for services not provided or charging for services that were unnecessary.

Although anyone can commit health care fraud, it typically involves a health care provider billing insurers for treatment that was not provided or unnecessary. Health care fraud practices also involve double billing and providing kickbacks for referrals.

Health care fraud crimes are prosecuted on both the state and federal levels. In Texas, the Texas Attorney General investigates and prosecutes health care fraud through its Texas Medicaid Fraud Control Unit and the Texas Medicaid Fraud Prevention Act.

On the federal level, the Department of Justice employs health care fraud prosecutors through its Medicare Fraud Strike Force in locations across the country, including two in Texas (Dallas and southern Texas). The statutes used by the federal government to prosecute health care fraud include:

False Claims Act — this law makes it illegal to overcharge or sell substandard goods or services to the federal government.

Criminal Health Care Fraud Statute — prohibits any scheme to defraud a health care benefits program or to obtain any property or money owned by a health care benefits program.

Anti-Kickback Statute — makes it unlawful to offer, pay, receive or solicit any remuneration — directly or indirectly — in order to obtain a referral for services or benefits that are reimbursed by a federal health care program.

The Stark Law — prohibits referrals of beneficiaries of federal health care benefits programs to an organization or individual if the referring physician has a fiduciary relationship with the organization or individual.

Punishment for federal health care fraud crimes can include prison time, fines, restitution and probation. A federal health care fraud charge is very serious and one that requires the expertise of an experienced white collar criminal attorney. With endless resources at its disposal, the federal government can devote a lot of time and effort into prosecuting a health care fraud crime.

The Cogdell Law Firm is a full service criminal litigation and appellate law firm. We provide client-focused representation at all stages of the process, whether our clients are seeking to avoid charges, have been charged, or are seeking reversal of a conviction on appeal. When results matter most, contact Dan Cogdell at (713) 426-2244 or [email protected]

About the Author

Dan Cogdell

Principal & Founder Principal and founding attorney at Cogdell Law Firm, Dan Cogdell, is often referred to by his contemporaries as a “Texas trial legend.” He has been practicing criminal defense law for 36 years, during which time he has handled some of the most complex and high-profile cases i...


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