You know the drill. Hospitals rack up a long list of charges while treating patients, from running tests to administering painkillers. In order to cover those charges, they collect insurance information from patients and submit claims to health insurance companies.
It probably doesn’t surprise you when we say mix-ups and mistakes are not uncommon during this process. What if we told you a “computer glitch” seems to have become a $21 million excuse at Blue Cross Blue Shield of Texas?
The insurance giant is currently at the center of a healthcare fraud case as big as this state, and criminal charges may be filed soon.
Texas Blue Cross Blue Shield and the “Computer Glitch”
In August, Blue Cross Blue Shield of Texas was ordered to pay $21 million in unpaid insurance claims to Knox County Hospital. These claims have been piling up since June 2017, when BCBS claimed that a “computer glitch” erased or misplaced claims filed by the 14-bed acute care facility.
Despite the supposed glitch, Knox County Hospital continued to submit claims to BCBS and treat patients. Allegedly, BCBS representatives would tell the hospital that the claims were being processed, but they were never actually paid.
BCBS is fighting these accusations and has not paid the hospital the $21 million. They recently filed a motion to move the case from the state of Texas to a federal court.
Bobby Burnett, the judge who ordered that BCBS pay up, also filed a restraining order against the insurance provider. If BCBS fails to reimburse the hospital, they may find themselves facing criminal charges of healthcare fraud.
Different Types of Healthcare Fraud in Texas
Insurance companies are not the only defendants in Texas healthcare fraud cases. There are many different types of fraud committed by hospitals, doctors, and even individual patients.
All of the following actions may be considered healthcare fraud:
- Billing for more expensive services than those actually provided (also called “upcoding”)
- Billing for each step of a procedure separately in order to get more money out of the healthcare provider (known as “unbundling”)
- Billing for services that were never provided in the first place
- Accepting kickbacks by referring certain medications or procedures to patients
- Forging signatures on claims
- Diagnosing a patient in order to recommend expensive medications or procedures
Healthcare Fraud Penalties
The state of Texas dictates that healthcare fraud charges depend on how much money was involved in the case.
If the services or medications that were defrauded are valued at less than $200, then the defendant may face Class C misdemeanor charges and never spend a day behind bars. Rarely do healthcare fraud cases only involve $200 worth of treatments or claims, though.
Once the value of the defrauded claims reaches $2,500, you’re involved in a felony case.
If a healthcare fraud scheme involves over $300,000, the fraudsters involved may be looking at a felony of the first degree. This could mean years in jail.
Charged with Healthcare Fraud in Texas?
Healthcare fraud charges could involve $21 million in withheld payments under the guise of a “computer glitch.” Or healthcare fraud charges could involve an honest-to-goodness computer glitch that looked fraudulent.
If you have been charged with healthcare fraud, you can fight back and avoid penalties. Don’t let a misunderstanding put you behind bars. Call a Texas criminal attorney for more information on how to defend against healthcare fraud charges.
About the Author:
After getting his Juris Doctor from the University of Houston Law Center, Jeff Hampton began practicing criminal law in Texas in 2005. Before becoming a defense attorney, he worked as a prosecutor for the Tarrant County District Attorney’s Office – experience he uses to anticipate and cast doubt on the arguments that will be used against his clients. Over the course of his career, he has helped countless Texans protect their rights and get the best possible outcome in their criminal cases. His skill has earned him recognition from the National Trial Lawyers (Top 100 Trial Lawyers) and Avvo (Top Attorney in Criminal Defense, Top Attorney in DUI & DWI, 10/10 Superb Rating), and he is Lead Counsel rated.