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Healthcare Fraud

The state of Florida, and South Florida in particular, has long been a hotbed for committing healthcare fraud, and prosecutors and judges are cracking down hard on shady healthcare professionals throughout the state. State and federal charges, almost always felonies, can be brought for a myriad of issues regarding Medicare and Medicaid fraud. With over thirty years of litigation experience, the Tony Moss Firm, L.L.C. successfully represents clients charged with serious felonies for healthcare fraud in the Miami, Fort Lauderdale, and greater Florida region. Let him help you fight for your rights and provide you with the legal representation that you need.

Florida and Federal Healthcare Fraud

Medicare and Medicaid are two government programs that provide healthcare insurance for people who cannot afford the costs of medical care on their own. Medicare is strictly a federal program, but Medicaid is a joint program between the federal and state governments. As a result, state and federal charges can be brought against you in a healthcare fraud case. Examples of healthcare fraud include:

  • Billing for services not provided;
  • Billing Medicare/Medicaid and the recipient for the same services;
  • Self-referrals;
  • Administering unnecessary services;
  • Receiving kickbacks for certain drugs or treatments;
  • Providing false information in a Medicare/Medicaid application;
  • Forging a prescription;
  • Lending or reselling Medicare benefits to another party;
  • Using more than one Medicare card;

…and other medically-related activities that constitute fraud

Florida and Federal Healthcare Fraud Law

Under Florida law, healthcare fraud prosecutions are governed by multiple statutes. Chapter 409 defines healthcare fraud as the “intentional deception or misrepresentation made by a person with the knowledge that the deception results in unauthorized benefit to herself or himself or another person.” Chapter 812 defines the penalties that can be imposed if found guilty of state healthcare fraud.

Under federal law, healthcare fraud is governed by multiple statutes and acts. The False Claims Act (31 U.S.C. §§ 3729–3733), Physician Self-Referral Law (42 U.S.C. § 1395nn), the Criminal Health Care Fraud Statute (18 U.S.C. §§ 1347, 1349), and The Anti-Kickback Statute (42 U.S.C. § 1320a–7b(b)) are just a few of the laws that the federal government can use to bring criminal charges for healthcare fraud. Each of these statutes is highly technical in nature, and the same conduct can and does often violate multiple statutes at once.

An example: In recent years, “sober home” prosecutions have grown in number and visibility in the federal Southern District of Florida. “Sober home” generally refers to a home or facility which provides transitional housing to individuals who have completed long-term substance abuse or mental health rehabilitation, along with support services, access to medical care, and so on. Often, however, shady sober home operators recruit patients to their facilities, using lower-level employees to do so, and pay the recruiters for their services–both of which are violations of patient recruiting and anti-kickback provisions. They will also advertise and bill insurance carriers for services that were never provided, or were not medically appropriate; or they will submit bogus claims to Medicare and Medicaid. (Since these practices often involve transactions by telephone, U.S. mail, or email, these schemes not only involve various forms of healthcare fraud, but wire and mail fraud as well.)

State and federal laws impose heavy sanctions and penalties upon anyone found guilty of committing healthcare fraud. Some of the possible punishments for violating state and/or federal healthcare fraud statutes include:

  • Between 1-20 years in federal prison;
  • Expulsion from the Medicare/Medicaid programs;
  • Loss of medical licenses;
  • Loss of staff privileges;
  • Fines of $10,000 to $50,000 per violation; and
  • Fines of three times the amount claimed for each fraudulent item or service.

Let a Healthcare Fraud Attorney Help

With the government’s aggressive approach to healthcare fraud in Florida it is more important than ever to have an experienced healthcare fraud attorney by your side. If you or someone that you know has been accused of committing state or federal healthcare fraud in the Miami, Fort Lauderdale, or greater Florida area, let the Tony Moss Firm, L.L.C. help. Call or contact Tony Moss today for a free and confidential consultation on your case. Because fairness and justice are essential human values, he will to be a zealous advocate for your case and get you the justice that you deserve.

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