Healthcare Fraud

Miami Health Care Fraud Lawyer

Ready To Protect Your Rights, Reputation And Freedom

Since many retirees live in Florida, health care fraud is one of the most commonly committed crimes in the state. Medical professionals and business orders are often targets of Medicare and Medicaid fraud audits and investigations, resulting in being suspected of fraud and facing both state and federal criminal charges.

If you have been accused of health care fraud in Miami, let my firm, Jonathan B. Blecher, P.A., defend you from start to finish. With more than 40 years of legal experience, I have represented thousands of clients facing a wide range of white collar crimes throughout South Florida. Do not hesitate to let me thoroughly review your case, determine all your legal options, and help you obtain the most favorable outcome in court.

Call (786) 977-9355 or fill out my online contact form today to schedule a free consultation.

What Is Health Care Fraud?

In general, health care fraud involves a conspiracy or scheme to falsely represent medical services to insurance companies in order to turn a profit. Such activity can result in millions of dollars over a span of years or decades.

Both Medicare and Medicaid are health programs that provide certain patients with medical services and treatment. Funded by the federal government, Medicare is available to elderly individuals who are at least 65 years old and those with disabilities. Medicare is available to low-income individuals — no matter what age — and is funded by both the state and federal government.

After a medical professional provides services or treatment to a Medicare or Medicaid patient, they are reimbursed by the government through a private insurer that holds the money in a trust fund. A health care provider generally commits health care fraud

Common examples of health care fraud include:

Billing for services that were not performed on the patient
Billing for unnecessary services
Billing Medicare/Medicaid and the patient for the same services
Falsifying claims or diagnoses
Prescribing unnecessary medications to the patient
Participating in illegal referrals or kickbacks
Upcoding for costly, medically unwarranted services
Lending or reselling Medicare or Medicaid benefits to another party

Florida Health Care Fraud Law

According to Florida law, if a Medicaid provider receives an amount of up to $10,000, it is considered a third-degree felony, punishable by imprisonment for up to five years. If a scheme involves an amount between more than $10,000 and less than $50,000, then the offense is a second-degree felony, which carries a maximum prison term of 15 years.

If a scheme involves more than $50,000, then the offense is a first-degree felony, which can result in imprisonment for up to 30 years. Additionally, a fine for all offenses can be up to five times the profit earned from the fraud.

If a healthcare provider made less than $20,000 from attempting to defraud the state government, then the offense is a third-degree felony. If the scheme involved between more than $20,000 and less than $100,000, then the offense is a third-degree felony. A scheme involving $100,000 or more is a first-degree felony.

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Federal Health Care Fraud Law

A healthcare provider can commit federal health care fraud by illegally and knowingly defrauding or attempting to defraud any health care benefit program or obtaining any money or property from the health care program under false or fraudulent pretenses. Since this is considered a federal crime, a conviction is punishable by a maximum 20-year prison sentence. However, if the offense involved a death, then a conviction carries a life sentence.

According to the False Claims Act, if a healthcare provider submits false or fraudulent claims to the federal government under the Medicaid or Medicare program, the offense carries a maximum federal prison term of five years and a fine of up to $250,000 for a person and $500,000 for a business.

Under the False Statements Act, if a healthcare provider makes any false or fraudulent statement (e.g., submitting false documents, marking up the cost of medical devices, etc.) to the federal government in order to obtain reimbursement for any services provided, a conviction carries a maximum federal prison term of five years and a fine of up to $100,000.

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