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12-05-2016 - Legal Updates

In Texas, a juvenile criminal record can be sealed in two ways:  (1) automatically restricted to everyone except criminal justice agencies; and (2) permanently sealed and concealed from all.  The…

11-05-2016 - Legal Updates

In Texas, sexting crimes committed by minors and adults are treated differently, with different laws used to prosecute minors versus adults and differing penalties as well. Minor Sexting Texas’ law…

10-05-2016 - Legal Updates

The mother of “affluenza” teen Ethan Couch, who received probation for killing four people while driving drunk, made the grave error of trying to help her son escape more trouble…

09-05-2016 - Legal Updates

Typically, federal courts have exclusive jurisdiction over federal offenses and state courts have exclusive jurisdiction over state offenses.   In some cases, certain crimes can qualify as both federal and state…

06-05-2016 - Legal Updates

  Texas passed a stand your ground law in 2007, which allows for the use of force “when and to the degree the actor reasonably believes the force is immediately…

05-05-2016 - Fraud

A Watertown, Massachusetts, man has been convicted of securities fraud after a federal jury in Boston found him guilty of profiting from an insider trading tip he received on a…

HEALTH CARE FRAUD

Houston, TX Health Care Fraud Defense Lawyers

The mere existence of a Health Care Fraud investigation, much less a formal charge or accusation, may cause havoc for a physician, health care provider, hospital or clinic or even an entire hospital. Increasingly, federal and state “Health Care Task Forces” are targeting individuals and corporations affiliated with providing health care services. Those prosecutors are highly motivated to seek charges and are many times “led” by investigators with no real world experience in providing care or treating patients.

Health Care Task Forces

It should be no surprise that, given sweeping changes under the Affordable Health Care Act, the Health Care Industry is at a historic “cross-road” both in terms of economic stress and zealous law enforcement over-regulation. Too often, those associated with such Task Forces may have an agenda that affects the objectivity and accuracy of both the investigations and the resulting charging decisions. Simply put, innocent healthcare providers are finding themselves in the cross hairs of Health Care Fraud Task Forces across the State of Texas and the United States.

Two such Federal Task Forces have been conducting a variety of Federal Investigations in both the Southern District of Texas and the Eastern District of Texas. An earlier iteration of the same Federal Health Care Task Force previously charged individuals in the Miami, Florida, area with serious Federal Offenses (including Conspiracy, Health Care Fraud and Money Laundering) and ultimately sent dozens of physicians to prison.

The Texas Attorney General’s Office has likewise been extremely active in the investigation of Health Care and Medicaid Fraud in Texas. The Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) has worked alongside local, state, and federal agencies and obtained numerous convictions both in the Houston area and South Texas (Brownsville and Edinburg) for Conspiracy, Fraudulent Billing Schemes and Durable Medical Equipment related fraud.

Frequently, these investigations are led by law enforcement agents and assistant federal prosecutors (or assistant attorney generals) with little to no real-world health care training or experience. These decision-makers may be inadequately educated to understand the complexities and nuances of the health care and billing decisions that “real world” providers face on a 24/7 basis. Thus, prosecutorial agendas and pre-dispositions can trump accuracy and a thorough review of the health care provider’s actions and conduct.

Extensive Experience in Health Care Fraud Defense

Dan Cogdell has had extensive experience in the successful defense of a variety of Health Care Fraud cases, including verdicts of “Not Guilty” in the following specific Health Care crimes:

  • Conspiracy to Commit Health Care Fraud;
  • Health Care Fraud;
  • Conspiracy to Commit Insurance Fraud (Excessive Billing);
  • Insurance Fraud (Excessive Billing);
  • Health Care Fraud (Billing For Services Not Provided);
  • Health Care Fraud (Up-Coding);
  • Health Care Fraud (Unbundling);
  • Mail Fraud (Using the Mail to Commit Health Care Fraud);
  • Money Laundering (Depositing Illegally Obtained Funds); and
  • Criminal Contempt (Illegally Dispensing Medication in Violation of a Court Order).

Successful Results in Health Care Fraud Defense

Dan has not only obtained verdicts of “Not Guilty” in Federal Prosecutions in Texas for each of the above offenses, he has assisted numerous physicians who were being prosecuted in other federal jurisdictions. In the last two years Dan has tried healthcare fraud cases to verdict in several states outside of Texas, including Georgia and Kentucky.

