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Medicaid and Government Benefits Fraud in Texas
Medicaid fraud and government benefits fraud are aggressively investigated and prosecuted in Texas, with both state and federal agencies targeting individuals and businesses accused of misusing public funds. Common examples include billing for services not provided, falsifying eligibility information, and receiving benefits under multiple identities. These offenses are charged under Texas Human Resources Code § 36.02 and can lead to felony convictions, loss of benefits, restitution, and even exclusion from future government programs. In this post, we explain how these cases are built, what penalties apply, and the legal defenses that may help. If you’re under investigation or have been charged, now is the time to contact a qualified attorney near you who understands how to fight back against fraud allegations.
Medicaid and Government Benefits Fraud in Texas
Fraud involving Medicaid and other government assistance programs is a significant concern in Texas. Such offenses not only drain public resources but also carry severe legal consequences for those involved. This article provides an in-depth look at the various forms of Medicaid and government benefits fraud in Texas, the applicable laws, penalties, and potential defenses.
Understanding Medicaid and Government Benefits Fraud
Medicaid and government benefits fraud encompasses a range of deceptive practices aimed at unlawfully obtaining funds or services from public assistance programs. These fraudulent activities can be committed by individuals, healthcare providers, or organizations.
Types of Fraudulent Activities
1. Billing for Services Not Rendered
Healthcare providers may submit claims for medical services or procedures that were never performed. For example, in a notable case, the owner of Buenos Dias Adult Daycare in Laredo was accused of billing over $168,000 to Medicaid for services not provided between January 2020 and April 2022. Investigations revealed that clients were marked present when absent, and transportation times were falsified. Laredo Morning Times
2. Falsifying Information
Applicants may provide false information regarding income, household size, or employment status to qualify for benefits they are not entitled to receive.
3. Kickbacks and Bribery
Offering or receiving compensation to induce referrals for services covered by Medicaid is illegal. Such arrangements can lead to overutilization and increased costs for the program.
4. Identity Theft
Using another person's identity to obtain medical services or benefits constitutes fraud. In the case of Dubin v. United States, the defendant was convicted of healthcare fraud and aggravated identity theft for overbilling Medicaid using a patient's information without proper authorization. Wikipedia
5. Unemployment Insurance Fraud
Willfully misrepresenting or concealing facts to receive unemployment benefits is considered fraud. Penalties can include repayment of benefits, fines, and criminal prosecution. Wikipedia
Legal Framework in Texas
Texas Penal Code
Under the Texas Penal Code, various statutes address fraud-related offenses:Wikipedia
- Chapter 35A: Specifically targets Medicaid fraud, outlining offenses such as making false statements or representations to obtain benefits.
- Chapter 32: Covers fraud more broadly, including forgery, credit card fraud, and other deceptive practices.
False Claims Act
The federal False Claims Act imposes liability on individuals or entities that knowingly submit false claims to the government. Penalties include treble damages and fines ranging from $11,665 to $23,331 per violation. Wikipedia
Texas Medicaid Fraud Prevention Act (TMFPA)
Enacted in 1995, the TMFPA allows the state to pursue civil actions against individuals or entities that commit Medicaid fraud. It includes provisions for whistleblower lawsuits and imposes penalties similar to the federal False Claims Act.Wikipedia
Penalties for Fraud
Penalties for Medicaid and government benefits fraud in Texas can be severe:
- Criminal Penalties: Depending on the amount involved, offenses can range from misdemeanors to felonies, with potential imprisonment and fines.
- Civil Penalties: Under the TMFPA and False Claims Act, violators may face substantial fines and be required to repay the fraudulent amounts.
- Administrative Sanctions: Healthcare providers may face exclusion from Medicaid programs and loss of licensure.
Defense Strategies
Defending against fraud charges requires a comprehensive legal approach. Potential defenses include:
- Lack of Intent: Demonstrating that any misstatements were unintentional.
- Insufficient Evidence: Challenging the adequacy of the prosecution's evidence.
- Mistaken Identity: Proving that the defendant was not involved in the fraudulent activity.
- Statute of Limitations: Asserting that the time limit for prosecution has expired.
Conclusion
Medicaid and government benefits fraud are serious offenses with significant legal consequences in Texas. If you or someone you know is facing such charges, it's crucial to seek experienced legal representation.
Contact Walker Law Office at (713) 228-2611 or visit https://www.walkerlawhouston.com/contact/ to schedule a consultation and protect your rights.
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