Medicare Scheme Costs Texas-based Hospice Group CEO 15 Years

Originally published by John Floyd.

Some white collar crimes are often seen as having little or no impact on society at large. These are generally referred to as victimless crimes. But the reality is that these crimes are anything but victimless.

 

A good example is the case in which a 50-year-old Texas CEO was recently sentenced to 15 years behind bars for healthcare fraud.

 

The scheme put in place by the CEO falsely convinced a large number of people that they had only a few months live and then enrolling them in hospice care programs for which they were not qualified or needed.

 

Most of these people suffered from long-term incurable diseases such as Alzheimer and dementia or who suffered from other mental disabilities that confined them to group homes, nursing homes or in housing projects. Placing them in palliative hospice care for years made hem ineligible for medical coverage for curative medical services.

 

Cases like this are why healthcare fraud is taken so seriously at both state and federal levels.

 

Here’s what you need to know about criminal healthcare laws and penalties in Texas.

 

What Is Healthcare Fraud?

 

Healthcare fraud is a crime that can be committed by both individuals and corporate entities. Regardless of the scale, healthcare fraud can result in multiple counts of fraud based on how the fraud was committed and the nature of the crime itself.

 

Healthcare fraud is defined as the intentional misrepresentation or deception of services for reimbursement. It is a crime that can take many forms, the most common include:

 

• Medicare fraud
• Medicaid fraud
• Health insurance and medical billing fraud
• Home healthcare fraud
• Drug fraud

 

You can commit these types of fraud if you:

 

• Provide any type of false information to maximize benefits on an insurance claim
• Use coverage of someone else
• Forge an invoice or receipt, or alter it
• File a claim for services or medications that weren’t actually received
• Use the insurance card of another person for the treatment of someone else
• Bill for unnecessary supplies, services, or equipment
• Bill for services or supplies that were not provided
• Fake the diagnosis of a patient to justify unnecessary procedures and tests
• Accept a kickback for the referral of patients
• Drive up the costs of services by billing procedures or stages of care separately
• Refer a patient for unnecessary services where the doctor has investment or ownership

 

Penalties for Healthcare Fraud

 

While some instances of healthcare fraud are the result of mistakes, that doesn’t mean it cannot lead to serious legal consequences.

 

Healthcare fraud can be charged in Texas as either a misdemeanor or a felony. How it is punished depends on the severity of the crime and the facts surrounding the case.

 

In most instances, fraud that involves $100 to $2,500 in losses is a Class A or Class B

misdemeanor, which can result in a sentence of up to one year in jail and the responsibility to pay fines up to $4,000.

 

If the fraud resulted in less than $100 in losses can still be charged as a Class C misdemeanor. This may be the least serious of all charges, but it can still result in fines of as much as $500.

 

Losses of between $2,500 and $30,000 or an even that result in the death or injury of someone is a felony offense. The penalties for this level run the gamut but can result in as many as 99 years in prison and fines of as much as $10,000.

 

Healthcare fraud is not a victimless crime, meaning that the consequences can be much more significant than some realize.

 

The penalties for these kinds of crimes are steep. For this reason, if you’re facing accusations it’s imperative to have an experienced Texas criminal defense attorney representing you.

 

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