The ideal result, of course, when being investigated for a health care fraud offense is to avoid charges altogether. Through a detailed (and pre-accusation) investigation and legal analysis, Dan has helped physicians avoid being charged with any crime. Of course, such result presupposes an early involvement with the Cogdell Law Firm to permit both an independent investigation and review, and a dialogue with law enforcement to avert the filing of criminal charges.

Notable examples of health care fraud cases tried by Dan Cogdell include:

  • Alternative Cancer Physician Stanislaw Burzinksi. Charged with 41 Counts of Contempt as well as Health Care Fraud, Cogdell (along with Mike Ramsey and John Ackermann) secured an acquittal on all charges. Burzinski had engaged in a decade long fight with the U.S. Food and Drug Administration in his belief that his treatment protocol was both necessary and lifesaving. Ultimately, all charges were dismissed.
  • Dr. James Ghadiali. Charged with Insurance Fraud, Medicare Fraud, Wire Fraud and Conspiracy, Cogdell’s client was fully exonerated after a three-week trial. During the cross examination of the Government’s primary witness, Cogdell was able to prove that the critical testimony relied upon by the Government for conviction was not only factually suspect but legally inaccurate.
  • Dr. Gloria Keraga. Charged with Insurance Fraud and Health Care Fraud in the Spring Shadows Glen Psychiatric Fraud case, Cogdell secured a dismissal of all charges after six months in trial.

Importance of Support Staff

Successful representation of complex matters such as health care fraud requires an experienced lawyer who is knowledgeable about the relevant areas involved (C.P.T. Codes, Medical Billing, Medicaid and Medicare Regulations, etc.). Dan Cogdell is such a lawyer.

Additionally, the defense team needs to include a properly trained and experienced staff, skilled in reviewing the discovery material, assimilating the prosecutorial theories and properly developing the core defensive themes. The team at our firm has quite literally “been there and done that.”

These types of cases are a completely different challenge than the traditional “blood and guts” state prosecution case. Choose your lawyer especially carefully in this type of case. Not only does your career likely depend on finding the proper lawyer, so might your freedom.

Health Care Fraud: Our Approach

Our approach to the defense of health care fraud investigations is direct and straightforward. Quite simply, it is a 3-step process once we assume responsibility in any health care fraud case:

Inform, investigate and represent.

Inform: We recognize that the initial and most immediate need of a client who is under investigation for, or who has been charged with, health care fraud is to educate that client on what is required to be proven and what the possible defenses are. Early on, we not only learn the facts from our client’s perspective, we also assist our clients in understanding the strengths and weaknesses of the prosecution’s case, and we educate the client on how to best position the defense.

Investigate: In any health care fraud case, there is substantial and immediate investigative defensive fact gathering that needs to occur. It is not feasible to “sit back and hope” that charges will be avoided or defended successfully. Indeed, the investigative opportunity that exists prior to formal charges being filed (or shortly thereafter) may be fleeting. If witnesses are not timely located and interviewed, the opportunity to do so may disappear. Likewise, there is inevitably needed legal research that must be completed at this early stage to appraise both the client and the defense team of any changes in the applicable law or procedures. This is also the time that not only must our team consult, meet, and confer with our client, it may well be the time to liaise with opposing counsel to either maximize the opportunity for avoiding charges, or minimizing the severity of the charges that will be filed. Again, this is a time for action and effort, not hope or despair.

Represent: Should charges be filed, aggressive representation is what we thrive on. Intensive document review and zealous scrutiny of the prosecution’s witnesses and legal theories is the focus of this phase. Our team prides itself on both aggressive and creative pre-trial motion practice and recognition that most victories come from juries, not judges.

Effective advocacy and the right result require more than financial resources and experience. It requires due diligence and hard work. Quite simply, defending complex white collar cases requires a blue collar work ethic. Should we assume responsibility in your case, we will demand that work ethic not only of ourselves, but also of you. If you are not prepared to not only work with us, but alongside us so that we can achieve the best result possible in your case, please look elsewhere. We are not here to achieve any result but the best result, and our experience informs us that this requires strong cooperation and an equally high work ethic from both attorney and client.