Antitrust laws were established to protect trade and commerce from abusive practices. Violations can include price-fixing, price discrimination, restraints, and monopolization.
Miami · Fort Lauderdale · All Across Florida · Available 24/7 · Hablamos Espanol
Miami Healthcare Fraud Attorney
If you are a Miami-based or South Florida-based doctor or a licensed medical professional under investigation for healthcare fraud, you need to act immediately. The minute you are accused of being involved in a healthcare fraud scheme in Miami or the greater South Florida area, you should speak to our competent Miami healthcare fraud lawyer.
Considering that billions of dollars are poured every year into government healthcare programs such as Medicare, Medicaid, and Tricare, state and federal officials relentlessly pursue and investigate healthcare crimes. How you respond to a target letter or subpoena could affect you and your family for years to come. At The Kirlew Law Firm, PLLC, our Miami white-collar crime lawyer defends clients in complex white-collar crime matters, including healthcare fraud.
We are proud to offer you a free phone consultation to help you plan a proactive defense strategy that will protect your rights in court.
What is Healthcare Fraud?
Healthcare fraud occurs when a licensed medical professional (or even a medical institution or group) knowingly submits false claims to a private or government health insurance program to receive financial benefits they are otherwise not entitled.
According to the U.S. Sentencing Commission, 340 federal cases involved healthcare fraud in fiscal year 2025. The median loss was $1,279,436, and 91% of sentenced individuals had little or no prior criminal history.
One local example occurred in 2025 when the U.S. Attorney’s Office for the Southern District of Florida announced charges against 37 defendants in June that year as part of a nationwide healthcare fraud enforcement operation involving Medicare, Medicaid, and controlled substances.
Whether the healthcare benefit plan is provided by Medicare, Medicaid, or a private employer, healthcare fraud is prosecuted using the same general principles. Like most white-collar crimes, healthcare fraud cases involve deception, fraudulent documents, using the internet or fax to submit invoices, and collusion with various individuals. These types of crime do not rely on the threat of physical force or violence.
Some examples of acts that can trigger a healthcare fraud investigation in Miami include but are not limited to:
- Prescribing unnecessary medications or performing unnecessary procedures to bill an insurance company.
- Billing for services that were never rendered.
- Unbundling or billing every step of one test or treatment as if they were individual procedures.
- Submitting inflated claims.
- Submitting claims for a patient who does not exist.
- Soliciting illegal “kickbacks” or referral fees.
Contact Us Today for a Phone Consultation
We’ll set up a phone consultation to get to know you and your circumstances.
How is Healthcare Fraud Prosecuted?
Healthcare fraud is predominantly prosecuted by the federal government and the U.S. Department of Justice (DOJ) Healthcare Fraud Strike Force, which is based in Washington D.C.
The following are just a few of the federal statutes that are used to prosecute healthcare fraud:
- The False Claims Act (FCA), 31 USC §§ 3729 – 3733
- Anti-Kickback Statute (AKS), 42 USC § 1320a–7b
- Physician Self-Referral (Stark) Law, 42 USC § 1395nn
- Criminal Health Care Fraud, 18 USC § 1347
Healthcare Fraud Penalties and Consequences
Defrauding federal healthcare programs is illegal. The consequences of a healthcare fraud conviction are severe and life-altering. A conviction can expose you to potential criminal, civil, and administrative liability. In a state where 151,000 people are locked up behind bars in a typical year, the risk associated with healthcare fraud should not be underestimated.
The potential penalties and consequences of a healthcare fraud conviction are:
- Exclusion from participating in any Federal healthcare program.
- Loss of professional licenses.
- Up to 30 years in federal prison.
- Fines of up to $250,000 per offense.
- Fines of up to three times the number of false claims submitted.
- Forfeiture of all assets related to the charged offense.
Substitute forfeiture of assets unrelated to the charged offense.
What Are the Potential Consequences of a Healthcare Fraud Investigation?
Even before formal criminal charges are filed, a healthcare fraud investigation can have serious consequences for medical professionals and healthcare businesses throughout Miami. Federal authorities may request extensive financial records, patient files, and billing documentation. Investigations can disrupt daily operations, damage professional reputations, and create uncertainty for employees and patients.
Depending on the allegations and actions taken by regulators, additional consequences may include:
- Suspension or revocation of Medicare and Medicaid billing privileges
- Investigations by Florida professional licensing boards that could lead to suspension or revocation of a medical license
- Freezing or seizure of assets connected to suspected fraud
- Loss of contracts with private insurance providers
- Significant financial losses and interruptions to patient care
The U.S. Department of Health and Human Services Office of Inspector General also maintains an exclusion program that can prevent individuals and businesses from receiving payments through federal healthcare programs. These consequences can threaten a medical professional’s career and the financial stability of an entire practice.
Defense Strategies You Can Use Against Healthcare Fraud Accusations
Being accused of healthcare fraud can quickly put you on the defensive. When you work with an experienced healthcare fraud attorney, you can counter those accusations by presenting evidence and arguments that challenge the prosecution’s claims and raise reasonable doubt about whether your actions constituted a crime.
