San Antonio Healthcare Fraud Lawyer

When someone is ill or injured, they expect to receive the quality care needed to recover. The last thing someone recovering from a medical event needs or wants is to have to deal with a legal issue impacting their care. Unfortunately, healthcare fraud can end in confusion, worry, and a lower standard of care for patients, as well as financial losses for the government.

A common misconception about healthcare fraud is the idea that it is only committed by individuals seeking unnecessary medications or reimbursement. On the contrary, San Antonio healthcare fraud lawyers see many instances of healthcare fraud perpetrated by doctors and practices. If you have information about ongoing healthcare fraud in San Antonio, TX, reach out to our whistleblower attorneys today.

What is Healthcare Fraud?

In general, fraud is the practice of deliberate deception in order to get something or achieve something without going through the proper channels. This type of fraud specifically targets the healthcare system, and the goal is to obtain money from government healthcare programs under false pretenses. Government healthcare programs in San Antonio include Medicare and Medicaid at the federal level, as well as state programs such as Texas’s CHIP (Children’s Healthcare Insurance Program).

Healthcare fraud can be committed by individuals or patients, but medical professionals are responsible for a significant portion of the healthcare fraud that happens in San Antonio and throughout the United States. According to the US Department of Health and Human Services, 138 healthcare fraud cases resulted in charges against defendants, 42 of which – or around 30 percent – were medical professionals. Fraud in the medical field tends to happen on the billing side, so the patients themselves may not realize that their medical treatments are being misrepresented to benefit their doctor or medical practice.

How Healthcare Fraud Affects Patient Care in San Antonio

When someone commits fraud against the government, the money they receive dishonestly comes from taxpayers. This means that not only is the patient being indirectly impacted, but so are their neighbors and community – and even the medical office staff.

Patient care may be directly affected, as well. Medical professionals engaged in healthcare fraud may provide medically unnecessary services – often expensive ones – in order to collect a higher payout from the government. Patients may be put through procedures or tests that they do not genuinely need, perhaps under the guise of “ruling things out.”

How Do People Get away with Healthcare Fraud?

Healthcare fraud, like any type of fraud, is a sneaky practice. In order for someone to get away with defrauding the federal or state healthcare system, they must disguise fraudulent activity as completely normal, routine practices. Here are a few ways healthcare fraud happens in San Antonio and is concealed from patients and the government.

Kickbacks

A kickback is a form of bribery. It happens when a person (i.e., a medical professional in cases of healthcare fraud) agrees to do something illegal or unethical in exchange for money, goods, or services. In healthcare, these schemes may involve a doctor and a pharmaceutical company or another medical practice. The medical professional taking the kickback agrees to prescribe a certain medication or refer patients to a particular practice in exchange for a commission, regardless of whether or not it is the best option for the patient.

Billing Fraud

Some fraud happens behind the scenes in a billing office, out of sight of patients. Fraudulent billing can sometimes be hard to catch due to the occurrence of genuine billing errors, but here are the most common types of healthcare billing fraud in San Antonio:

Phantom billing: when a healthcare practice bills insurance or Medicare/Medicaid for services that were never performed.
Double billing: billing twice for the same service.
Incorrect coding: deliberately entering the wrong alphanumeric billing code to bill a more expensive service than the one which was actually performed.

If you spot any of these things happening in your office, contact Tycko & Zavareei LLP to speak with a San Antonio healthcare fraud lawyer.

Whistleblowers and Healthcare Fraud in San Antonio

Healthcare fraud can happen anywhere, including San Antonio, Texas. The government relies on help from everyday citizens to stop fraud when it occurs. Everyday people who spot signs of fraud and let the proper authorities know about it are called whistleblowers, and they have played a vital role in maintaining a fair and honest economy and government throughout history.

The United States False Claims Act was passed in response to a high rate of defense contractor fraud against the federal government. Not only did the law make defrauding the federal government a punishable offense, but it also established specific protections and rewards for whistleblowers.

Coming forward to make a False Claims Act disclosure gives a whistleblower certain rights, like the right to stay anonymous during the investigation into their claim. Whistleblowers are also protected against direct retaliation for their disclosure. Should their help lead to a successful qui tam lawsuit, the whistleblower may be entitled to a portion of the money that the government recovers as a reward.