Healthcare Fraud

Over the past few decades, addressing healthcare fraud has become a growing concern in the United States. Everyone knows healthcare providers carry the responsibility of working ethically, which doesn’t just mean providing high-quality care to their patients but also maintaining transparency when billing Medicaid, Medicare, or a private health insurance company. However, the procedures to bill these companies can be extensive and complicated.

A Medicare billing audit can quickly turn into a criminal investigation. In cases of Medicaid or Medicare fraud, the government moves quickly to prosecute companies that have overcharged clients for services or have allowed clients to use a fake insurance card. Unfortunately, healthcare fraud does not carry light penalties in the state of Florida.

If you have been charged for healthcare fraud, it is important to act quickly and retain an experienced criminal defense attorney that can aggressively defend your legal rights.

Healthcare Fraud Lawyer in Hernando County, Florida

If you’re under investigation for healthcare fraud, you need to acquire legal representation from an experienced lawyer well-versed in this area of law. Ashley Aulls is a criminal defense attorney that has practiced law since 1996. He is skilled at  fighting criminal charges, including healthcare fraud cases like yours. He knows what it takes to build a strong defense and can do the same for your charges.

To protect your rights and schedule your consultation with Brooksville defense lawyer Ashley Aulls, call (352) 593-4115 today. The Law Office of Ashley Aulls, P.A. represents clients in Brooksville, North Weeki Wachee, High Point, Hernando Beach, Hill ‘n Dale, Inverness Highlands, Sugarmill Woods, Lecanto, Wildwood, Lake Panasoffkee, and Bushnell, Florida.

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Information Center

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What is Healthcare Fraud?

Fraud refers to any deliberate unlawful and deceitful act with the intention of securing an unfair or unlawful gain. It involves the false representation of facts or withholding important information for some type of benefit. Although fraud crimes can vary in scope and nature, they are classified as white-collar crimes.

One of the most common fraud offenses persecuted in Florida is healthcare fraud. Healthcare fraud can be committed by patients, medical providers, or others who deceive the health care system. The offense can occur in several different forms including:

Fraud committed by medical providers:

  • Billing for services that were never performed
  • Waiving deductibles or copays for certain patients
  • Billing for services that are not considered necessary
  • Modifying medical records
  • Altering the description of services, dates, or identities
  • Submitting multiple claims for the same service

Fraud committed by patients:

  • Obtaining prescription pills and then selling them on the black market to gain profit
  • Allowing a friend to use a Medicare or Medicaid card so they can obtain supplies or services
  • Lying on an application for Medicare or Medicaid in order to receive benefits

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Medicaid Fraud by a Provider in Florida

According to Florida Statute § 409.920, a Medicaid provider is prohibited to:

  • Knowingly make any false statement or false representation of a material fact, by commission or omission, in any claim submitted to Florida Agency for Health Care Administration.
  • Knowingly make claims for items or services that are not authorized to be reimbursed by the Medicaid program.
  • Knowingly charge, solicit, or accept anything of value, other than an authorized copayment from a Medicaid recipient, from any source in addition to the amount legally payable for an item or service.
  • Knowingly make any false statement or false representation, by commission or omission, in any document containing items of income and expense.
  • Knowingly solicit, offer, pay, or receive any kickback, bride, or rebate, in exchange for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made.
  • Knowingly submit false information to the Medicaid program for the purpose of being accepted as a Medicaid provider.
  • Knowingly use a Medicaid provider’s identification number or a Medicaid recipient’s identification number to make a claim for items or services that aren’t authorized to be reimbursed by the Medicaid program.

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Penalties for Medicaid Fraud in Florida

Florida healthcare fraud cases are often complex, and the penalties a Medicaid provider can face is dependent on various factors such as the value of the services, goods, or benefits involved in the case. If a Medicaid provider receives $10,000 or less, the sentence will be a third-degree felony, which is punishable by up to 5 years in prison and up to $5000 in fines.

For a scheme involving more than $10,000 but less than $50,000, the penalty will be classified as a second-degree felony, which is punishable by up to 15 years in prison and up to $10,000 in fines. If a fraud involves more than $50,000, it will be classified as a first-degree felony. A first-degree felony is punishable by up to 30 years in prison and up to $10,000 in fines.

If a patient commits Medicaid fraud, he or she can face the following penalties according to the dollar value of fraud:

  • Under $20,000: third-degree felony punishable by up to $5,000 in fines and up to 5 years of imprisonment
  • $20,000 to $99,999: second-degree felony punishable by up to $10,000 in fines and up to 15 years of imprisonment
  • $100,000 or more: first-degree felony punishable by up to $10,000 in fines and up to 30 years of imprisonment

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Additional Resources for Healthcare Fraud

FBI: Healthcare Fraud – Access the Federal Bureau of Investigation (FBI) website to view information on healthcare fraud. The page lists tips for avoiding healthcare fraud, common types of healthcare fraud, and prescription medication abuse.

Centers for Medicare & Medicaid Services: Healthcare Fraud Prevention Partnership – Follow the link provided to learn more about Healthcare Fraud Prevention Partnership (HFPP) offered by the Centers for Medicare & Medicaid Services (CMS). The HPPP combats healthcare fraud, waste, and abuse. Access the website to learn how to become a partner and view upcoming events.

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Florida Healthcare Fraud Attorney in Brooksville

If you or a loved have been arrested for healthcare fraud, it is important take your charges seriously. Penalties for healthcare fraud in the state of Florida are not light therefore it is in your best interest to seek legal counsel as soon as possible. At The Law Office of Ashley Aulls, P.A., criminal defense attorney Ashley Aulls has represented clients charged with all types of white-collar crimes including healthcare fraud.

Call (352) 593-4115 to schedule your consultation today. The Law Office of Ashley Aulls, P.A. works with clients throughout Hernando County, including Brookridge, Brooksville, High Point, Nobleton, Lake Lindsey, Istachatta, Pine Island, Timber Pines, Wiscon, Weeki Wachee, and more.

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