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Medicare/Medicaid Fraud

Medicaid and Medicare are national health insurance programs for qualifying individual. Both programs help people who have a difficult time paying for medical costs. In 2016, the Congressional Budget Office estimated that $365 billion was spent on Medicaid and Medicare services. 

Medicaid and Medicare fraud can be committed in a variety of ways. People commit Medicare or Medicaid fraud by making false claims, charging others for services, or making false statements about your income and expenses. Doctors can also be guilty of Medicaid or Medicare fraud. Professional medical personnel are guilty of fraud if they accept bribes, refer patients for compensation or charge others for services covered under Medicare or Medicaid.

There is a lot of money funneling through Medicare and Medicaid programs. Committing fraudulent schemes for a personal benefit can be tempting. However, Medicaid or Medicare fraud isn’t something to take lightly. You could be criminally charged on both the state and federal level. 

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. 

Attorney for Medicare Fraud in Pinellas County, Florida

The U.S Department is always on high alert for people committing fraud. They even accept tips of fraud from American citizens through the U.S. Department of Health and Services. 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 attorney at Morris Law Firm, P.A.. At Morris Law Firm, P.A., we provide excellent legal service 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 (727) 388-4736. We represent people accused of white collar crimes throughout the greater Pinellas County area including Bradenton, Clearwater, St. Petersburg and Dunedin.

Overview of Medicare/Medicaid Fraud


Medicaid and Medicare Laws in Florida

Florida is unique because it has its own set of laws concerning Medicaid and Medicare fraud. Florida Statute § 409.920(2) states you cannot:

  • 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;
  • Charge, solicit, or accept anything of value for a Medicaid or Medicare service;
  • 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;
  • Solicit, accept a bribe, or receive compensation for referring a person to a healthcare physician or healthcare facility;
  • Solicit, accept a bribe, or receive compensation for obtaining any goods or services that are a part of the Medicaid program;
  • Submit misleading information so you are accepted as a Medicaid provider; or
  • 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. 

Penalties for Medicaid or Medicare Fraud in Florida

Florida penalties for Medicaid or Medicare fraud depend on the value of the benefits you used. The following chart lists out the penalties for committing Medicaid or Medicare fraud. 

Amount Spent

Offense Level

Fine

Prison 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

 


Federal Laws for Medicaid or Medicare Fraud

The United States has several statutes that addressing Medicaid or Medicare fraud. One of them is found in Title 18 § 287 of the United States Code, also known as the False Claims Act. The Act states you cannot make a false, fictitious or fraudulent claim to any government department or agency. So, making a false claim while applying or reapplying for Medicare or Medicaid may result in a $25,000 fine and a prison sentence of up to five years. 

The U.S. Code 18 § 1001, or False Statements Act, states healthcare providers are not allowed to make any false or fraudulent statements to a government agency. So, a physician cannot lie to receive a certain Medicaid or Medicare goods and services. Violation of the False Statements Act may result in five years in prison and a fine determined by the court.

It’s important to know a person can face multiple charges under the False Statements Act. With every false statement, there can be a new charge. This means offenders could be burdened with ridiculous fines and an extremely long incarceration if they face multiple counts. 

It’s also illegal for health physicians to accept bribes or compensation for Medicaid or Medicare services. The Anti-Kickback Statute can be found in U.S. Code 42 § 1320(7b). A physician cannot solicit or receive remuneration for:

  • 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.

In addition to this, 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.

Violating the Anti-Kickback Statue may result in a $25,000 fine and a prison sentence of up to five years. 

Physicians are not allowed to accept money offers or be compensated for referring a patient. This is often called the Stark Laws and can be found in U.S. Code Title 42 § 1395nn. People who violate the Stark laws may face civil sanctions. Health care professionals that accept remuneration for a service or referral could face a fine of up to $15,000. 

Some physicians or entities will devise up a cross-referral arrangement. This involves physicians making referrals to a particular entity for a financial reason. Doctors who are a part of cross-referral arrangements may face a civil sanction up to $100,000. 


Additional Resources

Florida Medicaid Fraud Laws – Visit the official website for the Florida Senate to find more information about Medicaid fraud. Access the statues to learn the different ways a person can commit fraud, the penalties, 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. Access the documents to see Medicaid fraud statistics, civil settlements and judgements, and see comparisons of reports from 2013-2016.


Lawyer for Medicaid or Medicare Fraud in St. Petersburg, Florida

If you or someone you know has been charged with healthcare fraud, it’s imperative you contact an experienced attorney. A conviction could mean large fines and possibly prison time. Don’t back down without a fight. Call the attorneys at Morris Law Firm, P.A. now for a strong defense.

Morris Law Firm, P.A. excels at representing people with fraud allegations. We will use all our resources to uncover all your possible legal options. Don’t speak another word to authorities and call (727) 388-4736 for a free consultation. 

We practice law at the Pinellas County Center of Justice and surrounding areas including Oldsmar, Tarpon Springs, Tampa and Pinellas Park.


This article was last updated on December 31, 2018.