Healthcare fraud not only drives up medical costs, it can also result in harm to patients.

A Texas healthcare fraud enforcement operation coordinated among several federal and state agencies illustrates the determination to uncover fraudulent practices and to hold those involved accountable.

What happened

In September 2019, the Justice Department revealed that as a result of healthcare fraud enforcement, it pressed charges against 58 people across the state of Texas for participation in Medicare and pill mill fraud. The sweep was a coordinated operation led by the Health Care Fraud Unit of the Criminal Division and incorporated the assistance of Medicare Strike Force partners including the FBI, the Health and Human Services-Office of Inspector General and the Drug Enforcement Administration along with Texas State Medicaid Fraud Control Units. Doctors and other medical professionals were charged in the fraud scheme as well as those who were responsible for diverting opioids. Altogether, the fraudulent activities represented a loss to Medicare of $66 million.

Who the scheme affects

The scheme involved billing Medicare, Medicaid, TRICARE—insurance coverage for military members and their families—and private insurance companies for results the account holders never received, unnecessary prescription drugs or medications that were never distributed or even purchased in the first place. As the 2019 sweep illustrates, doctors might become part of a scheme. However, implementation of healthcare fraud may be such that a doctor might have no knowledge of a scheme carried out by employees in his or her practice. It is more difficult for a pill mill to exist in a pharmacy environment without the pharmacist knowing.

How to proceed

If you are under investigation for healthcare fraud, or if you sense an investigation is imminent, your next steps involve protecting your rights and building a successful defense. Remember that, if convicted, the penalties you face can be severe. Your future is at stake and you will want the best outcome possible for your case.