Florida Statute § 409.920 defines and criminalizes Medicaid fraud in Florida, defining it as knowingly and willfully committing fraud to obtain or attempt to obtain Medicaid benefits or payments. The statute provides detailed definitions and examples of fraudulent activities.
Being accused of medicaid fraud is a frequent worry for Medicaid recipients in Florida, and whether the result of incorrectly entered information, a clerical error, or a false report, a charge can mean anything from losing the government assistance you depend on to jail time.
Brooksville Medicaid Fraud Defense Lawyer
Receiving a Medicaid fraud charge is a serious and stressful situation. If you have been charged with Medicaid fraud in Hernando County, Sumter County, Citrus County, or the surrounding areas, including Spring Hill, Brooksville, Timber Pines, Homosassa Springs, Floral City, and Bushnell, contact The Law Office of Ashley Aulls, P.A.. Ashley Aulls comes from a background of successful legal professionals and has practiced law since 1996.
He knows what it takes to build a strong and comprehensive defense while being open to the client’s needs and worries – client education and open communication.
To schedule your initial case consultation and find out what The Law Office of Ashley Aulls, P.A. can do for your Medicaid fraud case, call (352) 593-4115 today.
Information Center
- Medicaid Fraud Crimes and Definitions
- Penalties for Florida Medicaid Fraud Offenses
- Common Defenses Against Medicaid Fraud Charges
- Additional Resources
- Defense Attorney for Hernando County Medicaid Fraud
Medicaid Fraud Crimes and Definitions
If you’re a Florida resident accused of Medicaid fraud, it’s important to understand what constitutes each type of offense. Many Medicaid fraud involve proving elements such as intent or knowledge. The absence of these elements could provide a basis for your defense attorney to construct a defense aimed at reducing or dismissing your Medicaid fraud charges.
Examples of Medicaid fraud offenses frequently encountered in the courts in Brooksville and surrounding areas include:
Medicaid Fraud: Fla. Stat. §§ 409.920 & 409.9201 – Medicaid fraud involves deliberate deception or misrepresentation by an individual or entity with the intent of securing an undeserved benefit or payment from the Medicaid program. This can include falsifying information, billing for services not provided, or misrepresenting one’s eligibility.
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Provider Fraud: Perpetrated by healthcare providers, such as doctors or nursing homes, who bill for services not rendered or overbill for services.
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Recipient Fraud: Involves Medicaid beneficiaries who falsify their eligibility or commit other forms of deceit to receive benefits they are not entitled to.
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Third-Party Fraud: Includes actions by individuals or entities that assist providers or recipients in committing fraud.
Federal False Claims Act: (31 U.S.C. § 3729 et seq.) – Florida Medicaid fraud cases can also fall under this federal statute, which allows for the prosecution of fraudulent claims made to federal programs, including Medicaid. It provides for civil penalties and qui tam actions, where private individuals can sue on behalf of the government.
Penalties for Florida Medicaid Fraud Offenses
In Florida, the penalties for a Medicaid fraud conviction depend on the specific nature of the offense and its classification. In Florida, offenses are categorized into misdemeanors and felonies, with varying degrees of severity, where first-degree offenses are the most serious. According to Fla. Stat. §§ 775.082-084, the maximum penalties for misdemeanor and felony offenses in Florida vary by class, with the following maximums for each category:
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Third-Degree Felony: Carries a maximum penalty of 5 years in prison and a $5,000 fine.
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Second-Degree Felony: Carries up to 15 years in prison and fines.
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First-Degree Felony: Carries up to 30 years in prison and substantial fines.
The classification of Medicaid fraud offenses into first, second, or third degree felonies is determined by several factors, including the total dollar amount involved, whether the fraud was individual or an organized scheme, whether the defendant is accused of primary participation or being an accessory, and prior criminal history.
Additional Penalties
In addition to the above criminal penalties, those convicted of Medicaid fraud may face some of the following penalties.
Restitution Fines
Offenders may be required to pay restitution to the Medicaid program, reimbursing the amount fraudulently obtained. In addition to criminal penalties, those found guilty of Medicaid fraud can face civil fines under the False Claims Act or Florida statutes. These fines can be substantial, reaching several times the amount of the fraudulent claim.
Exclusion From Medicaid
Providers convicted of Medicaid fraud may be excluded from participating in the Medicaid program, which can significantly impact their practice or business. The Florida Agency for Health Care Administration (AHCA) may impose administrative sanctions on providers, such as suspension or revocation of their Medicaid provider status.
Common Defenses Against Medicaid Fraud Charges
Lack of Intent: Showing that the defendant didn’t mean to commit fraud. For example, if a healthcare provider can prove that a billing mistake happened due to an administrative error, it shows they didn’t intend to defraud anyone.
Mistake of Fact: Arguing that any mistakes were just errors, not deliberate fraud. For instance, if a procedure was incorrectly coded due to a clerical error, leading to an overpayment, it was not intentional.
Compliance with Regulations: Proving that the defendant followed the rules for Medicare and Medicaid billing. This might include showing that the billed services were necessary and documented correctly according to the rules.
Absence of Financial Gain: Showing that the defendant didn’t profit from the alleged fraud. For example, if a physician can prove that any overpayments were quickly returned to Medicare or Medicaid, it suggests there was no financial motive.
Third-Party Liability: Pointing out that someone else, like an employee or contractor, may be responsible for the fraud. For example, if an office manager handled billing and committed fraud without the physician knowing, the physician might not be at fault.
Good Faith Defense: Showing that the defendant honestly believed their actions were lawful. For instance, if a healthcare provider followed the advice of a billing consultant who was later found to be incorrect, it shows they acted in good faith.
Statute of Limitations: Arguing that the case should be dismissed because it was filed too late. For example, if the alleged fraud happened more than five years ago and the law says fraud cases must be filed within five years, the charges can be dropped.
Procedural Errors: Highlighting mistakes made during the investigation or prosecution. This might include issues like mishandling evidence or violating the defendant’s rights, which could weaken the case.
Resources for Brooksville Medicaid Fraud
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Florida Agency for Health Care Administration (AHCA) Medicaid Fraud – The Florida Agency for Health Care Administration (AHCA) provides information on Medicaid fraud, including the types of fraud investigated, how to report suspected fraud, and the agency’s role in combating Medicaid fraud. This site can help individuals understand the scope of Medicaid fraud and the investigation process.
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National Health Care Anti-Fraud Association (NHCAA) – The NHCAA is a national organization focused on combating healthcare fraud. Their website provides resources and tools for understanding healthcare fraud, including Medicaid fraud. It offers insights into the types of fraud, case studies, and preventive measures.
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Hernando County Department of Health and Human Services – Health and Human Services has a certified application counselor to help with questions and the Medicaid enrollment process. Contact their office for help if needed at 352-540-4338 or request an appointment on-line.
Defense Attorney for Hernando County Medicaid Fraud
With a background rooted in successful legal practice and a commitment to respectful, client-focused service, Ashley Aulls is dedicated to providing a strong defense and clear guidance. If facing Medicaid fraud charges, it is crucial to seek legal help promptly.
If you are considering a qualified defense attorney for your Medicaid fraud charge, it is best to contact him as soon as possible after your arrest. The Law Office of Ashley Aulls, P.A. can even represent you in any related hearing in Hernando County, Pasco County, Citris County, and Sumter County, FL.
To schedule your initial case consultation with Brooksville defense lawyer Ashley Aulls, call (352) 593-4115 today.