What Are the Penalties for Medicare Fraud in Florida?
Find Out (For Yourself) Why Florida Health Care Providers Want Oberheiden, P.C. on Their Team: (214) 692-2171
Florida doctors and business owners are notorious targets of Medicare fraud audits and investigations. Each year, in Florida and in particular Miami, hundreds of respected cardiologists, cardiovascular surgeons, and business owners are declared outliers, fraud suspects, and potential defendants by overzealous auditors and prosecutors. Things have gone so out of control that you may be a Medicare fraud suspect simply because your practice is more successful than others.
When this happens to you, know that the attorneys of Oberheiden, P.C. are available to offer you the experience of hundreds of Medicare cases resolved for their clients. Just like you would probably not expect a dentist to treat a heart attack or a podiatrist to conduct spine surgery, you should also know that Medicare Fraud Defense is too complex, too consequential to have inexperienced attorneys experiment with your life and freedom.
Oberheiden, P.C. Defends Florida Medicare Providers
Oberheiden, P.C. has demolished Medicare fraud allegations throughout Florida and in over 40 states nationwide in trials, in audits, and in government investigations. Because of our focus on defending doctors and health care business owners (rather than doing drunk driving cases), we understand both health care regulations as well as what it takes to negotiate or argue a criminal defense case. Our team members include:
- Former DOJ Officials and S. Senate Confirmed Attorneys
- Respected Defense and Trial Counsel
- No Junior Lawyers
When you are worried about your license and your reputation, you should leave those worries to the trusted and proven attorneys at Oberheiden, P.C. Just like your patients trust you and you. We have successfully represented:
- Mobile Ambulance Transportation Cases
- Mobile Radiology Services
- Home Health Care Agency (Form 485 Cases)
- Hospice Care Representation
- Illegal Kickbacks
- Any Form of Medicare Fraudulent Billing
- Mental Health Care Providers
- Dialysis Centers
- Family Medicine Doctors
- Internal Medicine Specialists
- Pain Management Doctors
- Medicare Clinic Owners
What Are the Penalties for Civil Medicare Fraud in Florida?
Federal prosecutors in Florida often prosecute Medicare violations which occurred unintentional as a federal civil case. In civil Medicare investigations the government claims that a Medicare provider submitted false claims to CMS, violated Stark Law or the Anti-Kickback Statute. Many of these allegations stem from a whistleblower complaint filed under the federal False Claims Act.
If found liable, a Medicare business can face draconian penalties beginning at more than $ 10,000 per violation (e.g. per submitted claim). Because the Civil Monetary Penalty Law and the False Claims Act can quickly take a business out of business, attorneys with a proven defense record in Medicare Fraud cases should be considered for skilled representation.
If your business received a subpoena from the U.S. Attorney’s Office or the Department of Health and Human Services informing you about possible civil health care violations, call Oberheiden PC right away. Oberheiden PC lawyers have successfully defended clients against civil fraud allegations in almost the entire United States, an experience hard to find elsewhere. Call us at (214) 692-2171 and see how we would protect your business and your monies.
What Does the Government Have to Prove in a Florida Medicare Fraud Case?
Under 18 U.S.C. 1347, the government must prove the existence of all of the following elements beyond a reasonable doubt.
- The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a health care benefit program or obtain money or property from a health care benefit program by means of false or fraudulent pretenses, representations, or promises;
- The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the health care benefit program; and
- The defendant acted with the intent to defraud the health care benefit program.
What Are the Penalties for Criminal Medicare Fraud in Florida?
Penalty calculation in Florida Medicare Fraud cases are complex and depend on many factors. If you have questions or need guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Call us at (214) 692-2171.
A defendant convicted of Medicare fraud in Florida must expect severe penalties. These penalties include up to 10 years imprisonment per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment. The exact penalty depends on the amount that the government can prove in damages to CMS/Medicare. Ultimately, the Federal Sentencing Guidelines will recommend a sentence to the presiding judge, who is free to follow the recommendation or to deviate from it. Here are a couple of recent Medicare Fraud examples from Florida federal courts.
- An owner of multiple Florida home health agencies pleaded guilty to his role in a $66 million Medicare fraud scheme. According to the plea agreement, the owner of the home health agencies would pay individuals to act as recruiters to find patients to refer to his multiple home health agencies. Once the patients were referred to the agencies, the owner would bill Medicare for home health services that were not medically necessary or that were never provided. The owner of the home health agencies pleaded guilty to one count of health care fraud and one count of wire fraud. The owner was sentenced to 20 years in prison for his role in the offense.
- An owner of a pain management clinic in Miami pleaded guilty to his role in a Medicare fraud scheme. The owner ran a described “pill mill” that would sell opioids for cash and also prescribe medically unnecessary drugs to patients and then subsequently bill the prescriptions to Medicare for reimbursement. According to the plea agreement, the owner of the clinic is responsible for 7,500 fraudulent prescriptions. The owner would also advise the doctors working at the clinic to falsify medical records of patients that would support the need for prescription opioids. The owner pleaded guilty to one count to conspiracy to distribute controlled substances.
- A Miami man pleaded guilty for his role in a Medicare fraud scheme that involved illegal referrals and kickbacks. The man worked for the state court system in Miami and conspired with elderly defendants in the court system to obtain their mental health evaluations in order to refer them to a behavioral health center in Miami. The man received cash payments for his referrals of defendants to the behavioral health center. The plea agreement further showed that the man knew several of the defendants were not mentally ill or did not qualify for mental health services to be reimbursed by Medicare. The man was sentenced in the Southern District of Florida to 60 months in prison for his role in the offense.
- A Miami man has pleaded guilty for his role in a $10 million Medicare fraud scheme. According to the plea agreement, the man owned a home health agency and submitted to Medicare for reimbursement hundreds of fraudulent claims for services that were not medically necessary or services that were not performed. The plea agreement further showed that the Miami man would falsify patient records in order to make certain patients eligible for home health services that they otherwise would not be entitled to. As a result of this scheme, the man was sentenced to 97 months in prison.
- A South Florida pharmacist was found guilty by a federal jury for his role in a scheme to defraud Medicare. According to evidence presented at trial, the pharmacist submitted reimbursement requests to Medicare hundreds of prescriptions for compounded drugs that were either not medically necessary or were not provided. The pharmacist ran a telemedicine company that established no real patient/prescriber relationship and the pharmacist only tool the patient information in order to bill Medicare. As a result of the scheme, Medicare paid out $5 million for the fraudulent claims.