Healthcare Fraud

A 2010 report by the National Health Care Anti-Fraud Association estimates healthcare fraud causes between $70 and $234 billion in financial losses annually. This measures between 3 and 10 percent of the national expenditure on health care.

If you’ve been charged with healthcare fraud, you need a fighter on your side. Penalties for healthcare fraud can be harsh. You could be sentenced to a lengthy term of imprisonment and fined thousands of dollars. Mounting a strong defense is crucial. 

Defense Attorney for Healthcare Fraud in Palm Beach County

The attorneys at Meltzer & Bell, P.A. have extensive experience defending clients accused of fraud and other white-collar crimes. We offer personalized attention to your case to achieve the best possible result. We aim to reduce or dismiss your charges whenever possible. Contact us for a free consultation.

Call (561) 557-8686 or fill out our online form. You can reach us 24 hours a day, seven days a week. One of our accomplished attorneys will review your case details and recommend how to proceed. We represent clients in West Palm Beach, Belle Glade, Delray Beach, and many other Palm Beach County communities.


Overview of Healthcare Fraud in West Palm Beach, Florida


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What is Healthcare Fraud?

Fraud involves intentionally misrepresenting information or deceiving others to illegally receive a benefit. Most people who commit healthcare fraud have one goal: to obtain money they are not entitled to. Some of the more prevalent healthcare fraud schemes target the Medicare and Medicaid programs. Common scams include:

  • Accepting kickbacks for patient referrals;
  • Billing for services or items that were never provided to the patient; and
  • Billing for services that were not medically necessary. 

Fraud affects both the private and public sectors of the healthcare industry. Both patients and healthcare providers are able to commit healthcare fraud. If you commit healthcare fraud, you could be charged under Florida state law or federal law. 


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State Charges for Healthcare Fraud in Florida

Florida Statute 817.50 makes it illegal to fraudulently obtain goods and services from a healthcare provider. This law is charged as a second-degree misdemeanor. Maximum penalties include a $500 fine and two months in jail. This is one of the lesser healthcare fraud charges; however, the stakes increase drastically when you commit fraud against the government.

Medicaid is a federal program, but it is executed and managed locally within each state. Each state’s Medicaid Fraud Control Unit handles oversight of Medicaid fraud and abuse. Two of Florida’s more frequently violated state Medicaid laws cover Medicaid fraud (Florida Statute 409.9201) and Medicaid provider fraud (Florida Statute 409.920).

Medicaid fraud

Florida’s Medicaid fraud statute deals with the illegal purchase and sale of Medicaid-funded prescription drugs and any other false or fraudulent claims submitted to Medicaid. Violations of this law are charged as a felony. Violators face the following maximum penalties according to the dollar value of fraud committed:

  • Under $20,000: felony of the third degree; $5,000 fine and five-year prison sentence;
  • $20,000 to $99,999: felony of the second degree; $10,000 fine and 15-year prison sentence; and
  • $100,000 or more: felony of the first degree; $10,000 fine and 30-year prison sentence.

Medicaid Provider Fraud

Florida’s Medicaid provider fraud statute encompasses a broader scope of fraudulent activity. Some examples of illegal activity under this statute include:

  • Providing higher-than-normal provider fees on quotes;
  • Accepting or paying kickbacks; and
  • Misusing another person’s Medicaid number to submit a false or fraudulent claim to Medicaid.

The penalties for Medicaid provider fraud closely reflect those prescribed for Florida’s Medicaid fraud law. The main difference is the threshold for the different felony degrees is lower. Providers convicted of defrauding Medicaid face the following maximum penalties based on the cumulative fraudulent amount billed to Medicaid:

  • $10,000 or less: third-degree felony; $5,000 fine and five years in prison;
  • $10,001 to $49,999: second-degree felony; 15 years in prison and $10,000 fine; and
  • $50,000 or more: first-degree felony; 30 years in prison and $10,000 fine.

An experienced criminal defense attorney can explain Florida’s healthcare fraud laws in more detail.


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Federal Charges and Penalties for Healthcare Fraud in Palm Beach County

Other types of healthcare fraud fall under the jurisdiction of the U.S. government. Most federal healthcare prosecution involves Medicare fraud. Among the more frequently abused federal anti-fraud statutes are: 

  • Stark Law;
  • Anti-Kickback Statute (AKS); and
  • False Claims Act.

“Stark Law” refers to a group of laws defined by 42 U.S.C. 1395nn governing the illegal practice of physician self-referral (sending patients to other medical service providers in which the referring physician has a vested financial interest). Violators of Stark Law face a civil monetary penalty of $15,000 per violation. Penalties increase almost sevenfold for each attempt to knowingly circumvent this law.

The Anti-Kickback Statute is defined by 42 U.S.C. 1320a-7b(b). This law makes it illegal for health care service providers to offer or accept bribes in exchange for preferential treatment. The potential criminal penalties for violating this law include a maximum fine of $25,000 and up to five years in prison. Additional civil penalties include a punitive fine of up to $50,000 as well as a per-violation fine totaling triple the amount of the kickback.

The False Claims Act found at 31 U.S.C. 3729 more broadly outlaws the submission of false or fraudulent claims to the federal government and its employees. False Medicare and Medicaid claims fall within this scope. Penalties are usually civil, but more extreme violations can be prosecuted criminally as well. Each violation carries a fine between $5,500 and $11,000. A criminal conviction under this statute carries up to five years in prison and a maximum fine of $250,000.


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Additional Resources

What Does Health Care Fraud Look Like? | NHCAA – The National Health Care Anti-Fraud Association is a private-public organization made up of private health insurers as well as law enforcement officials and regulators. Visit this page to view a list of the most common types of health care fraud.

National Health Care Fraud Takedown | US DOJ – The United States Department of Justice published this press release on a nationwide health care fraud enforcement effort in June 2018. Hundreds of millions of dollars in fraudulent billings were uncovered across the state of Florida. Visit this page to read about the large scale of this enforcement action as well as the results. 

Medicaid provider fraud | Florida Statute 409.920 – Florida’s Online Sunshine website, the official website of the Florida Legislature, hosts an electronic copy of the Florida Statutes. Visit this link to read the full text of Florida’s law concerning Medicaid fraud committed by providers. Here you can find a thorough description of illegal Medicaid activities and the associated punishments prescribed by state law.


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Defense Lawyer for Healthcare Fraud in West Palm Beach

Healthcare fraud is a serious problem in the United States, and prosecutors treat it as such. Whatever the specific charge you face, it’s a bad idea to defend yourself in court. The highly trained legal team at Meltzer & Bell, P.A. can help you achieve the best possible outcome. We offer a free initial consultation. 

Call (561) 557-8686 or submit a form online to get started. One of our attorneys will go over your case with you and discuss your options. You can reach us 24 hours a day, seven days a week. Meltzer & Bell, P.A. represents Palm Beach County clients in Lantana, Riviera Beach, Wellington, and other communities across South Florida.


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