Health Care Fraud Defense Attorney in Miami, FL, Defending DOJ and OIG Investigations and Medicare and Medicaid Cases for Clients in South Florida and Nationwide
Both providers and patients can face criminal charges in connection with healthcare fraud. Whether you’re accused of submitting fraudulent claims to get an insurer to overpay your practice or of using deception to claim benefits you’re not entitled to as a patient, you could spend years in prison if convicted of this offense. You need a Miami healthcare fraud lawyer who will fight for you without backing down.
At Forge Litigation Group, I handle healthcare fraud cases at both the state and federal levels with dedicated advocacy and extensive legal knowledge. Each case begins with a confidential consultation and initial advice tailored to your unique situation. For help understanding your rights and potential options for defending against healthcare fraud charges, contact me today.
Understanding Healthcare Fraud Charges in South Florida and Nationwide
The crime of healthcare fraud can encompass any type of intentional deception perpetrated to obtain payments or benefits that one is not entitled to from a health insurance program. Examples of accusations a Miami healthcare fraud lawyer can help you fight include:
- Falsifying medical records to reflect services not performed or influence insurers’ coverage decisions
- Billing for services that were unnecessary or were never actually provided
- Billing for the same service more than once
- Breaking up bills for the same service and submitting them in a fragmented manner to improperly increase reimbursement amounts
- Upcoding, or billing for more severe conditions or more expensive services instead of the true medical condition or procedure
- Performing unnecessary or unwarranted medical services as a provider for economic purposes rather than because such treatment was in the patient’s best interests
- Creating fake patient identities and using these identities to submit fraudulent claims for payment
- Receiving bribes or improper kickbacks as a healthcare provider for promoting or prescribing certain drugs or for ordering unnecessary tests
- Misrepresenting eligibility for medical benefits under an insurance program
- Committing identity theft by using someone else’s stolen information to receive medical services or prescriptions
- Knowingly allowing another person to fraudulently use your health insurance benefits
As a non-violent offense facilitated through deception that typically involves some form of financial gain, healthcare fraud is considered a white-collar crime regardless of whether a patient or a provider is the one committing the violation. Presenting an effective white-collar crime defense demands extensive knowledge of the law, solid legal strategy, and a dedicated focus on achieving a favorable outcome.
Federal Healthcare Fraud Charges
The federal law that addresses the crime of healthcare fraud is Section 1347 of Chapter 18 of the United States Code. This statute applies to healthcare providers, patients, or others who make a knowing, willful attempt to either:
- Defraud a healthcare benefit system, or
- Obtain benefits, services, or items from a health care benefit program under false pretenses, misrepresentations, or deception
Under this statute, fraud committed against any healthcare benefit or health insurance program is a violation of federal law and, as such, could result in federal healthcare fraud charges. However, the federal government doesn’t always get involved in matters of alleged healthcare fraud.
The types of cases that most commonly lead to federal charges are those in which the alleged fraud targeted a federal program rather than a private insurance program. Examples of the federal healthcare fraud cases I often handle include Medicare fraud, Medicaid fraud, TRICARE fraud, and fraud against the Department of Veterans Affairs.
If you are convicted of a federal healthcare fraud charge, the penalties are severe. You could face up to 10 years in prison for violating this federal law. Further penalties can be imposed for fraudulent schemes that cause bodily harm to a patient. For example, if you’re accused of performing unnecessary procedures on a patient that led to physical harm, you could face up to 20 years of imprisonment. When healthcare fraud contributes to someone’s death, including due to exposing patients to unnecessary procedures and the risks they carry or to cutting corners on quality of care, you can be sentenced to “any term of years,” including life imprisonment, under federal law.
Florida’s Laws Against Healthcare Fraud
Even if the offense you’re accused of committing doesn’t catch the attention of the Department of Justice (DOJ), the Office of Inspector General (OIG), or federal law enforcement agencies or prosecutors, you can still face serious repercussions due to criminal charges filed at the state level.
