Health Care Fraud Attorney | Criminal Defense Lawyer

Miami Criminal Lawyer David J. Joffe

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What is Health Care Fraud?

stethescope Healthcare fraud is the intentional deception or misrepresentation of healthcare transactions by a provider, employer group, or member for the sake of receiving an unauthorized benefit or financial gain. Individuals convicted of this crime face imprisonment and substantial fines.

Health care fraud can be perpetrated by a provider, such as a doctor or therapist, an insured member, or an employer.

What was once regarded as simple billing errors are now routinely pursued as fraud and abuse. As efforts to detect and prosecute healthcare fraud have grown more aggressive, the need for experienced defense counsel has become critical. The difference between a simple billing error, a civil False Claims Act prosecution and criminal indictment often depend upon your attorney's advocacy and representation.

Examples of Provider Healthcare Fraud include:

Misrepresenting oneself as a licensed healthcare provider
Kickbacks in return for referring patients or influencing the provision of health care are other common schemes
Providing services by untrained personnel
Failing to supervise unlicensed personnel
Distributing non-approved devices or drugs

Fraudulent billing practices, such as

Billing for services, procedures and/or supplies that were not provided
Billing for non-covered services as if they were covered items
Deliberately billing for duplicate payment for services
Misrepresentations of dates, descriptions of services, or subscribers/providers
Providing false employer group and/or group membership information
Incorrect reporting of diagnoses or procedures to maximize insurance reimbursement
Performing and billing for medically unnecessary services in order to obtain insurance reimbursement
Unbundling - charging Medicare separately for services that are actually a part of a single procedure
Fraudulent cost reporting by institutional providers

Examples of Insured Member Health Care Fraud include:

Using someone else's coverage or Medicare insurance card to obtain healthcare
Filing claims for services or medications not received
Forging or altering bills or receipts
Doctor shopping -- going from one physician to another to obtain multiple prescriptions for an controlled substance

Examples of Employer Health Care Fraud include:

False portrayal of an employer group to secure healthcare coverage
Enrolling employees who are not eligible for healthcare coverage
Changing hire or termination dates to expand dates of coverage
Creating phony health insurance companies or employee benefit plans.

Filing False Medicaid and Medicare Claims is Fraudulent

Most civil healthcare fraud matters involve the False Claims Act (FCA), under which the federal government may bring civil enforcement actions and seek damages and penalties against providers who knew that false or fraudulent bills were submitted to Medicare, Medicaid, or other federal health programs.

In 1986, when Congress amended the FCA to address Medicaid and Medicare fraud the intention was for all providers to take responsibility for ensuring the accuracy of the bills they submit for reimbursement. The purpose of the law is to single out those providers who recklessly or with deliberate indifference allow fraudulent billing practices to occur or continue.

Overall, the FCA has powerful and far reaching effects. First, it has been the vehicle for recovering hundreds of millions of dollars of fraudulently obtained funds each year. Second, the statute encourages providers to take responsibility for the accuracy of their claims - because they may be liable under FCA if they are reckless or deliberately ignorant of wrongdoing by employees. Finally, the statute helps to deter providers from committing fraud, because of its damage and penalty provisions.

Joffe & Joffe, PA
Miami Criminal Attorney

MIAMI
305-579-0048
FORT LAUDERDALE
954-723-0007
PALM BEACH
561-659-1991
NAPLES
239-263-6161
TAMPA
813-250-3533

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Miami lawyer Joffe is an AV® Peer Review Rated criminal defense attorney who represents clients in federal and state criminal matters across the State of Florida.

What is Health Care Fraud?

Filing False Medicaid and Medicare Claims is Fraudulent

Miami lawyer Joffe is an AV® Peer Review Rated criminal defense attorney
who represents clients in federal and state criminal matters across the State of Florida.