Miami Federal Healthcare Fraud Lawyer

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Miami Federal Healthcare Fraud Attorney

Healthcare fraud charges are serious and often involve filing false healthcare claims, Medicare fraud, and kickbacks. The scope of healthcare prosecutions is overly broad and highly fact-specific, often based on whistleblower claims and corporate compliance audits. While some healthcare providers and beneficiaries actively try to manipulate the system for profit, many face federal criminal charges resulting from simple oversight errors. Hiring the right attorney as quickly as possible can help ensure the defendant understands the process and their options at every step.

At Michael J. Rosen, P.A., we have the answers you need to help you face a Miami federal healthcare fraud charge. You can feel confident in our ability to help with our nearly 50 years of experience defending clients from federal criminal charges. Working with our team means the facts of your case will be properly reviewed, and the right plan will be put together to defend against the charges you face. Federal cases involving Medicaid fraud or Medicare fraud often move quickly, so getting the right attorney on your side could make the difference in your case.

Healthcare Fraud

Healthcare fraud occurs when a medical professional, patient, or other person attempts to gain benefits or payments by intentionally deceiving the healthcare system. Charges for healthcare fraud can be filed against healthcare providers and those who receive benefits.

Medicare and Medicaid providers could face charges for several types of issues, including:

• Billing for healthcare services that weren’t actually provided.
• Filing claims falsely for services or medical conditions
• Sharing fees illegally, which violates anti-kickback laws.
• Covering claims for illnesses that don’t exist.
• Upcoding (billing for more costly services than those provided)
• Waiving copays or deductibles and then over-billing benefit plans
• Offering products or services claiming to be preventative or healing for certain conditions when there is a question of their safety or effectiveness

Those who are beneficiaries of Medicare or Medicaid could face charges for incidents such as:

• Providing false information on a Medicare or Medicaid application
• Providing or using forged prescriptions
• Reselling medications that were obtained through the Medicaid program
• Allowing another individual to use your Medicare or Medicaid card.
• Failing claims for services they never received.

These charges come with serious penalties, including hefty fines or jail time. However, to be charged with a crime, the following elements must be true:

• There existed a scheme by the defendant that either successfully or attempted to defraud a healthcare benefit program.
• The fraudulent activity was directly connected to the delivery or payment of benefits or services provided by a healthcare benefit program.
• The act or attempt was made so willingly and knowingly.

Under the False Claims Act, fraudulent charges could also be brought against those individuals who knowingly:

• Provide a false claim to the government or know someone who does.
• Provide a false statement or record to obtain a claim payment from the government.

Penalties for Healthcare Fraud

Criminal convictions of healthcare fraud carry a penalty of up to 10 years in prison. However, the prison sentence could rise to 20 years if the fraud causes serious bodily injury and is directly linked to fraudulent activity. If the fraud results in death, the defendant could face life imprisonment.

Alongside these penalties, other charges associated with healthcare fraud that carry additional prison terms include:

• Conspiracy to commit healthcare fraud (up to 20 years in prison)
• False Claims Act violation (5 years imprisonment per occurrence or life if numerous counts are filed)
• Money laundering (maximum of 10 years in prison; 18 USC section 1957); (maximum of 20 years in prison; 18 USC section 1956)
• Conspiracy to commit money laundering (maximum of 5 years in prison; 18 USC section 371)
• Wire fraud (maximum of 20 years in prison)

In addition to time in prison, those convicted could face numerous fines as well.

• Healthcare fraud could cost up to $250,000.
• Anti-Kickback violations could cost $50,000 or up to three times the amount of the kickback – whichever is bigger.
• False Claims Act violations could cost $21,500 per claim or three times the damages sustained by the government

Lastly, professionals that are convicted of fraud could incur the following:

• Loss of professional license
• Loss of registration with the DEA
• Exclusion from benefits programs
• Suspension of payments on outstanding invoices.
• Loss of staffing privileges

These federally charged penalties could also be combined with state-level penalties, skyrocketing the potential prison time and costs for those convicted.

FAQs About Miami, FL Healthcare Fraud Laws

What Is the Penalty for Healthcare Fraud in Florida?

Penalties for healthcare fraud charges can range from prison terms as high as 20 years to financial penalties costing hundreds of thousands of dollars. These penalties could be imposed at both the state and federal levels. The exact penalties you could incur depend on the circumstances of the case and any additional charges you may face.

How Do I Report Healthcare Fraud in Florida?

Florida uses the Medicaid billing fraud online complaint form for those who wish to report fraudulent activity. If you feel a healthcare provider has committed fraud, you are encouraged to call the Office of the Attorney General at 1-866-966-7226 or through their website, myfloridalegal.com. Reports may also be filed by telephone at 1-888-419-3456.

What Are Examples of Insurance Fraud in Healthcare?

Insurance fraud can present in several ways but may include acts such as misclassifying a non-covered medical treatment as a necessity, falsifying a patient’s diagnosis to justify tests, surgeries, or procedures, breaking a procedure into multiple steps for billing instead of as a whole, or charging a patient beyond the insurance term for a copay.

Whom Do I Contact To Report Healthcare Fraud?

Reporting healthcare fraud to the proper authorities is the necessary first step in a proper investigation. Suspected healthcare fraud should be reported to the FBI through their website at tips.fbi.gov or by contacting your health insurance provider. Even if you are in doubt, it is important to notify one of the entities or an attorney who can help review your evidence and contact the right organization.

Contact A Miami Federal Healthcare Fraud Attorney Today

If you are facing charges of healthcare fraud, you deserve an attorney on your side who has the experience and is committed to fighting for your rights. At Michael J. Rosen, P.A., our Miami criminal defense attorneys will review the facts of your case to help build the strongest defense possible to seek a dismissal or a reduction of the charges filed against you. With our help, you could avoid a costly penalty and time in prison. Contact our offices today and let our team get to work for you.

“Ultimately, trial preparation and defense is what we do.” – Michael J. Rosen.
We invite you to call the firm to set up an appointment. (305) 446-6116.