Fort Lauderdale Healthcare Fraud Lawyer

Fort Lauderdale Healthcare Fraud Attorney

As a healthcare provider or licensed medical professional, there is a lot you can lose when accused of being involved in a healthcare fraud scheme. If you receive a target letter or subpoena, it’s important to seek the aid of a qualified Fort Lauderdale healthcare fraud lawyer who can help you respond appropriately. Securing the assistance of a Fort Lauderdale white collar crime lawyer is a smart move during a fraud investigation.

Hire a Healthcare Fraud Lawyer

Accusations of healthcare fraud can have far-reaching effects on your professional credibility and reputation. If convicted, in addition to prison time and fines, you can have your professional license revoked or lose the ability to participate in Federal healthcare programs. You need to hire a healthcare fraud lawyer to ensure a more favorable outcome. At The Kirlew Law Firm, we have years of experience representing clients through negotiations and litigation.

Florida Healthcare Fraud

Healthcare fraud costs each state millions of dollars each year. The United States Sentencing Commission tracks healthcare fraud sentences throughout the country. During fiscal year 2024, there were a total of 395 healthcare fraud cases in the country, a 19.7% increase since 2020. Of these cases:

• $2,532,314 median loss for these offenses
• 18.2% involved a loss of less than $250,000
• 19.8% involved a loss greater than $9,500,000
• 27 months is the average sentence length

The Southern District of Florida had the highest number of healthcare fraud offenses, with 65 offenses.

Healthcare fraud cases originating in Fort Lauderdale can be heard in either federal or state court. Federal cases are heard at the U.S. District Court for the Southern District of Florida, while state cases are heard by the 17th Judicial Circuit. Federal cases typically involve Medicare or Medicaid fraud or federal statutes. State cases could involve state Medicaid fraud or violations of state laws. Federal cases typically involve Medicare or Medicaid fraud or violations of specific federal statutes.

Common Types of Healthcare Fraud in Florida

Healthcare fraud is a type of white-collar crime where a healthcare professional or someone working within a medical facility misrepresents a claim for their own personal gain. Like all forms of white-collar crime, deception is used to gain access to funds illegally. Some common types of healthcare fraud include:

• Billing for nonexistent services
• Upcoding
• Unbundling
• Billing more than once
• Falsifying patient records
• Billing for more services than were used
• Billing for unnecessary services
• Kickbacks
• Phantom billing
• Prescription fraud

Healthcare Fraud Defenses

Healthcare billing systems are heavily scrutinized, and one small error can create a situation where you are facing healthcare fraud charges. Even if the charges are later dismissed or you are acquitted, the damage to your reputation can take years to fix.

It is important to have an experienced Fort Lauderdale healthcare fraud attorney who can help mitigate the negative effects of these allegations and formulate an effective defense. Common defense strategies include:

• Challenging intent. You should not be criminally charged for an honest or careless mistake. Without the intent to commit a crime, charges should be dismissed.
• Challenging the evidence. In some cases, the evidence may show evidence of fraud, but there is actually a simple explanation or misunderstanding.
• Lack of knowledge. The fraud could have occurred due to another person’s actions at the same facility or in a shared workspace.
• Legal compliance. Demonstrating that you are working within the legal guidelines can be proof that you are not engaging in fraudulent activities.

In some cases, the most favorable outcome may be a plea agreement for a lesser charge or reduced penalties.

FAQs

How to Prove Healthcare Fraud?

To prove healthcare fraud in Fort Lauderdale, Florida, prosecutors have to prove three elements. Prosecutors have to prove there was a false claim, the accused knew about the false claim with the intent to receive financial gain, and the false information led to harm. All three elements have to be met for the crime to be prosecuted. If the accused acted in good faith without knowing the claim was false, they had no intent to commit a criminal act.

What Evidence Is Needed to Prove Health Insurance Fraud?

To prove health insurance fraud, different types of evidence are collected that are connected to the fraud. Evidence could include false statements made by the accused, billing or financial records, medical records of patients, witness statements, or professional testimony. Investigators also collect emails, text messages, and phone recordings that could provide evidence of the deception.

What Is the False Claims Act?

The False Claims Act is a federal statute that sets the penalty for knowingly submitting a false claim to the government. The penalty for violating the False Claims Act is three times the government’s damages plus a penalty fee.

The same penalty also applies when false record materials are used or when someone purposely avoids making a government payment. Private citizens are also allowed to file civil claims on the government’s behalf and share in the settlement.

Is Healthcare Fraud a Criminal or Civil Offense?

Healthcare fraud can be tried as both a criminal and civil offense. There are criminal statutes that make various deceptive practices criminal offenses. When a medical professional or facility engages in deceptive practices to gain additional funds, they are committing a criminal act. There can also be civil offenses tied to the misappropriation of funds, requiring offenders to pay damages, fines, or restitution. The specific statutes that define these criminal offenses outline the potential penalties involved.

Is Healthcare Fraud a State or Federal Offense?

Healthcare fraud can be tried as either a state or federal offense, depending on the specific crime committed, which statutes were violated, or the program that was targeted. When federal programs are targeted, such as Medicare or VA benefits, the case is a federal matter. If a state program is targeted, such as state Medicaid or private insurance, the case would be tried at the state level. In some instances, state and federal charges could overlap due to shared funding.

Contact The Kirlew Law Firm, PLLC

Oftentimes, healthcare paperwork is reviewed by computer programs or office workers with little or no medical experience. Simple mistakes can be flagged as possible fraud by individuals who do not fully understand the information they are reviewing. When facing healthcare fraud allegations, you need a Fort Lauderdale healthcare fraud attorney to help explain errors or oversights. Contact The Kirlew Law Firm today to schedule your initial consultation.