Penalties for Fraud in the Form of Kickbacks

Both paying or receiving kickbacks in the healthcare industry are explicitly prohibited by law in Texas. The Anti-Kickback Statute defines the crime and criminal penalties. The crime is described as receiving, offering, paying or soliciting payment for a medical referral.

This type of action is a crime because it encourages healthcare providers to act based on profit rather than in the best interests of patients.

If you’re convicted of paying or receiving kickbacks, then you may face both criminal and civil penalties such as:

• Up to five years in jail
• Fines up to $25,000
• A permanent ban from federal healthcare programs
• Revocation of your medical license
• Civil damages up to $50,000

In addition to the Anti-Kickback Statute, there are other laws that regulate this type of behavior. The Stark Law prohibits doctors from referring patients to others that they’re in a financial relationship with. There are some exceptions to these laws, but it will still cost time and money to defend yourself against this type of fraud charge.

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Laws Regulating How Physicians Delegate Duties in the Office

Laws prohibit doctors from delegating specific duties to other medical staff. The Medical Practice Act describes the types of situations in which it’s appropriate for a doctor to delegate tasks to others. 

In general, physicians can only delegate medical tasks to qualified and trained individuals. Even when these tasks are delegated to others, the physician must still supervise the procedure.

If you’re found in violation of this act, you could be criminally charged with a Class A misdemeanor. You may face jail time and fines.

Penalties for Providing Unnecessary Medical Services

The False Claim Act protects patients from getting charged for medical services that were provided but were not actually medically necessary. This type of healthcare fraud happens when doctors order treatments, services, or products that aren’t medically necessary in order to profit off of the patient.

It’s difficult to prove that certain treatments are not medically necessary. Often, doctors attempt treatments that don’t work. If the doctor has ordered the treatment in good faith, then that situation would not be considered healthcare fraud.

If you are convicted of providing unnecessary medical services to patients, then you could get hit with civil penalties on each individual claim. Right now, the minimum penalty is around $11,000. The maximum penalty per clam is around $22,000.

In addition to financial penalties, you’ll be permanently excluded from participating in Medicare and Medicaid programs. As for jail time, you can expect a maximum jail sentence of five years.

Penalties for Upcoding or Billing Patients for Services Not Provided

Upcoding happens when a doctor earns a profit by charging for a more expensive service than provided. It’s similar to charging a patient for services that were never provided.

The severity of the penalties for this crime is directly dependent on the damages caused.

If the value of your upcoding was above $2,500, then it’s possible you could get charged with a felony. Felony crimes carry very heavy penalties. If the value of your billing offenses is over $300,000, then you could get charged with a first-degree felony. This type of crime can carry a life-long jail sentence and fines up to $10,000.

Penalties Associated with Shopping for Doctors

Patients often attempt to doctor-shop to obtain extra prescription pills. They may do this in order to feed a habit, or they may be motivated to sell the pills for a profit.

Sometimes, individuals may be unaware that what they’re doing is a crime. According to the Controlled Substances Act, it’s a crime for anyone to obtain drugs by deceit. Violating this prohibition will result in a felony charge in Texas.

The penalties the patient receives hinges on the motivation. Sometimes, Texas courts will be more lenient on those who are suffering from an addiction. They may offer to send the patient to a diversionary program as an alternative to jail.

If you were attempting to make a profit, then courts may not view your case so lightly. You could get several years of jail time on top of significant fines.

Punishments for Committing Medical Identity Theft

Identity theft, whether committed for financial gain or medical care, is a serious crime. Typically, the suspect steals a victim’s personal information and then uses it to get medical insurance or medical services.

If you’re convicted of this crime, then you’ll be facing a felony charge. Felonies carry more serious penalties than misdemeanors. The minimum penalties you could face with a felony is 180 days in jail and fines as high as $10,000.

Also, you may face civil penalties.

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Penalties for Prescribing Prescriptions Without a Medical Need

The nation is currently undergoing what’s being called an opioid crisis. Hundreds are addicted to opioids as a result of the pharmaceutical industry actions and reckless prescribing practices. When a doctor prescribes a drug without a medical need, he or she is fueling the crisis.

As a doctor accused of this type of healthcare fraud, you will be charged with a felony. Your medical license could be revoked or suspended.

Increasing Healthcare Fraud Arrests

The Department of Justice is very concerned with prosecuting cases of healthcare fraud. In fact, it’s a top priority for the organization. That’s why the penalties for these crimes are so steep. If you’re a practicing physician, then you need to make it a priority to ensure you obey the laws.

Getting convicted of any form of healthcare fraud will not only result in heavy punishments — it will also put your medical reputation at risk. 

If you’ve been accused of healthcare fraud in Texas, take advantage of  your Constitutional right to hire legal representation.