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Healthcare Fraud Defense

Healthcare Fraud cases are pursued by both federal and state officials.  However, the federal government is much more likely to investigate, arrest, and charge a large number of doctors, pharmacies, third-party billers, and others involved in their perceived scheme.  Healthcare fraud is, most simply, defined as misleading a healthcare provider into believing that a patient needs medical services or prescriptions that are not actually medically necessary.  Said another way, if you or someone being investigated for healthcare fraud ever billed an insurance provider for goods or services that were not necessary or, even worse, not provided, you can be held liable under both the federal and state statutes.  


Federal officials often charge healthcare fraud cases under a conspiracy – two or more people conspiring either to commit any offense against the United States, or to defraud the United States, or any agency thereof in any manner or for any purpose – because healthcare fraud normally requires more than one individual to create the fraud.  For example, if a doctor’s office is fraudulently billing a healthcare provider for services rendered that were not actually rendered, it is very common to find that multiple individuals were aware of the conduct – doctors, office managers, receptionists, and third-party billing companies.  Very seldom are healthcare fraud schemes perpetrated solely by one individual. 


If you find yourself under investigation and need a Dallas federal healthcare fraud lawyer, you need to find a lawyer or law firm with extensive experience of these cases. Federal criminal defense lawyer Gregg Gallian of Gallian Defense Firm has handled many Healthcare Fraud cases criminally. These cases have been investigated all across Texas. And, most importantly, Gregg has successfully convinced federal prosecutors not to charge his clients in some situations. Gregg’s trial experience includes one of the largest criminal healthcare fraud/commercial bribery cases ever prosecuted


Call today to schedule your free case review and let Gallian Firm fight for you!

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Health Care Fraud Statutes


Violation of Federal Law:


(a)Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice—

(1)to defraud any health care benefit program; or

(2)to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury (as defined in section 1365 of this title), such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.

Violation of Texas Law:


Sec. 35A.02. HEALTH CARE FRAUD. (a) A person commits an offense if the person:


(1) knowingly makes or causes to be made a false statement or misrepresentation of a material fact to permit a person to receive a benefit or payment under a health care program that is not authorized or that is greater than the benefit or payment that is authorized;


(2) knowingly conceals or fails to disclose information that permits a person to receive a benefit or payment under a health care program that is not authorized or that is greater than the benefit or payment that is authorized;


(3) knowingly applies for and receives a benefit or payment on behalf of another person under a health care program and converts any part of the benefit or payment to a use other than for the benefit of the person on whose behalf it was received;


(4) knowingly makes, causes to be made, induces, or seeks to induce the making of a false statement or misrepresentation of material fact concerning:


Read more here…

Healthcare Fraud Frequently Asked Questions (FAQ's)

Healthcare fraud is a serious crime that threatens the freedom and future of hundreds of patients, medical providers, and other individuals every year.  These charges could be a result of a number of errors or employee mistakes, but it is wise to obtain a health care fraud defense lawyer if you are charged with any crime related to medical billing fraud or healthcare fraud.

If you are involved in a healthcare scheme, no matter how minuscule your role may seem, you can be held equally responsible for your involvement under the law of conspiracy

If you are facing charges of healthcare fraud, it would be wise to reach out to Gallian Defense Firm as soon as possible so that we can begin building your case.

These crimes are serious and often tried at a federal level. Penalties are harsh and without proper legal representation, you could face major financial penalties and decades in prison.

Healthcare fraud is defined as knowingly and intentionally executing (or attempting to) a scheme to defraud any healthcare benefit program. This usually involves several fraudulent tactics intended to manipulate the healthcare program to generate monetary benefits for false items or services.

Healthcare fraud can be divided into three categories, including Medicare fraud, prescription drug fraud, and medical fraud.

Healthcare fraud and abuse both involve performing unauthorized business practices for financial gain. The only difference between fraud and abuse is determined by the intention.

Examples of Healthcare Abuse include:

  • Overscheduling Patients
  • Questionable Billing Practices 
  • Inconsistent Rates of Services
  • If your charges are lessened to healthcare abuse you will face lesser penalties than a healthcare fraud conviction. 

The severity of your criminal charges will determine whether your case is tried at a state or federal level. This will depend on several factors, including the location of the crimes, laws violated, and the amount of money involved in the scheme.

Healthcare fraud becomes a federal crime when certain acts are violated and/or circumstance criteria is met, including violations of the:

  • False Claims Act
  • Kickback Statute
  • Crime Results in Injury/Death

When several agencies get involved, including the FBI and insurance companies, the federal government will prosecute your crime at a federal level. The penalties for federal and state healthcare fraud are significantly different. 

Federal criminal convictions face the harshest penalties, often sentenced to decades behind bars.

What Are the Penalties for State Healthcare Fraud in Dallas?

Penalties for healthcare fraud can range from misdemeanor offenses to state felony charges. The period for which you are sentenced depends on the amount of money that was stolen and other important factors can also influence penalties.

What Are the Penalties for A Misdemeanor Conviction?

You will be charged with a Class B misdemeanor if the amount of money that was stolen is between $100-$750. This conviction can result in six months in jail and $2000 in fines.


Class A Misdemeanors are the most serious misdemeanor charges, reserved for cases in which $750-$2500 was stolen. Penalties include 1 year in jail and fines of up to $4000.

What Are Texas State Jail Felony Charges?

Texas state jail felony charges are reserved for schemes involving thefts of $2500- $30,000. These crimes put you at risk of spending two years in jail and $10,0000 in fines.

What Other Penalties Could Result?

Patients could face disbarment from receiving future government healthcare assistance. Medical professionals could potentially lose their license to perform medical services. 


These penalties would be catastrophic to an individual’s health, reputation, and future employment opportunities.

