The health care industry is massive, having many working parts. The financial side of health care is complex, making it a critical part but also one sensitive to misconduct. Thus, financial crimes could be suspected if the money side of things does not add up, causing employees and executives in the industry to face serious allegations regarding fraud. Because the criminal consequences could be severe, it is important that one understands their criminal defense options when faced with fraud allegations.
Health care fraud allegations
Based on recent reports, four medical workers at Hillcroft Physician are currently in custody based on alleged connections to a $32 million health care fraud scheme. Those charged included a medical director and operator. All four have been charged with the conspiracy to commit health care fraud. One was additionally charged with five counts of making false statements that related to health care matters.
Charges
Initial investigation suggests that the four individuals submitted false and fraudulent claims to both Medicaid and Medicare that were either not provided as billed or was not provided by a qualified, licensed and enrolled provider. Additionally, the four individuals are accused of misleading both patients and staff that two of them were licensed to practice medicine in the state of Texas. It was further alleged that the other two directed the two individuals to pose as licensed medical professionals.
The two individuals accused of posing as medical professionals were accused of examining, diagnosing, treating, referring and prescribing drugs for patients without a medical licenses. It was asserted that many of these patients were non-English speaking Medicaid clients. The other two individuals are accused of directing the billing staff at Hillcroft Physicians to submit false claims to both Medicare and Medicaid as if they had been seen and treated. In some of these cases, the individual was out of the country when these claims would have occurred.
Lastly, all four are accused of submitting $31 million claims to Medicaid and $600,000 in claims to Medicare, for which Medicaid paid $12.2 million and Medicare paid $25,000.
When one’s career, reputation and livelihood are at stake, it is imperative that one explores the defense options afforded to them. By taking steps to protect one’s rights, it may be possible to reduce or dismiss all or some of the charges against the accused. This could ultimately help one to clear their name and avoid harsh penalties.