The Insurance Fraud Statute in Florida
Section 817.234 of Florida Statutes establishes the crime of insurance fraud when a person knowingly makes a false or misleading statement to any insurer or conceals important information from an insurer to obtain benefits or payments. This statute includes fraud committed by both patients and practitioners against health insurance programs.
Under this statute, the value of benefits, services, goods (such as prescription medications), or payments fraudulently obtained determines the grade of the charge and the sentences that could be imposed, as provided in Sections 775.082, 775.083, and 775.084 of Florida Statutes.
- Insurance fraud amounting to less than $20,000: A third-degree felony, punishable by up to five years of imprisonment and up to $5,000 in fines
- Insurance fraud valued at $20,000 to less than $100,000: A felony of the second degree, punishable by up to 15 years of imprisonment and up to $10,000 in fines
- Insurance fraud valued at $100,000 or more: A first-degree felony, punishable by up to 30 years of imprisonment and up to $10,000 in fines
Florida’s Communications Fraud Statute
Section 817.034 of Florida Statutes, known as the Florida Communications Fraud Act, applies to ongoing schemes to defraud rather than one-off false statements. The statute recognizes two related offenses, each with its own penalty structure.
Communications fraud refers to making a single false or fraudulent communication as part of a broader scheme. If the value involved is less than $300, the offense is a first-degree misdemeanor (up to 1 year in jail and a $1,000 fine). If the value is $300 or more, it becomes a third-degree felony (up to 5 years in prison and a $5,000 fine).
This statute also covers organized fraud, which pertains to actually obtaining property, services, or benefits through a scheme to defraud. Penalties for organized fraud scale with the value of the property, services, or benefits obtained or sought:
- Healthcare fraud valued at less than $20,000: A third-degree felony, punishable by up to five years of imprisonment and up to $5,000 in fines
- Healthcare fraud valued at $20,000 to less than $50,000: A second-degree felony, punishable by up to 15 years of imprisonment and up to $10,000 in fines
- Healthcare fraud valued at $50,000 or more: A first-degree felony, punishable by up to 30 years of imprisonment and up to $10,000 in fines
Because healthcare fraud often involves repeated false billing or misrepresentations to insurers, prosecutors may charge both communications fraud (for the fraudulent claims submitted) and organized fraud (for the overall scheme and amounts obtained).
Medicaid Fraud Laws in Florida
In practice, Medicaid fraud in Florida is often addressed on two parallel tracks: civil recovery actions under the Florida False Claims Act (Sections 68.081-68.092 of Florida Statutes) to recoup state funds, and criminal prosecutions under Chapter 409 (Medicaid fraud), Chapter 817 (insurance fraud), or Chapter 893 (controlled substances) to impose fines, restitution, and potential imprisonment.
Chapter 409 of Title XXX, Florida Statutes, addresses fraud against Medicaid, which in Florida is jointly funded by the state and federal government.
Section 409.920 focuses on Medicaid provider fraud. Fraud by Medicaid providers can include making false statements or representations, making or aiding claims for unauthorized services or benefits, receiving or paying kickbacks or bribes, knowingly submitting false statements or claims to the Medicaid program, and other forms of fraud.
The consequences of a conviction of Medicaid provider fraud in Florida depend on the value of the benefits, services, or payments received or pursued.
- Medicaid provider fraud amounting to $10,000 or less: A third-degree felony in Florida, punishable by up to five years of imprisonment and up to $5,000 in fines
- Medicaid provider fraud valued at more than $10,000 to less than $50,000: A second-degree felony, punishable by up to 15 years of imprisonment and up to $10,000 in fines
- Medicaid provider fraud valued at $50,000 or above: A first-degree felony, punishable by up to 30 years of imprisonment and up to $10,000 in fines
Additionally, this statute establishes that a person convicted of healthcare fraud can be ordered to pay a fine that amounts to five times the amount unlawfully gained or the loss incurred by Medicaid.
