It is nearly impossible to turn on the news these days and not hear stories about serious Medicare and Medicaid budget shortfalls. It should come as no surprise, then, to learn that federal law enforcement is engaged in a serious effort to crack down on suspected Medicare and Medicaid fraud.
Earlier this month, a Houston doctor was arrested and charged with health care fraud and conspiracy to commit healthcare fraud. Federal authorities allege that he was engaged in a scheme that resulted in approximately $390,000 worth of unwarranted Medicare and Medicaid reimbursements.
The doctor operated a family practice clinic in Houston. According to the indictment, the doctor worked with an accomplice who operated a home health care service. The accomplice would send technicians into patients' homes to perform testing for inner ear problems. The doctor and the accomplice then "padded" those bills before sending them in for reimbursement.
Patients have testified that the technicians did not perform all of the tests they claimed to have done. In the most serious case, one patient's account was billed for tests on 161 days in one year, for a total of more than 800 examinations. Other patients were billed for upwards of 500 tests during a single year.
In total, the doctor has been charged with 13 counts of fraud and conspiracy. Each carries a potential penalty of 10 years in federal prison and a fine of up to $250,000, going to show just how serious the punishment for white collar crime can be.
Source: FBI Houston Division, "Houston Doctor Arrested on Charges of Health Care Fraud," August 20, 2012.
To learn more about defending fraud and other white collar crimes charges, please visit our Texas White Collar Crime page.