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Health Care Fraud

Health care fraud has long been, and continues to be, a serious problem in the state of Texas. The crime is often committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments. Unfortunately, the crime carries harsh penalties, including time in prison, steep fines, and consequences that can impact a person’s professional career.

As the U.S. population ages, more citizens are expected to use Medicare and Medicaid to supply their healthcare needs. Therefore, healthcare fraud is also known as “Medicare fraud” or “Medicaid fraud.” If you have been charged with healthcare fraud or Medicaid fraud, we highly recommend you seek legal counsel immediately. Contact Law Office of Price & Wiggins, P.C. today.

Texas Healthcare Fraud Attorney in Georgetown

When you’ve been accused of healthcare fraud, trust our Georgetown federal criminal defense attorneys for the comprehensive legal guidance your case requires. We have the sophisticated knowledge and extensive experience needed to fully protect your rights at every stage of your criminal case. If you have been charged with healthcare fraud, contact Law Office of Price & Wiggins, P.C. today.

Law Office of Price & Wiggins, P.C. defends clients in Georgetown, TX. We also represent clients in surrounding areas of Round Rock, Cedar Park, Leander, Taylor, Hutto, Killeen, Temple, Belton or Harker Heights, contact Law Office of Price & Wiggins, P.C. Call us today at (512) 354-1880 to schedule a free consultation. We are knowledgeable in all areas of Texas’ violent crime laws and will make every effort to fight the allegations against you.


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Information Center


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What is Healthcare Fraud?

Fraud is a term that refers to criminal offenses involving fraudulent acts, theft, or dishonesty. Although fraud crimes can vary in scope and nature, they are classified under the category of white-collar crimes. Texas Penal Code 35.02 states it’s illegal to use deceit, deception, or misrepresent facts to a healthcare program in an effort to obtain some type of benefit. Healthcare fraud is a type of white-collar crime that usually involves the filing of dishonest health care claims in order to generate profit.

Fraudulent health care schemes come in many forms. In some instances, healthcare fraud may include medical providers defrauding healthcare benefit programs by submitting inaccurate claims for services. In other cases, medical providers may be accused of healthcare fraud for defrauding patients through services that were not medically necessary. Healthcare patients may also commit health care fraud by providing false information when applying for programs or services or using another person’s insurance card.


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White Collar Crimes in Texas

As stated previously, the term white-collar crime is synonymous with the full range of frauds committed by people from all walks of life. The primary motive is typically financial in nature. According to the FBI, a key agency that investigates these offenses, “these crimes are characterized by deceit, concealment, or violation of trust.”

Additional white-collar offenses include, but are not limited to, the following:

  • Forgery: Per Texas Penal Code § 32.21, signing another person’s name or otherwise falsifying a legal document constitutes the crime of forgery. This offense can result in a Class A misdemeanor, state jail felony or felony of the third-degree conviction.
  • Credit Card Fraud: Under Texas Penal Code § 32.31, an individual can be charged a credit card fraud offense if they buy a credit or debit card from a person, they know is not the issuer of the credit card or if they steal a credit card. This offense can result in a state jail felony or a felony of the third-degree conviction.
  • Money Laundering: The crime of laundering money is prosecuted under Texas Penal Code Section 34.02. The term “money laundering” is best described as the illegal process of making large amounts of money generated by a criminal activity. Money laundering charges can range from first-degree felony to state jail felony.

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Common Types of Healthcare Fraud in Texas

Healthcare fraud can occur in several different forms, from misrepresenting material facts to gain a healthcare benefit or billing for services that never occurred. At Law Office of Price & Wiggins, P.C., our Georgetown fraud attorneys handle all types of healthcare fraud claims, including cases involving: 

  • Billing for services never performed
  • Misrepresentation of the type or level of service provided
  • Billing for a more expensive service than the one performed
  • Waiving copays or deductibles for patients
  • Billing for services that are not considered medically necessary

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Texas Healthcare Fraud Penalties

Chapter 35 of the Texas Penal Code describes the penalties for someone convicted of healthcare fraud. They range from misdemeanors to felonies. Per Texas statute, they are listed as follows:

  • Class C misdemeanor: Value of the claim is less than $100.
  • Class B misdemeanor: Value of the claim is $100 or more but less than $750;
  • Class A misdemeanor: Value of the claim is $750 or more but less than $2,500;
  • State jail felony: Value of the claim is $2,500 or more but less than $30,000;
  • Third-degree felony: Value of the claim is $30,000 or more but less than $150,000;
  • Second-degree felony: Value of the claim is $150,000 or more but less than $300,000;
  • First-degree felony: Value of the claim is $300,000 or more; OR an act committed in connection with the commission of the offense places a person at risk of death or serious bodily injury.

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Additional Resources on Healthcare Fraud

Texas Penal Code: Insurance Fraud – Chapter 35 of The Texas Penal Code describes the insurance fraud crime. Visit the webpage to learn about the penalties associated with the offense. You’ll also be able to view how certain terms, such as “insurance policy” are defined.

Texas Attorney General: Consumer Fraud – Visit the Attorney General’s website to learn more about how to avoid becoming a victim of consumer fraud. You can view the answers to common questions such as, “how do I file a consumer complaint?” and “what to do if my identity is stolen?


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Georgetown Healthcare Fraud Lawyers in TX

Were you arrested in Texas for healthcare fraud? Time is of the essence. It’s important to obtain skilled legal representation so contact Law Office of Price & Wiggins, P.C. right now. Our lawyers are experienced in fighting health care fraud cases in both state and federal court.

Michael J. Price is a skilled defense lawyer in Georgetown who represents individuals in Temple, Taylor, Round Rock, Leander, Killeen, and many other surrounding areas of Williamson County and Bell County. Call (512) 354-1880 have one provide an honest and thorough evaluation of your case during a free initial consultation.


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