After reviewing the evidence and specific allegations you are facing, a defense attorney can:
- Challenge whether billing errors were intentional
- Demonstrate that disputed medical procedures were necessary and properly documented
- Establish that billing practices complied with healthcare regulations
- Question the reliability of financial records being used against you
- Challenge allegations of unlawful kickbacks when applicable
These and other steps can potentially lead to favorable outcomes that safeguard your reputation and ability to continue delivering healthcare services.
Who Investigates Healthcare Fraud in Miami?
Healthcare fraud investigations in Miami may involve federal and/or state agents. Investigators from these and other law enforcement agencies may examine patient records, insurance claims, and communications.
- Federal Bureau of Investigation: These federal agents investigate suspected healthcare fraud involving private insurers and government healthcare programs.
- Department of Health and Human Services Office of Inspector General: This government group may look into fraud involving Medicare and other federal healthcare programs
- Florida Attorney General’s Medicaid Fraud Control Unit: When Medicaid fraud is suspected, this unit may investigate alleged criminal activity.
- U.S. Department of Justice: The DOJ coordinates federal prosecutions through the U.S. Attorney’s Office for the Southern District of Florida
These agencies may collaborate during complex investigations involving multiple healthcare providers or businesses. Being contacted by investigators does not necessarily mean criminal charges will follow, but understanding the allegations and your legal obligations is essential.
Why You Should Hire a Healthcare Fraud Lawyer
Whether your healthcare business is based out of Olympia Heights, Coral Gables, Hialeah Gardens, or elsewhere in Miami, the decision to hire a healthcare fraud lawyer can make a meaningful difference in the outcome of your case. A Miami healthcare fraud attorney brings years or decades of experience, and their first-hand knowledge of the law and healthcare fraud penalties can greatly improve your odds of securing a favorable resolution to your case.
A healthcare fraud attorney can:
- Investigate the circumstances surrounding the healthcare fraud allegations
- Review medical records, billing statements, and insurance claims for discrepancies
- Identify potential violations of your constitutional rights during the investigation
- Challenge allegations that billing errors or administrative mistakes were intentional
- Speak with medical and financial workers to evaluate the prosecution’s evidence
- Respond to federal subpoenas and requests for business records
- Negotiate with prosecutors to pursue reduced or dismissed charges
- Prepare a comprehensive defense and represent you at trial when necessary
By taking the time to review the case, scrutinize the evidence, and carefully listen to your account of events, they can counter the accusations that you are facing. Whether your case ultimately resolves through direct talks with prosecutors, pursuing dropped charges, or requesting a trial, the right approach and legal support can make all the difference in how your criminal case plays out.
FAQs
Q: What Qualifies as Healthcare Fraud?
A: What qualifies as healthcare fraud is generally any intentional act of deception or misrepresentation intended to obtain payments or benefits from a healthcare program or insurer unlawfully.
Common examples include billing for services never provided, submitting false insurance claims, falsifying patient records, and billing for medically unnecessary procedures. Healthcare fraud can involve physicians, hospitals, medical billing companies, patients, and other individuals or organizations.
Q: What Is the Penalty for Insurance Fraud in Florida?
A: The penalty for insurance fraud in Florida depends on the value of the fraudulent claims and other circumstances. Under Florida Statute § 817.234, insurance fraud can result in third-degree, second-degree, or first-degree felony charges. Depending on the severity of the offense, a conviction could lead to five, 15, or 30 years in prison, along with substantial fines and other consequences.
Q: What Evidence Is Needed to Prove Fraud?
A: The evidence needed to prove fraud generally includes documentation demonstrating that someone knowingly made false statements or misrepresented information to obtain payments or benefits unlawfully.
Prosecutors may rely on medical records, insurance claims, billing statements, financial transactions, emails, and witness testimony. In healthcare fraud cases, prosecutors must also establish the required criminal intent, rather than merely demonstrating that billing errors or administrative mistakes occurred.
Q: What Are Some Examples of Healthcare Fraud?
A: Some examples of healthcare fraud include billing Medicare or Medicaid for services never provided, submitting claims for medically unnecessary procedures, falsifying patient diagnoses, and receiving illegal kickbacks for patient referrals. Other examples include double billing, using another person’s insurance information, and misrepresenting services to obtain higher reimbursements. These activities may violate Florida or federal healthcare fraud laws.
You Need to Act Quickly to Defend Your Rights. Contact Our Brian Kirlew and the Kirlew Law Firm NOW!
As soon as you receive a subpoena or a federal agent asks to speak to you about a healthcare fraud criminal investigation, it would help if you were concerned. Bear in mind that when federal agents reach out to someone, the investigation itself has been ongoing for a long time, and they likely already have their prosecution strategy drawn out.
It is critical to contact our Miami white-collar criminal defense attorney when you suspect you are the target of a healthcare fraud criminal investigation. If you face something as career-threatening (and potentially life-changing) as healthcare fraud prosecution, your entire life is hanging by a thread. You need an experienced, knowledgeable, and aggressive Miami healthcare fraud defense attorney who will advocate for you and seek your interests.
