Miami Health Care Fraud Lawyer

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.