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News-making Health Care Fraud Cases

Florida ranks high among states for incidents of health care fraud. In response to the constantly increasing number of cases and convictions, federal agencies placed the nation’s first Medicare Fraud Strike Force in Miami to investigate suspected illegal activities and bring charges in state and/or federal court. Agency efforts have resulted in thousands of arrests, representing more than $2 billion in fraudulent activity. However, with the assistance of an experienced attorney, many of these allegations did not result in convictions.

The South Florida Business Journal recently compiled a list of health care fraud allegations that made news in 2015. Incidents within the compilation include the following:

  • Stemming from a 202 whistle blower lawsuit, a Miami-based senior home reportedly settled Medicare fraud charges in the amount of $17 million for an alleged kickback scheme. As stated in the report, the settlement amount was the largest ever paid by a skilled nursing home facility.
  • Three Miami residents reportedly pled guilty to participating in a $70 million fraud scheme, committed several community mental health centers. The group allegedly submitted false claims to Medicare between January 2008 and December 2010.
  • A $190 million fraud allegation broke in April, involving a U.S. senator and an ophthalmologist from West Palm Beach. According to the report, the doctor maintains his innocence regarding allegations that he misdiagnosed to bill for unnecessary test and medical procedures.

What is Health Care Fraud?

As exemplified by these incidents, health care fraud can encompass a variety of situations. This white collar crime involves the dishonest filing of information to manipulate the payment of health care benefit payments. While these fraud cases commonly involve health care providers, consumers and patients may also face fraud charges. There are generally three types of health care benefit fraud, including Medicare fraud, where the federal agency is billed for services that were not actually delivered to the patient; Medicaid fraud, where Medicaid is billed for services that were not actually delivered to the patient; and insurance fraud, where a private insurance company is fraudulently billed.

Some examples of fraud include:

  • Billing for unnecessary procedures;
  • Filing claims for patients who do not exist;
  • Taking kick-backs;
  • Illegally prescribing medications;
  • Counterfeit prescriptions;
  • Double billing;
  • Using another individual’s health insurance identification number; and
  • Altering claim forms for higher billing amounts.

Health care fraud allegations may be prosecuted in state or federal courts. In order to prove the allegations, prosecutors must prove that the defendant:

  • Committed an intentional deception or misrepresentation; and
  • Had knowledge that the deception would result in unauthorized benefit payments

If successful in proving the case, a conviction can result in significant jail time in a federal prison, substantial fines, loss of professional license and public stigma.

Let Our Attorneys Help You

A health care fraud conviction can have serious professional and personal consequences. It is important that you contact an experienced criminal law attorney at the first notification of allegations or an investigation. The attorneys at the office of Ratzan & Faccidomo have the experience and knowledge to provide you with the representation you need. Contact the office at (305) 330-3905 for a free and confidential consultation in Miami.

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