As a Florida physician or other health care provider, you hold a position of trust and responsibility. At the same time, the practice of medicine is governed by complex laws and procedures that can cause even the most conscientious health care provider to become entangled in allegations of fraud.
Numerous state and federal agencies actively investigate and prosecute doctors and other healthcare professionals suspected of committing health care fraud. If you are a health care professional, the mere allegation that you are involved in health care fraud can threaten your reputation and your livelihood. A conviction could lead to the loss of your medical license, exclusion from federal health care programs, hefty fines, and even a lengthy period of incarceration. Simply being charged with healthcare fraud – not convicted – can result in being unable to practice due to an AHCA disqualification.
With so much at stake, it is never too early to consult with an experienced Orlando health care fraud defense attorney. If you are the target of an investigation, if you have reason to believe you were inadvertently involved in a fraud scheme, or if you have already been charged with health care fraud, it is in your best interest to contact defense attorney Jonathan Rose as soon as possible. As a former prosecuting attorney himself, Jonathon Rose has a unique perspective on criminal investigations and prosecutions that give him an advantage when advising and defending Florida doctors and other health care professionals caught up in health care fraud investigations and prosecutions.
For the help you need to protect your rights and your future, call Jonathan Rose today at 407-894-4555 or submit the “Tell Us What Happened” form on our website.
What Is Health Care Fraud in Florida?
Allegations of health care fraud are typically investigated by federal law enforcement agencies, often with assistance from local and state law enforcement agencies in Florida. Pursuant to 18 U.S. Code §1347, health care fraud is defined as:
Knowingly and willfully executing, or attempting to execute, a scheme or artifice in connection with the delivery of or payment for health care benefits, items, or services to:
- Defraud any health care benefit program OR
- Obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of any health care benefit program.
A charge of health care fraud can have serious consequences for your career and your future. A conviction could subject you to a term of imprisonment of up to 10 years in prison and/or a fine of up to $250,000 for an individual or $500,000 for an organization. Moreover, you could face disciplinary action, up to and including the revocation of your medical license, even if you ultimately manage to avoid being convicted of a crime.
Having an experienced, knowledgeable health care attorney on your side can assure the best outcome for you and your family.
Attorney Jonathan Rose is an experienced defense attorney with expertise in health care defense. He has defended many doctors and other health care professionals in Florida against criminal charges, administrative complaints, and license suspensions. Call us today at 407-894-4555 or submit the “Tell Us What Happened” form on this website today to get started on your case.
What Are Some Common Examples of Health Care Fraud in Orlando, Florida, and throughout the U.S?
In the United States, the health care system is closely tied to both private and government insurance payment systems. This inseparable partnership between providers and payors creates numerous opportunities for health care fraud to occur, including:
- Kickbacks: Incentives received for patient referrals are generally not allowed by health care professionals and are heavily regulated by the Federal Anti-Kickback Statute.
- False Statements: Making a false or fraudulent statement in connection with the delivery of a payment for federal healthcare benefits, items, or services is a serious offense and can be charged in many different scenarios. The sentences for this offense can be significantly more than other healthcare related offenses, including kickback offenses. 18 U.S.C. § 1035. [link]
- Upcoding: Health care professionals must “code” all procedures, products, and visits when submitting reimbursement documents to insurance companies. If the code provided exceeds the complexity or cost of what the patient actually received, it may be considered “upcoding.” The inherently complex nature of medical coding makes it easy to unintentionally “upcode.”
- Double Billing: As the name implies, double billing involves submitting multiple identical claims for the same procedure, product, or service.
- Phantom Billing: This prevalent form of health care fraud occurs when a provider submits a bill for service visits or medical treatments that a patient did not receive.
- Unbundling: Submitting separate bills for medical procedures, services, or tests instead of using a single code is referred to as “unbundling” and is typically done to maximize reimbursement from insurance companies.
- Providing Unnecessary Services: It is illegal for a health care provider to falsify treatment plans or provide medically unnecessary procedures to increase the reimbursement amount from an insurance company.
If you are being investigated or have already been charged with health care fraud, Jonathan Rose will intervene on your behalf and fight to protect your career and your freedom. He knows the strategies used to investigate and prosecute doctors and other health care providers for fraud and can mount a powerful defense. Call 407-894-4555 or submit the “Tell Us What Happened” form on this website today to get started on your case.
What Are the Penalties for Health Care Fraud in Florida?
Like most people, you may think of health care fraud as a “white collar crime,” a term used to refer to non-violent, financially motivated criminal offenses. What you may not realize are the numerous and varied ways in which you might be held liable for health care fraud at both the state and federal levels.
At the federal level, a conviction under 18 U.S. Code § 1347 is punishable by a term of imprisonment of up to 10 years in prison and/or a fine of up to $250,000 for an individual or $500,000 for an organization. If serious injury to a person occurs, the potential prison term increases to 20 years.
In addition, the federal Civil False Claims Act makes it illegal to submit claims for payment to Medicare or Medicaid that you know or should know are fraudulent. Each instance of an item or a service billed to Medicare or Medicaid counts as a claim, and each claim found to be fraudulent can result in a fine of up to three times the federal program’s loss plus an additional fine of $5,000 -10,000 per claim.
Under Florida state law, a health care provider may be charged with a third-degree felony if the provider “with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost or repair of damaged property in support of a claim under an insurance policy knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete, or misleading information concerning any fact or thing material to the claim.” If convicted, you face up to five years in prison and a fine for each count of insurance fraud.
Finally, those who work in the health care industry, including doctors, nurses, dentists, and other health care professionals, face significant extra-judicial ramifications if they are charged, much less convicted, of health care fraud. Specifically, allegations of health care fraud will likely be reviewed by the Florida Board of Medicine (or other appropriate licensing board), which could lead to disciplinary action against your license up to, and including, revocation of your privileges to practice in the health care industry in the State of Florida.
Attorney Jonathan Rose has experience in all aspects of health care defense and will put his experience, skill and commitment to fight for the rights of health care professionals to work protecting your Florida medical license, your career, and your future.
Contact Experienced Orlando Health Care Fraud Attorney Jonathan Rose for the Help You Need
If you have reason to believe you are under investigation for health care fraud in Florida, or you have already been formally charged with health care fraud, it is crucial to your future that you get help from an experienced health care fraud defense attorney as soon as possible. The laws and procedures relating to health care fraud are extremely complex, making it all too easy for innocent doctors and others in the industry to become involved in a criminal prosecution. The sooner you get an attorney on your side, the better your odds are of stopping an ongoing investigation from catching you in its net or from being convicted if the case moves on to prosecution.
Florida health care fraud attorney Jonathan Rose’s previous experience as a prosecuting attorney gives him a unique perspective and skill that he now puts to use defending clients accused of health care fraud. If you are being accused of health care fraud in Florida, you need the experience, skills, and commitment that attorney Jonathan Rose brings to every case.
If you believe you are under investigation for or have already been charged with, health care fraud, do not hesitate to contact Orlando health care fraud defense attorney Jonathan Rose today by calling 407-894-4555 or submitting the “Tell Us What Happened” form on our website.