Health Care Fraud

State, as well as federal charges, can be brought for issues revolving around health care fraud in Miami. Typically prosecuted as a felony and governed under several statutes, health care fraud is a broad term covering fraudulent schemes involving arrangements for public and private health insurance. Anyone in the medical industry can face fraud allegations, including physicians, insurance providers, pharmacy reps, medical equipment suppliers, Medicare and Medicaid contract carriers, labs, healthcare facilities, agencies, and also nursing homes.

Considering how broad it is, health care fraud may constitute a broad array of distinct scenarios. Some examples include:

  • Billing a patient or the insurance company for services that were not performed.
  • Making a self-referral
  • Applying for Medicare or Medicaid with false information
  • Allowing another party to borrow or resell Medicare benefits
  • Utilizing multiple Medicare cards

The majority of health care payment processes are running on some form of autopilot. An individual receives coverage under an insurance policy, receives consultation from a health care professional who takes care of requesting specific tests or procedures, and the insurance company receives a bill for those procedures. In the bulk of cases, the insurance company relies merely on the submitted details. There is very little time and resources to perform a thorough analysis regarding the specifics of the bill. It makes getting money earned via fraudulent claims surprisingly simple for people.

As far as Medicare and Medicaid fraud is concerned, the government also has an opportunity to recoup money that's been lost as a result of fraud. Such recoveries go a considerably long way in both financing fraud-fighting initiatives and bringing funds back into the programs.

Some of the health care crimes that we handle include, but are not limited to when our clients are accused of: Excessively billing Medicare and/or Medicaid; Overbilling Medicare and/or Medicaid; Filing fraudulent claims to Medicare and/or Medicaid; Filing excessive claims to Medicare and/or Medicaid, etc. Those accused of these types of offenses include doctors, nurses, nursing homes, clinics, home health care professionals, surgeons, etc.

Health care-related fraud includes a criminal penalty of up to 10 years in jail and significant financial fines. The False Claims Act (FCA) requires the federal government to seek fines of up to $ 10,000 on each incorrect allegation, adding up to three times the amount for other amounts. Those fines can easily add up, and medical practitioners convicted of a felony also lose their license to practice health care.

To elaborate, state and federal law places heavy sanctions and fines on those found guilty of committing fraud in the healthcare sector. Several of the potential penalties for contravening the laws of the state and/or federal health fraud include:

  • As long as 20 years in federal jail
  • Being expelled from the Medicare / Medicaid program
  • Loss of doctor's licenses or personnel privileges
  • Fines ranging $10,000 and $50,000 for each violation
  • Fines three times the amount claimed based on the number of fraudulent services or items.

However, a billing mistake is not always fraud, nor is every order of a retest or a decision that may drive up the cost care. Likewise, not every medical practitioner who has ties with someone who commits fraud is in on it. Being prosecuted for fraud will make it harder for a licensed health care worker to find and maintain a job. A conviction carries with it many significant consequences, as mentioned above.

There is much at stake for any medical person that is under investigation for potential fraud. One way to protect yourself is to seek the assistance of an experienced defense attorney who has a solid foundation of fraud prosecutions generally, and the very particular details of health care fraud claims.

The general information provided above about health care fraud in Fort Lauderdale is meant for educational purposes only and is not a substitute for speaking directly with an attorney about the facts and circumstances of your case. Please call 954.500.0003 in Broward or 305.674.0003 in Miami to schedule a consultation with the Law Offices of Mark Eiglarsh.

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