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.
"At our meeting, you answered my questions and gave me hope in what was still an uncertain situation. Many thanks to you and your staff for the kindness and compassion that was shown to me. I had indeed called on the right defense attorney."
"He kept me informed, kept it real, and most importantly cared. He was always available by cell or at the office. When I was in jail he came to visit at least once every ten days. At first I thought he was too good to be true but in talking to some of his other clients he is the real deal."
"Michael Salnick is a force to reckon with in the courtroom. He has the respect of Judges, State Attorneys and police. I don't believe there is another I would trust. If you value your life and freedom do not hesitate to employ Michael and his team to represent you."