Healthcare fraud crimes are vigorously prosecuted in Florida. Insurance and healthcare billing can be complex and any attempt to defraud the system carries severe consequences.
Intentionally submitting a false claim or making a false representation to receive a federal payment is a crime. The law leaves room for billing errors and mistakes. However, a knowing, willful plan to defraud a healthcare benefit program like Medicaid can lead to criminal charges for healthcare fraud.
The most common defense to healthcare fraud is disproving intent. For an act to constitute healthcare fraud, a person must knowingly submit a false claim or make a false representation for the purpose of receiving an unwarranted federal payment. So, if the alleged fraud is a mistake or other unintentional error, this would be a defense.
The penalties for healthcare fraud are severe. A conviction can result in over a decade spent in federal prison. Doctors and medical professionals should contact an experienced healthcare fraud defense attorney when charged with this crime.
Medicaid fraud: This is one of the most commonly charged forms of healthcare fraud in Florida, involving billing for services that were not provided to the patient or that were not medically necessary. Medicaid fraud is not just illegal, but it is also harmful to Medicaid patients because it can interfere with patient care.
Overbilling: Billing for unnecessary services or services not actually performed is a crime. This includes billing a payer for a missed appointment, home health services, prescription drugs, and durable medical equipment expenses. Over-diagnosing - and thus providing unnecessary treatments - is another form of overbilling.
Upcoding: This entails billing for a more costly procedure than what was actually performed. This conduct can lead to criminal charges for healthcare fraud. All medical procedures and visits are billed using Current Procedural Terminology (CPT) codes, a standard billing language created by The American Medical Association (AMA). Therefore, codes should not vary between providers.
False invoices or double billing: False invoices involve invoicing a patient for an office visit or procedure that did not take place. Double billing entails charging a patient multiple times for the same office visit or procedure.
Other forms of healthcare fraud include inducing or paying others for referrals or wrongly referring patients. In fact, the Anti-Kickback Statute exists to deter this fraudulent act. Under this statute, it is illegal to offer or accept any inducement to a doctor, hospital, or other medical provider to use a product or receive referrals.