Houston’s Trusted Legal Defense for Medicare and Medicaid Fraud Cases

If you were contacted by the State Attorney General or the Office of Inspector General concerning Medicare or Medicaid fraud, you need to act right away. Even if it’s a groundless accusation based on false testimony by a disgruntled ex-employee or a competitor, a fraud charge can do irreparable damage to your reputation; failure to respond can place you in legal jeopardy and result in the suspension of your Medicare or Medicaid number.

Medicare and Medicaid fraud charges carry serious consequences beyond just fines. These accusations claim you sent false information to government health programs to get payments you did not earn. Investigations begin when computers flag odd billing patterns, employees or competitors report concerns, patients complain or audits find problems. You risk more than money. You could lose your medical license, face imprisonment, pay substantial fines and be excluded from federal health programs for a mandatory minimum of five years.

At Mallett Saper LLP, our attorneys will defend you against criminal charges and administrative actions. We will protect your license and fight for your right to keep practicing medicine. We provide robust legal representation for high-stakes federal and state-level criminal matters throughout Texas and the United States.

Common Types Of Healthcare Fraud Charges We Defend

Fraud charges sometimes result from billing patterns revealed in routine administrative audits. These patterns may mean nothing, but it opens the door to further audits and investigations, costing you time and money. Most fraud charges are related to one of the following accusations:

• Billing for services that were not performed
• Upcoding or submitting inaccurate billing codes to get higher reimbursements
• Recommending or performing services that are unnecessary
• Billing both a private insurer and Medicare or Medicaid for the same services
• Accepting or inducing referrals by offering payments or anything of value

Individual doctors accused of Medicare or Medicaid fraud also face possible disciplinary actions. Penalties may include having privileges at hospitals revoked, excessive fines and criminal prosecution. The sooner you contact an attorney to protect your rights, the better your chances of avoiding additional charges and penalties.

Medicare Vs. Medicaid Fraud: What Is The Difference?

You need to know the difference between Medicare and Medicaid fraud. It affects who investigates you and what penalties you face.

Medicare is a federal program. The Centers for Medicare and Medicaid Services runs it. Fraud cases are federal crimes. The FBI, HHS Office of Inspector General and Department of Justice handle investigations.

State and federal governments jointly fund Medicaid; consequently, Medicaid fraud is routinely investigated by both state Medicaid Fraud Control Units and federal agencies, exposing providers to federal prosecution and penalties.

Because Medicaid is jointly funded, state or federal authorities can prosecute healthcare fraud. Both carry severe criminal penalties, substantial fines and mandatory exclusion from government health programs.

How We Will Help: Our Legal Services

Our attorneys will represent you at every stage of a Medicare or Medicaid fraud case. Our help starts the moment you get any contact from the government.

We will handle subpoenas and Civil Investigative Demands for you. This keeps you from accidentally giving information that can hurt your case. Before you meet with investigators, we will prepare you completely. We will attend all meetings with you. We will protect your rights and stop you from saying things prosecutors could twist against you.

We will also run our own internal investigation. We will find problems in your billing and records before the government does. Our lawyers talk directly with the Attorney General’s office and the Office of Inspector General. We will work to resolve your case without criminal charges when possible.

If your case goes to court, we will fight hard for you in state and federal courts. We also handle administrative actions that happen alongside criminal cases. This includes:

• Responding to suspension notices
• Fighting program exclusions
• Protecting your provider enrollment status

We will defend both your freedom and your ability to practice medicine.

Why Choose Our Medicare And Medicaid Fraud Attorneys

Our attorneys have decades of experience in federal criminal defense and healthcare law. We have defended physicians, dentists, pharmacists, home health agencies and other healthcare providers across Texas and beyond.

Our team is known for strong negotiation skills and courtroom work. We get good results even in complex, high-stakes cases. Attorney Edward A. Mallett has been selected for inclusion in the Texas Super Lawyers list from 2003 to 2005 and from 2008 to 2022. Attorney Gus A. Saper has been selected for inclusion in the Texas Super Lawyers list from 2020 to 2026.

Your career and freedom are at risk. You need attorneys who have fought these battles before and know how to win.

Frequently Asked Questions About Medicare And Medicaid Fraud Charges

Here are answers to common questions we hear from healthcare providers facing fraud investigations:

What should I do if I receive a Medicare audit or investigation notice?

Do not respond to any requests or speak with investigators without first consulting an attorney. Immediately preserve all billing records, patient files, correspondence and electronic data related to the audit period. Contact our firm before taking any action, as your initial response can significantly impact the trajectory of the investigation.

Can I be charged if an employee submitted improper claims?

Yes, healthcare providers can face criminal and civil liability for fraudulent claims submitted by employees, even if you did not personally prepare or submit them. Prosecutors often argue that providers are responsible for maintaining adequate oversight and compliance systems. However, lack of knowledge or intent can be a viable defense, which is why immediate legal representation is critical to investigate the facts and build your defense.

If you have other questions about your specific situation, reach out to us for a confidential consultation.

Contact The Fraud Attorneys At Mallett Saper LLP

Before you speak with representatives from the Attorney General or the Office of the Inspector General, contact Mallett Saper LLP by calling 713-423-6769 or filling out our online contact form.