Texas Healthcare Investigations Lawyer

Understanding Healthcare Investigations in Texas

Healthcare investigations often involve detailed audits, allegations of fraud, or regulatory compliance reviews. These matters can be initiated by federal agencies like the Department of Justice, HHS Office of Inspector General, and CMS, or by state authorities such as the Texas Medical Board or Texas Health and Human Services. Common issues in healthcare investigations include:

• Alleged violations of the False Claims Act
• Anti-Kickback Statute claims
• Stark Law compliance
• Improper billing practices
• Medicare and Medicaid recoupment claims
• Telemedicine and compounding pharmacy fraud

Investigations may start as routine audits but can quickly escalate if inconsistencies or alleged violations are discovered. Acting early is the best way to protect your practice and ensure a favorable outcome.

Our Legal Services for Healthcare Providers

We provide a full range of legal services for healthcare providers facing investigations, audits, or compliance challenges. Our representation includes both defense and proactive measures to help prevent future issues. Our services include:

• Healthcare Fraud Defense: Representing clients in civil and criminal investigations under the False Claims Act, Anti-Kickback Statute, Stark Law, and related federal and state regulations.
• Medicare and Medicaid Audit Representation: Defending providers in audits conducted by CMS, UPIC, RAC, and other administrative agencies.
• Internal Investigations: Conducting thorough reviews of suspected compliance issues, billing errors, or regulatory breaches.
• Telemedicine and Compounding Pharmacy Compliance: Advising practices on legal and regulatory requirements for specialized services.
• Medical License Defense: Protecting physicians, nurses, and healthcare professionals facing licensing board inquiries or disciplinary actions.
• Corporate Compliance Planning: Drafting compliance programs, training staff, and creating agreements to reduce the risk of future investigations.

We work closely with clients to understand their unique operations and challenges, helping to create strategies that protect both the business and the individuals involved.

Who We Represent

Our legal services extend to all types of healthcare providers and organizations. We represent:

• Individual physicians, corporate executives, and healthcare professionals
• Hospitals, clinics, and large health systems
• Physician groups and ambulatory surgical centers
• Long-term care, home health, and hospice providers
• Pharmacies, pharmacists, and pharmacy technicians
• Medical device manufacturers and durable medical equipment companies
• Diagnostic and testing facilities
• Management service organizations

By understanding the specific risks and regulatory requirements for each type of provider, we deliver precise and effective representation tailored to your business.

Common Issues in Healthcare Investigations

Healthcare investigations can arise from many sources, and the legal risks are significant. Providers often face scrutiny for issues such as:

• Billing for services not rendered or performed improperly
• Failing to document medical necessity
• Improper referral arrangements or kickbacks
• Noncompliance with Medicare and Medicaid rules
• Violations of HIPAA privacy and security regulations
• Corporate practice of medicine concerns

Addressing these matters requires a combination of legal expertise, industry knowledge, and practical solutions that reduce exposure while maintaining patient care standards.

Responding to Federal and State Audits

Audits from federal and state agencies are increasingly common. These reviews can involve extensive documentation requests, financial scrutiny, and examinations of operational practices. Effective audit response includes:

• Collecting and reviewing all relevant documents
• Preparing accurate and complete submissions to regulatory agencies
• Advising clients on their rights and obligations during the audit
• Negotiating with investigators to resolve potential issues
• Reducing the risk of escalation to civil or criminal investigations

Early and thorough legal guidance during an audit can prevent small issues from becoming major legal or financial problems.

Internal Investigations and Compliance Planning

We help healthcare providers perform internal investigations to identify potential compliance issues before they result in penalties or investigations. This proactive approach includes:

• Reviewing billing practices and patient records
• Assessing risk areas in telemedicine, laboratory, and pharmacy services
• Evaluating employment and compensation agreements
• Conducting staff interviews and training on compliance practices
• Developing policies to prevent future violations

Compliance programs are tailored to each practice, ensuring that policies are enforceable, practical, and effective in reducing regulatory exposure.

Litigation and Defense in Healthcare Investigations

When investigations escalate, litigation may become necessary. We provide defense representation in civil, administrative, and criminal proceedings related to:

• False Claims Act violations
• Anti-Kickback and Stark Law claims
• Medicare and Medicaid payment disputes
• Enforcement actions by the Texas Medical Board and other state agencies
• HIPAA violations and data security breaches

Our team includes attorneys with extensive trial and regulatory experience, including former prosecutors and in-house healthcare counsel. This combination allows us to anticipate challenges, respond effectively, and achieve favorable outcomes.

Proactive Measures to Reduce Legal Risks

Preventing investigations is as important as defending against them. Our proactive services include:

• Drafting and reviewing medical contracts and agreements
• Establishing robust compliance programs
• Advising on licensure, credentialing, and regulatory requirements
• Conducting audits of billing and operational practices
• Providing staff training on compliance, documentation, and patient care standards

By implementing these measures, healthcare providers can reduce the likelihood of audits, investigations, and penalties while maintaining smooth operations.

Serving Texas Cities: Houston, San Antonio, Dallas, Fort Worth, Austin, El Paso, Arlington, Corpus Christi, Plano, Lubbock, Laredo, Irving, Garland, Frisco, McKinney, Denton, Midland, Abilene, Waco, Tyler, Beaumont, Odessa, Round Rock, Carrollton, Lewisville, McAllen, Wichita Falls, San Marcos, Galveston, Nacogdoches, Amarillo