At The Kirlew Law Firm, PLLC, we have years of legal experience handling all types of white-collar defense cases in Miami and greater South Florida. Our healthcare fraud defense attorneys can effectively intervene in the investigation and quickly gather the necessary information to execute a strategic defense.
When you retain our white-collar criminal defense services, you can count on the support and strength of experience. Brian Kirlew, Esq. and his Miami healthcare fraud defense team have a proven track record of getting results in and out of the courtroom. Contact us without any obligations. We are here to help you!
Contact a Miami White Collar Criminal Attorney today!
If you are being investigated for a white-collar crime at the state or federal level (or both), the sooner you get a qualified attorney on your side to protect your rights, the better. Brian Kirlew, Esq., is experienced and skilled at handling these complex and sensitive matters and is here to represent you in court.
Our criminal defense attorneys in Miami are proud to offer you a phone consultation to make sure that we can effectively serve you. Contact us immediately to get started.
This form of white-collar crime is increasingly common as more people use computers, phones, and other internet-enabled devices to commit acts of fraud, hacking, extortion, and theft.
Thieves take personal information to access banking and financial accounts, make purchases, open utility accounts, or steal tax refunds. In some cases, an identity thief may even use a false identity during an arrest.
This white-collar crime occurs when a thrift utilizes a stolen credit card or other information from that account to make unauthorized purchases. In some cases, they may use the stolen information to take out cash advances against the account.
The illicit selling of fake goods or services over the phone. Many phone scams are framed as a giveaway, or free offer in exchange for sensitive information, like access to banking or credit card accounts.
Often paired with another form of fraud, bankruptcy fraud can be the concealment of assets to prevent forfeiting them, filing incomplete or false forms, filing multiple times in different locations using fake or forged documents, and bribing of court-appointed trustees.
Largely committed by organized crime groups, this form of fraud includes performing unnecessary procedures to bill an insurance company, billing for services that were never rendered, and billing every step of one procedure as if they were individual procedures.
Environmental law makes actions like the illegal disposal of waste, improper storage of hazardous materials, or failure to comply with EPA and state regulations illegal.
An act committed to defraud an insurance company is considered a white-collar crime. This could include attempting to obtain benefits or advantages that an individual is not entitled to or when an insurer denies benefits that someone is due.
One of the most common forms of fraud, mail fraud is when the USPS or private carrier is used to commit a crime of deceit. This could be to obtain money or to sell and distribute illicit goods.
These forms of fraud start with a scheme to steal or obtain financial information by using false representation or promises of goods and services in return.
Crimes committed through extortion and coercion are considered racketeering. Generally, a racketeer obtains money or goods from someone using intimidation tactics or force.
Largely connected to federal government contracting or federally-funded programs, government fraud might involve public housing, agricultural programs, corporate subsidies, and bribery.
This form of white-collar crime is the deliberate failure to pay your taxes or the underpayment of the taxes you owe. It can be underreporting of income, overreporting of deductions, or improperly claiming tax credits and exemptions.
Also called investment fraud, securities fraud involves misrepresenting the information that investors use to make financial decisions.
This is the trading of the stock or securities of a public company that is based on non-public information about the company. This is the profiteering of information based on a company’s assets.
A bribe is the giving or receiving of something of value in order to influence the actions of another person or group.
The major focus of the FBI, public corruption covers a variety of crimes, including the violation of federal law by public officials, fraud related to the procurement, contracts, and funding of federal programs, and other crimes that are related to local, state, and federal governments.
By withholding assets, funds, or goods from an employer or business partner, you are committing an act of embezzlement.
Generally sponsored by foreign entities or outside corporations, economic espionage can target the U.S. government, U.S. companies, or other establishments and institutions. Economic espionage is the unlawful obtaining of financial information.
Trade secrets are the information or assets that give a company an advantage over others in the market. The theft of these assets is when someone uses this information without consent of the business.
Contact a Miami White Collar Criminal Attorney today!
If you are being investigated for a White Collar crime at the state or federal level (or both), the sooner you get a qualified attorney on your side to protect your rights, the better. Brian Kirlew, Esq. is experienced and skilled at handling these complex and sensitive matters, and is here to represent you in court. Our criminal defense attorneys in Miami are proud to offer you a phone consultation to ensure that we can best serve you. Contact us immediately to get started.
Committed to aggressive, personalized legal representation for criminal defense, white collar, federal, and family law matters throughout Florida since 2012.
Ft. Lauderdale Satellite Office
888 S. Andrews Ave
Suite 201
Fort Lauderdale, FL 33316
© 2026 The Kirlew Law Firm, PLLC · 2103 Coral Way, Suite 401, Miami, FL 33145
Disclaimer | Site Map | Privacy Policy. Digital Marketing By: 
*Images are obtained under license from Canva and other third-party stock image providers, with attribution included where required.