In today’s inflated health insurance market, many individuals struggle to pay for medical expenses and prescriptions. Health care fraud may be committed by patients, health care professionals, or anyone else who violates federal health care laws. In the state of Florida, an upswing in instances of health care fraud has been noted over the last decade. In fact, the entire country has seen a significant number of health care-related fraud cases in the last decade. Government agencies have been cracking down and handing out federal penalties to individuals nationwide. Health care fraud allegations may lead to dozens of different charges, not to mention severe penalties, months of hassle and asset loss. Because it’s often tried as a federal offense, penalties are more strict than they would be at the state level. If you have been charged with health care fraud or believe that a government agency may raise related allegations against you, contacting an experienced Tampa health care fraud defense lawyer may be vital to protecting your rights and freedoms.

At Joffe Law, P.A., we have been defending the rights and liberties of clients for years. Our attorneys have decades of experience handling federal cases involving fraud and have successfully defended clients at both state and federal levels. With our knowledgeable and highly skilled legal team in your corner, you are more likely to minimize or eliminate charges of health care fraud. If you have been charged with health care fraud, you may be wondering what your next move should be. Understanding how health care fraud is defined, what acts are most commonly prosecuted, what the possible penalties of convictions may be, and if there are any possible defenses available, can be helpful.

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How is health care fraud defined?

Health care fraud is a type of insurance fraud that involves making fraudulent claims either mistakenly or intentionally to a government health care agency. Claims that lead to financial gain may be successfully prosecuted by government agencies at a federal level. Health care professionals who use agencies like Medicaid, Medicare, and Tricare, may be accused of committing health care fraud if they make a mistake in their billing process. Patients who have given false information to a government health care agency are also eligible for health care fraud prosecution. The prosecution process for health care fraud crimes may be carried out at a state level, federal level, or both. This means that counts of a single crime may be doubled and penalties can add up quickly. Essentially, health care fraud is a broad term that can cover any number of health care-related offenses. Offenses that involve government agencies should never be taken lightly.

What are the most common types?

There are a few health care fraud crimes that are carried out commonly in the state of Florida and in the United States in general.

  • Information fraud: One of the most common forms of health care fraud, information-related health care fraud is, in many cases, unintentional. With this crime, an individual or health care professional may either intentionally or accidentally enter incorrect information on a health care form or over the phone to a government health care worker. An example of information-related health care fraud would be if a person entered the wrong annual income amounts on a Medicaid application form. If they then received Medicaid services based on the numbers that they entered, they technically could be charged with a crime. While many individuals are never investigated, due to an increase of intentional Medicaid fraud crimes, if they are investigated, they may face serious penalties.
  • Medical device fraud: When medical devices are marketed for non-FDA approved purchases or when a knowingly defective device is sold, the individuals responsible may be charged with medical device health care fraud. Additionally, if device manufacturers are found to be paying kickbacks to doctors for promoting certain devices, fraud allegations may also be raised.
  • Coding fraud: Upcoding bills, unbundling services, and coding for a diagnosis that isn’t confirmed are all crimes that fall under coding fraud laws.
  • Home health care fraud: Medicaid and other agencies may provide medical services to patients who require in-home care. If home health care services bill the government for home health care services given to patients are ineligible, they may be charged with fraud. Additionally, they may also be charged if they are found to be manipulating assessment forms to give illusions of serious diagnoses or if they pay or receive illegal kickbacks for a number of patient referrals.
  • Hospital fraud: If a hospital decides to perform services that are not medically necessary in order to bill insurance providers, chooses to unnecessarily admit patients for profit, or bills health insurers for unnecessary services, all of the hospital personnel who have been involved may be charged with health care fraud.

Other prevalent forms of health care fraud include:

  • Stark Act fraud
  • Anti-Kickback Act fraud
  • Medically Unnecessary services like lab work

How is this crime penalized?

Health care fraud is taken very seriously by most government agencies, especially Medicaid. Under the following codes, penalties are assigned to different criminal acts.

  • 42 U.S. Code Section 1320a-7a: $10,000 in fines for each instance of an innacurate claim.
  • 42 U.S. Code Section 1320a-7B: five years imprisonment for each of any number of false statements.
  • 18 U.S.C. Section 1347: ten years in prison for willfully participating in any scheme to defraud a health insurer.
  • 18 U.S.C. Section 1035: five years in prison for any individual making false statements connected with delivering health care services or health care benefits.

Are there any defenses?

There are many defenses and mitigation strategies that may be applied in a case involving health care fraud. Only an experienced federal and state white collar defense attorney will be able to accurately explain what the possible defenses and mitigation strategies for your case might be. This is due to the fact that every health care fraud case is unique and will require a customized defensive strategy. Contact an experienced Tampa health care fraud attorney immediately after being charged.

Joffe Law, P.A. is there when you need us most

If you’ve been charged with health care fraud or related federal charges Tampa or Hillsborough County, contacting a lawyer specializing in criminal defense cases is a critical first step. At Joffe Law, P.A., we have an understanding and experienced legal team that can take your case on today. Our professionals can give your unique case the time and care that it requires for the best possible outcome in court.