Medicaid recipient fraud is covered by Section 409.9201 of Florida Statutes. This statute addresses false statements or representations made to the Medicaid program in order to obtain services or goods from the program, as well as the unauthorized sale or purchase of legend drugs paid for by Medicaid. The value of goods and services obtained by a recipient through Medicaid fraud impacts the severity of the charge and its potential penalties.
- Medicaid recipient fraud amounting to less than $20,000: A third-degree felony, punishable by up to five years of imprisonment and up to $5,000 in fines
- Medicaid recipient fraud valued at $20,000 to less than $100,000: A felony of the second degree, punishable by up to 15 years of imprisonment and up to $10,000 in fines
- Medicaid recipient fraud valued at $100,000 or more: A first-degree felony, punishable by up to 30 years of imprisonment and up to $10,000 in fines
Other Florida Laws That Could Apply in Healthcare Fraud Cases
The Florida False Claims Act, covered in Sections 68.081-68.092 of Florida Statutes, Title VI, also pertains to healthcare fraud at the state level. While this is a civil (non-criminal) law, it can affect you if you are charged with Medicaid fraud in Florida because it establishes the civil legal procedures through which the State of Florida can recover money damages and penalties for losses resulting from fraud beyond imposing criminal fines.
Section 456.0635 of Florida Statutes establishes licensure disqualifications for healthcare professionals based on certain fraud convictions.
Why You Need a Knowledgeable Health Care Fraud Defense Attorney in Miami, FL
As an attorney with a long history of practice in Miami and beyond, I recognize that the Southern District of Florida is one of the most active healthcare fraud districts in the United States. Prosecutors in and around this region often pursue charges of healthcare fraud here.
Having an experienced health care fraud defense attorney in Miami, FL, provides important advantages during the criminal justice process. I understand the procedural requirements of local courts and the ways that prosecutors in this region approach cases like yours. This knowledge helps me prepare effective defense strategies and secure my clients the most favorable outcomes possible.
How Forge Litigation Group Can Help
Healthcare fraud claims are complicated. You could be facing charges in both state and federal court, especially for allegations that involve Medicaid fraud. Your legal issues may involve not only serious criminal charges but also civil claims for damages that can impose a major financial burden.
I’m not only a Miami healthcare fraud lawyer but also an attorney who practices at the intersection of criminal defense and civil litigation. That means I’m used to the complexities of defending against criminal charges while also appreciating how parallel civil claims can impact you. I defend clients against both state-level and federal charges, even when these matters are proceeding simultaneously through separate courts.
This is a turbulent time, but you don’t have to face it alone. I’m here to guide you through the criminal justice process, considering every aspect of your legal matter to craft the most effective defense possible.
Why Choose Forge Litigation Group as Your Miami Healthcare Fraud Lawyer?
For a Miami healthcare fraud lawyer who will advocate tirelessly for you throughout the legal process, you need Forge Litigation Group I bring to every criminal defense case I handle:
- Decades of experience: I’ve practiced law for 25 years, and I began my career serving as an Assistant Public Defender in Miami-Dade County.
- A trial-ready perspective: I prepare every case for the possibility of going to trial and explore all avenues for achieving a favorable resolution for my clients.
- A client-first approach: I’m here to listen to your story and empathize with your concerns. I also travel to meet clients in jail, the hospital, or their homes when needed.
I’m personally and professionally invested in fighting for my clients’ best interests, and I deliver results-focused legal services with care, compassion, and dedication.
Contact a Miami Healthcare Fraud Lawyer at Forge Litigation Group Today for a Case Evaluation
The only way to determine what’s needed to present the most compelling defense possible against healthcare fraud charges is by discussing the specifics of your case with an experienced attorney. At my law firm, I offer confidential consultations to empower every defendant to make informed decisions about their legal strategy. During your consultation, I will gain an understanding of your unique situation, answer your legal questions, and provide initial feedback to guide your next steps.
Don’t face the criminal justice process alone. For help from a health care fraud defense attorney in Miami, FL, contact Forge Litigation Group online or call 786-933-8794 today.