What Are the Penalties for Federal Healthcare Fraud?

The federal government punishes healthcare fraud harshly. In addition to the aforementioned penalties, those convicted could also be sentenced to up to 99 years in federal prison.  To read more about federal crimes click here.

Who Investigates Healthcare Fraud?

The Federal Bureau of Investigations (FBI) is the agency that is primarily responsible for overseeing investigations of healthcare fraud. This is in partnership with other federal, state, and local agencies, including insurance investigative units.

What Are Some Common Examples of Medicare Fraud?

Medicare fraud is a complex crime that usually involves several individuals to execute, including medical providers and billing specialists. These schemes involve manipulating the Medicare system and using patient information for monetary gain.

Do I Need a Medical Billing Fraud Lawyer for Medical Fraud?

You will want to consult with a medical billing fraud lawyer if you are involved in any of the common examples of Medicare fraud.  These include billing fraud, falsifying patient diagnoses, and kickback schemes.


The following is an example of a Medicare fraud case that occurred in 2019 and was sentenced in 2021.


May 4, 2021, Houston—Brenda Rodriguez owned and operated the QC Medical Clinic in Richmond, TX. Her clinic provided unauthorized medical exams and billed Medicare for over $11 million for home healthcare services that patients either did not need and/or did not receive.  She was sentenced to 25 years in prison for conspiracy, aiding, and abetting a Medicare fraud.


Anyone who is involved in Medicare fraud can be charged for their role in the scheme. It is crucial to reach out for legal guidance if you or your employer has committed any of these crimes

What Is Medical Billing Fraud?

HEALTHCARE FRAUD DEFENSE Medical billing fraud involves charging the Medicare system for services that were never rendered. This typically involves adding false services to an existing claim or completely fabricating a claim.


This may also involve the unbundling of procedures. Providers use this tactic to bill the insurance company separately for each service provided to receive more money.


Medical billing fraud defense can be a complex type of criminal defense, and it is not recommended that any person charged with medical billing fraud try to go at it alone.  It is essential to try to get a case review and or consultation on your case.  Both of these are offered free, at no charge, by Gallian Defense Firm.

What Does it Mean to Falsify a Patient Diagnosis?

This involves falsifying patient records, including exams and test results to provide the patient with a false diagnosis. This diagnosis is then used to justify unnecessary surgeries, procedures, treatments, and medications.

What Are Kickbacks?

Kickbacks are funds that the pharmaceutical industry rewards physicians for prescribing certain medications or certain services Doctors can be charged with kickback fraud when there is evidence suggesting that the physician, and their payments, are directly related to the prescription, lab, and/or space used for the procedures.

What are Examples of Consumers Committing Healthcare Fraud?

Individuals can also be charged with healthcare fraud for attempting to reap financial benefits from their insurance company.


Examples of Consumer Fraud Include:


  • Using another person’s insurance coverage and/or card.
  • Providing false information in an insurance claim.
  • Altering a receipt for services.
  • Filing a false claim.

These are serious accusations and require the assistance of a criminal defense lawyer to prove your innocence and beat these charges.

What Defense Strategies Can a Healthcare Fraud Lawyer Use for Healthcare Fraud?

One of the principal foundational questions for a healthcare fraud lawyer to use as part of a healthcare fraud defense is to ensure the prosecution has evidence to prove that your crime was committed intentionally. There are several strategies that a healthcare fraud defense attorney may use to have your charges dropped or lessened.


Healthcare Fraud Defense Strategies Could Include:


  • Billing Mistakes
  • Confusion
  • Neglecting to Oversee Workers
  • Unqualified Workers

The goal of these strategies is to convince the jury that you did not have criminal intentions. Your actions were committed out of coercion, fear, or ignorance. Each case is unique. You may be able to shift the blame of your accusations by assisting in other investigations of interest.


Gregg Gallian will review the circumstances surrounding your case and determine the best route of defense. Gallian is an experienced healthcare fraud defense attorney who will work hard to challenge sentence recommendations and negotiate the most favorable outcome for your case.

Can I Avoid Jail Time for Healthcare Fraud?

Yes, it is possible to avoid a conviction and jail time for healthcare fraud. This will depend on what evidence the prosecution has that proves that you intentionally committed this crime. Without evidence, the prosecution does not have a case.  A strong healthcare fraud law firm like Gallian Defense Firm will do everything in their power to keep you out of jail.  They have a track record of success.

What Do I Do If I Have Been Charged with Healthcare Fraud in Texas?

It would be wise to seek a free consultation and free case review by contacting Gallian Defense Firm immediately.  If you are facing charges of healthcare fraud in Dallas or surrounding areas, these charges are serious and can destroy your future if you are convicted.


  1. Gather all documents relevant to your case, including information about others involved, bills, arrest records, and any other paperwork.
  2. Schedule a free consultation with Gregg Gallian to discuss the unique circumstances of your case.
  3. Let Mr. Gallian build the most effective defense based on the details of your criminal accusations.

Do not wait to contact a healthcare fraud criminal defense lawyer. The sooner you reach out for help, the more effective your defense case will be.

Why is Gallian Defense Firm My Best Choice for Healthcare Fraud Defense?

As a former state prosecutor, Gregg Gallian is the best choice for building your healthcare fraud defense case. He has an impressive legal success rate and has been voted among the best Dallas criminal defense lawyers since he began in private practice.  He has had 100’s of cases dismissed and achieved numerous aquittals in over 50 trials.

Reach Out to Gallian Firm Today if You Are Charged with Healthcare Fraud in Dallas

Do not face these serious healthcare fraud charges alone. Contact Gregg Gallian and allow him to begin building your defense case. Mr. Gallian will fight hard to protect your freedom, family, and future.  Call Gallian Firm today at (214) 432-8860 or send an email to [email protected]