A 54-year-old Texas man has been accused of stealing more than $25 million in a healthcare fraud scam. Allegedly he submitted false claims for medical services to insurance companies and has since been arrested by FBI agents.
This kind of fraud is one of the most commonly identified in healthcare fraud whistleblower cases. Healthcare fraud whistleblower cases are initiated by an employee or another individual who becomes aware of the scam and reports it to government authorities. In this healthcare fraud scam case, an in-home fitness therapy and training company was managed by the accused individual.
Claims Alleged in New Healthcare Fraud Scam Case
Between 2012 and 2017, the Texas man falsely registered as a healthcare provider with the Centers for Medicare and Medicaid Services and enrolled a minimum of 19 separate times; committing a healthcare fraud scam each one of those times, according to the criminal complaint lodged by the FBI. He used different variations of his name and different names to bill insurance companies as though he was a medical doctor. He received more than $3.9 million as a result of the health care fraud scam. He could be punished by up to a $250,000 fine and up to 10 years in prison.
The lawyer representing the accused person in the healthcare fraud scam case, argued that the client believed he was operating within the law and did not realize he was perpetrating healthcare fraud. Only licensed doctors and providers are eligible to offer services through Medicaid and Medicare. When someone tries to skirt the system or engage in complex schemes to get payments though any government healthcare program to which they are not entitled, criminal charges may be pursued.
The government has complex regulations that require that a person submit appropriate paperwork and not engage in any type of healthcare fraud, whether it is overbilling, fraudulently representing themselves as a licensed and approved medical provider, or billing for services that were never rendered. Complex healthcare fraud scams are not often easily identified and may be the result of years of government investigation.
Discovery of Healthcare Fraud Scams in the U.S.
Although the government does engage in regular investigative methods to identify instances of healthcare fraud, those employees working in healthcare facilities may have inside awareness about an ongoing scam. The government encourages these employees to come forward and share their concerns about healthcare fraud with a whistleblower claim. Many healthcare fraud scams brought forward in the United States begin with a whistleblower or an individual who works for the individual or provider’s practice that notices the scam taking place and reports it to the authorities.
Awareness of the rights of a whistleblower can be valuable information for an employee who believes that a doctor’s office may be carrying out healthcare fraud. Understanding your legal options is important and can be done by scheduling a consultation with a knowledgeable lawyer at Bradley/Grombacher immediately.