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Medicaid Provider Fraud Defense Lawyers in Florida

Florida Statute 409.920 Medicaid Provider Fraud Charges, Defenses, and Penalties

According to Florida Statute 409.920 Medicaid Provider Fraud, it is a crime for an individual to knowingly and willfully defraud the government's Medicaid program, or any other government managed care plan programs. Generally speaking, Medicaid fraud is collecting, charging, billing, or receiving benefits or compensation from Medicaid when an individual should not be receiving said benefits or compensation.

Medicaid fraud is a crime that is often committed by medical professionals such as nurses and doctors.

A few examples of Medicaid fraud crimes:

  • Filing false Medicaid claims
  • Filing excessive Medicaid claims
  • Overbilling or fraudulent billing to Medicaid
  • Unauthorized billing to Medicaid

It is essential to understand that the crime of fraud is an intentional act. If an individual did not intend to defraud Medicaid, and this can be proven, it is probable that no Medicaid fraud charges will be filed or a criminal conviction will not be attained in a criminal trial.

Medicaid fraud is committed when:

  • An individual intentionally makes, causes to be made, abets or aids in the construction of a false representation or false statement of fact, by either omission or commission, in any Medicaid claim submitted to the Medicaid agency or a Medicaid fiscal agent, or any government-managed health care plan for payment. See Florida Statute 409.920(2)(a)1.
  • An individual purposefully creates, causes to be made, abets, or aids in the production of a Medicaid claim for services or items that were not approved to be reimbursed by the Medicaid program. See Florida Statute 409.920(2)(a)2.
  • An individual knowingly charges, accepts, solicits, or receives something of value, other than an approved copayment from a Medicaid beneficiary, from a different source on top of the total amount lawfully payable for a service or item given to a Medicaid beneficiary through the Medicaid program or purposefully failing to provide the agency or its fiscal agent a credit when a payment has been received from a third-party source. See Florida Statute 409.920(2)(a)3.
  • An individual willfully and purposefully makes or causes to be made any false representation or false statement of a fact, either by omission or commission in any document comprising items of expense or income that is or could be managed by the agency to ascertain a specific or general or charge of payment for items or services that are performed by a provider. See Florida Statute 409.920(2)(a)4.
  • An individual intentionally offers, solicits, pays, or receives any compensation, including bribes, rebates, or kickbacks either directly or indirectly, covertly or overtly, in money or equivalent, in return for referring someone to a provider for the arranging or furnishing or for the giving of any service or item for which payment will be given, in part or in entirety, under the Medicaid program, or in return for purchasing, obtaining, leasing, arranging for or recommending, ordering, obtaining, leasing, purchasing, or placing an order for any service, goods, items, or facilities, in which some sort of payment will be presented, in part or in whole, under the Medicaid program. See Florida Statute 409.920(2)(a)5.
  • An individual deliberately submits misleading or false information or makes statements to the Medicaid program to be accepted as a Medicaid provider. Refer to Florida Statue 409.920(2)(a)6.
  • An individual plans or attempts to use or uses a Medicaid recipient's identification number or a Medicaid provider's identification number in order to make, cause to be made, or aid and abet in the manufacture of one or more Medicaid claims for services or items that are not authorized to be compensated by the Medicaid program. Please refer to Florida Statute 409.920(2)(a)7.

Investigating and Prosecuting Florida Medicaid Fraud Crimes

Florida's healthcare fraud statutes pertain to individuals and businesses that are contracted to provide medical services and are compensated by the federal government. The following medical industries are at a high risk of facing a Medicaid fraud investigation:

  • Bio Laboratories
  • Hospitals
  • Home Health Centers and Independent Providers
  • Medical Device Companies
  • Pharmacies
  • Physicians
  • Physician-Owned Entities
  • Toxicology Laboratories

Medicaid fraud criminal cases are typically investigated and prosecuted by the Office of the Inspector General's Fraud Strike Force. These cases usually target false billing executed by medical professionals, doctors, and nurses. Oftentimes law enforcement agencies will set up undercover "sting" operations on suspected individuals who could be engaged in Medicaid fraud. Many criminal investigations are opened due to tips provided by employees of those allegedly violating the law.

The Health Care Fraud Prevention and Enforcement Team ("HEAT") was created by the Department of Justice in conjunction with the Department of Health and Human Services. HEAT is dedicated to the prevention of fraud, waste, and abuse. HEAT only deals with Medicaid fraud and Medicaid fraud. If an individual is accused of Medicaid fraud, HEAT will aid in the prosecution of the criminal case.

In Medicaid fraud cases, the investigators may allege or uncover several other offenses that often accompany Medicaid fraud allegations. These criminal offenses might include:

  • Aggravated identity theft
  • Asset forfeiture charges
  • Conspiracy to commit healthcare fraud
  • Durable products fraud
  • Identity theft
  • Money laundering
  • Violations of anti-kickback statutes
  • Wire fraud charges

The State of Florida is one of the most regulated states when it comes to healthcare laws. Before you speak with investigators, contact Musca Law for your free case review.

Medicaid Fraud Criminal Cases Begin With an Audit

Medicaid fraud investigations begin with an extensive audit of financial records and billings. The healthcare provider or healthcare business that is being audited will receive a notice of a pending audit. If you or your business is about to be audited, it is essential that you contact Musca Law should you receive an audit notice.

Musca Law serves the entire State of Florida, and our firm has convenient office locations throughout Florida. Our criminal defense attorneys represent all types of healthcare businesses, individual healthcare providers, labs, medical and dental clinics, hospitals, pharmacies, and all healthcare businesses that are under investigation for fraudulent billing, illegal kickbacks, allegations of performing medically unnecessary treatments or surgical procedures, creating illegal joint ventures, and services not rendered charges. At Musca Law, our criminal fraud defense attorneys can assist you with:

  • Disciplinary proceedings
  • Healthcare fraud defense
  • Internal investigations
  • Jury trials
  • Licensure defense

If you or your business is under investigation by the FBI, Department of Justice, Office of Inspector General, or a Florida State law enforcement agency for insurance fraud, contact Musca Law today at 1-888-484-5057 for your free case review. All initial case reviews are free and confidential.

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