Throughout the past decade, regional and statewide Florida enforcement agencies have been collaborating with federal agencies, including the Health Care Fraud Unit of the Department of Justice’s Criminal Division’s Fraud Section, the Department of Health and Human Services’ Office of Inspector General (HHS-OIG), the FBI, and the Drug Enforcement Administration (DEA) to fight health care fraud and the opioid epidemic. These agencies investigate numerous health care providers in Florida and cast a wide net when they make arrests for health care fraud.
Unfortunately, they sometimes catch innocent doctors, nurses and other health care providers along with the guilty. For health care professionals, the allegations alone can threaten their licenses and their careers, whereas convictions can result in loss of their Florida medical licenses, exclusion from federal health care programs, thousands of dollars in fines, and significant prison time.
If you are being investigated for, or have been charged with, health care fraud, your career and your future are at risk. You need a defense attorney with expertise in defending Florida health care professionals.
Jonathan Rose has over 20 years of successful experience in state and federal court. He has a passion for protecting medical professionals from criminal charges and will put his knowledge of prosecutors’ strategies and experience defending doctors, nurses and other health care professionals against serious state, federal and administrative charges to work protecting your rights and aggressively defending you against all possible charges.
What Is Health Care Fraud?
Health care fraud occurs when an individual, a group, or an organization misrepresents something about the type, scope, or nature of medical treatment, services or items provided to a patient or patients, in a way that could result in unauthorized payments being made. Examples of health care fraud include:
- Billing for services or items not provided – Billing for services or health care items not actually provided is the most common and often the simplest form of health care fraud. Investigators frequently file charges based on interviews of patients or patients’ families who do not fully understand the issues at hand, thus leading to unwarranted and wrongful charges.
- Upcoding– Medical coding is a complex and frequently frustrating process for health care providers and organizations. Billing for items or services that are more complex and expensive than the ones actually provided is called upcoding and can be done by individuals or organizations inadvertently.
- Unbundling– Unbundling is the practice of submitting fragmented bills for medical procedures or tests to maximize the reimbursement from an insurance company. This happens when these bills should theoretically be billed together at a reduced cost.
- Providing unnecessary services– Falsifying treatment plans or medical records to justify providing and billing for unnecessary services can lead to serious charges of health care fraud. For example, in 2015, a Detroit-area physician was sentence to 45 years in prison for administering chemotherapy to healthy patients and fraudulently collecting $17.6 million for the treatments.
- Soliciting or receiving “kickbacks” – If a claim results from a kickback or is made in violation of the Stark law, it may be considered a false claim as well as a violation of the Anti-Kickback Statute or Stark Law.
What Are the Penalties for Health Care Fraud in Florida?
Under the civil False Claims Act, it is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are fraudulent. Each instance of an item or a service billed to Medicare or Medicaid counts as a claim, and each claim found to be fraudulent can result in a fine of up to three times the federal program’s loss plus $11,000. Under the criminal False Claims Act penalties for false claims include imprisonment and fines.
Under Florida state law, a physician or other health care practitioner who knowingly helps an insured party submit a fraudulent insurance claim to any insurance provider can be held liable for insurance fraud. Criminal penalties include substantial fines and a possible prison sentence. In addition, the Board of Medicine or other appropriate health care licensing board may issue administrative sanctions, such as disciplinary action against your license.
Protect Your Future from Health Care Fraud Charges and Penalties
When a Florida physician, nurse or other health care provider is charged with health care fraud, the government has most likely conducted a lengthy and in-depth investigation to collect damaging evidence. If you believe you are being investigated for health care fraud, consulting with an experienced health care defense attorney may help you avoid these serious charges.
If you have already been charged, it is crucial to get help immediately from a lawyer who has the knowledge and experience to assess your case and determine how best to move forward. To protect your rights, do not discuss the charges with anyone before you contact an attorney.
Attorney Jonathan Rose has more than 22 years of experience in state and federal courts, including experience in health care law and as a former prosecutor. Everyone is innocent until proven guilty, and Mr. Rose will build an aggressive defense that promotes your innocence. Call 407-894-4555 or submit the “Tell Us What Happened” form on our website to schedule a free initial consultation.