Meltzer and Bell, PA remains committed to the people of South Florida during this very difficult time. Please know that we are open and will remain so 24 hours a day, seven days a week to those in our community who need our help.

Medicaid or Medicare Fraud

Medicaid and Medicare are national health insurance programs you can apply to for assistance with physician and hospital payments. The U.S. spends billions of tax dollars to maintain the program every year and unfortunately that does make the market rife for fraud. It was found that in 2015 $365 billion was spent on both programs to maintain their services.

Medicaid and Medicare fraud can be committed in various ways. It’s often committed by making false claims, charging others for their Medicaid or Medicare services as well as making false statements to receive benefits. Healthcare professionals and physicians can also be guilty of the crime if they accept bribes, refer patients for compensation or charge others for services that would be covered under Medicaid or Medicare.

If you or someone you know has been charged with Medicare or Medicaid fraud, it’s vital that you contact an experienced criminal defense attorney.

Medicare Fraud Defense Attorney in Broward County, Fl

The U.S Department is always on high alert for people committing fraud and works with several departments including the Federal Investigations Bureau (FBI) to identify offenders. They even accept tips of fraud from American citizens through the U.S. Department of Health and Services online or over the phone. In 2017, there were 1,528 convictions related to Medicaid or Medicare fraud according to the Office of Inspector General.

If you’ve been charged with Medicaid or Medicare fraud, it’s crucial you get in contact with an economic crimes defense attorney at Meltzer & Bell. At Meltzer & Bell, we provide excellent and effective defenses for our clients. We will answer your questions, inform you on the legal process, and uncover all your legal options.

Call today to schedule a free consultation at (754) 755-8554. We accept clients throughout the greater Broward County area including Fort Lauderdale, Hollywood and Pompano Beach.

Overview of Medicaid or Medicare Fraud in FL


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Medicaid or Medicare Laws in Florida

The state of Florida is unique as it has its own laws regarding Medicaid or Medicare fraud. It’s important to understand that this means you can be charged on either a federal or state level depending on the facts of your case. The Florida Statutes Section 409.920(2) states a person is guilty of Medicaid or Medicare fraud if they do the following:

  • Fail to credit the agency for any payment you received from a third-party source;
  • Make false statements about documents involving your income and expenses;
  • Make any false statements or omit any statements in any Medicaid or Medicare claim;
  • Make false claims for goods or services that weren’t authorized by the program;
  • Submit misleading information so you are accepted as a Medicaid provider;
  • Use a Medicaid’s provider or recipient’s identification number to make a claim for goods or services that not authorized to be reimbursed by the program
  • Charge, solicit, or accept anything of value for a Medicaid or Medicare service; or
  • Solicit, accept a bribe, or receive compensation for referring a person to a healthcare physician or healthcare facility

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Penalties for Committing Medicaid or Medicare Fraud in FL

Amount SpentOffense LevelFinePrison Term
 

$10,000 or less

 

Third-Degree Felony

 

$5,000

5 Years in Prison

 

More than $10,000, but less than $50,000

 

Second-Degree Felony

 

$10,000

15 Years in Prison

 

More than $50,000

 

First-Degree Felony

 

$10,000

30 Years in Prison


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Federal Penalties for Medicaid and Medicare Fraud

The U.S. Code addresses Medicaid or Medicare fraud in Title 18 Section 287, also known as the False Claims Act. The Act states it’s illegal to make a false or fraudulent claim to any government agency or department. This would make filing any false claim or while reapplying to Medicaid with false facts a serious crime that could result in the following:

  • Up to 5 years in prison; and
  • A fine of up to $25,000

Additionally, the False Statements Act establishes that healthcare providers aren’t allowed to make false or fraudulent statements to a government agency. Essentially, healthcare professionals such as doctors or nurses cannot lie to a patient regarding their Medicaid or Medicare services. For instance, an doctor cannot tell a patient they must pay for a procedure while knowing that the treatment is covered by their Medicaid or Medicare program.

A person can face multiple charges for violating the False Statement Acts. Every new false statement is considered a separate charge. In the end, many offenders charged Medicaid or Medicare fraud will face multiple counts for one claim or instance.

The Anti-Kickback Statute found under U.S. Code Title 42 Section 1320(7b) establishes physicians cannot receive bribes or compensation for doing the following:

  • Referring a person to another health care physician or facility; OR
  • Purchasing, leasing or ordering any goods or service that’s under Medicaid or Medicare.

Additionally, a physician cannot compensate another person for:

  • Referring another person to a health care physician or facility; OR
  • Purchasing, leasing or ordering any good or services under Medicaid or Medicare.

Violation of the Anti-Kickback Statutes will result in a $25,000 fine and a prison sentence of up to 5 years.

Physicians that accept money offers or are compensated for referring a patient is also illegal. This is known as the Stark Laws, which are found under the U.S. Code Title 42 Section 1395nn. Violating these laws will result in civil sanctions, which includes a fine of up to $15,000.


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Additional Resources

Florida Medicaid Fraud Laws – Visit the official website for the Florida Senate to find more information about Medicaid fraud and it’s penalties. Access the statues to learn the different methods a person can commit fraud, the penalties for different types, and the Attorney General’s process for conducting statewide Medicaid fraud control.

Medicaid Fraud Control Units – Visit an official Medicaid Fraud Control Unit report by the Office of Inspector General and learn more about their unit dedicated to fighting those taking advantage of the Medicaid system. Access the documents to see Medicaid fraud statistics, civil settlements, and see comparisons of fraud reports from 2013-2016.


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Defense Lawyer for Medicaid or Medicare Fraud in Fort Lauderdale, FL

If you or someone you know has been charged with healthcare fraud, it’s within your best interest that you contact an experienced attorney. A conviction could mean large fines and possibly prison time for years. Don’t back down without a fight and gain effective legal representation as soon as possible. Call the attorneys at Meltzer & Bell now for a strong defense.

Meltzer & Bell has over 20 years of collective experience we will utilize for your case. You can reach us at (754) 755-8554 to set up your first consultation free. Meltzer & Bell accepts clients throughout the greater Broward County area including Pompano Beach, Hollywood and Coral Springs.


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