What Are the Penalties for Medicare Fraud in Florida?

Find Out (For Yourself) Why Florida Healthcare Providers Want Oberheiden, P.C. on Their Team: 888-680-1745

Florida doctors and business owners are notorious targets of Medicare fraud audits and investigations. In Florida, particularly Miami, hundreds of respected doctors, surgeons, and business owners are declared outliers, fraud suspects, and potential defendants by ambitious auditors and prosecutors. 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 the experience of hundreds of Medicare cases resolved for their clients. Medicare fraud defense is very complex and too important to trust inexperienced attorneys with your life and freedom.

Oberheiden, P.C. Defends Florida Medicare Providers

Oberheiden, P.C. has overcome Medicare fraud allegations throughout Florida and in over 40 states nationwide. Because we focus on defending doctors and healthcare business owners, rather than drunk driving cases, we understand both healthcare regulations and what it takes to negotiate or argue a criminal defense case. Our team members include:

• Former DOJ Officials and U.S. Senate Confirmed Attorneys
• Respected Defense and Trial Counsel
• No Junior Lawyers

When you’re concerned about your license and reputation, you should leave those worries to the proven attorneys of Oberheiden, P.C. Just like your patients trust you. We have successfully represented:

• Mobile Ambulance Transportation Cases
• Mobile Radiology Services
• Home Healthcare Agency (Form 485 Cases)
• Hospice Care Representation
• Illegal Kickbacks
• Any Form of Medicare Fraudulent Billing
• Mental Healthcare Providers
• Cardiologists
• Urologists
• Dialysis Centers
• Dentists
• Family Medicine Doctors
• Internal Medicine Specialists
• Pain Management Doctors
• Psychologists
• Psychiatrists
• Medicare Clinic Owners
• Nurses

What Are the Penalties for Civil Medicare Fraud in Florida?

Prosecutors in Florida often charge unintentional Medicare violations as a federal civil case. In civil Medicare cases the government claims that a 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 severe 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 run a business into bankruptcy, attorneys with a winning defense record in Medicare fraud cases should be sought for counsel.

If your business receives a subpoena from the U.S. Attorney’s Office or the Department of Health and Human Services (HHS) informing you about possible civil healthcare violations, call Oberheiden, P.C. right away. Our lawyers have successfully defended clients against civil fraud allegations in most of the United States. Such experience is hard to find elsewhere. Call us at 888-680-1745 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 healthcare benefit program or obtain money or property from a healthcare 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 healthcare benefit program; and

• The defendant acted with the intent to defraud the healthcare benefit program.

What Are the Penalties for Criminal Medicare Fraud in Florida?

Penalty calculations in Florida Medicare fraud cases are complex and depend on many factors. If you have questions or need guidance for an upcoming sentencing hearing, call Oberheiden, P.C. today for a free and confidential consultation. We are also available on weekends. Call us at 888-680-1745.

A defendant convicted of Medicare fraud in Florida must expect severe penalties. These penalties include up to 10 years in prison per count, a term of supervised release, criminal fines, asset forfeiture, and a mandatory special assessment. The exact penalty depends on the amount proven in damages to CMS/Medicare. Federal Sentencing Guidelines will recommend a sentence to the presiding judge who can follow the recommendation, or decide to deviate from it. Here are several recent Medicare fraud examples from Florida federal courts.

• An owner of multiple Florida home health agencies pleaded guilty in a $66 million Medicare fraud scheme. According to the plea agreement, the owner paid people to act as recruiters for patients to refer to his home health agencies. Once referred, the owner billed Medicare for home health services that were not medically necessary or were never provided. The owner of the home health agencies pleaded guilty to one count of healthcare 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 sold opioids for cash and also prescribed medically unnecessary drugs to patients. Then the prescriptions were sent to Medicare for reimbursement. According to the plea agreement, the owner of the clinic is responsible for 7,500 fraudulent prescriptions. The owner also advised the doctors at the clinic to falsify medical records of patients to support the need for prescription opioids. The owner pleaded guilty to one count of conspiracy to distribute controlled substances.

• A Miami man pleaded guilty for his role in a Medicare fraud scheme involving illegal referrals and kickbacks. He worked for the state court system in Miami and conspired with elderly defendants to obtain their mental health evaluations and refer them to a behavioral health center in Miami. The man received cash payments for the referrals. The plea agreement further showed that he knew several of the defendants were not mentally ill or did not qualify for mental health services reimbursed by Medicare. The man was sentenced in the Southern District of Florida to 60 months in prison for his role in the scheme.

• A Miami man 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 hundreds of fraudulent claims to Medicare for services that were not medically necessary or were not performed. The plea agreement further showed that he falsified records to make certain patients eligible for home health services for which they otherwise would not be entitled. As a result of this scheme, the man was sentenced to 97 months in prison.

• A South Florida pharmacist was found guilty for his role in a scheme to defraud Medicare. According to trial evidence, the pharmacist submitted claims to Medicare for hundreds of prescriptions 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 took the patient’s information to bill Medicare. As a result of the scheme, Medicare paid out $5 million for the fraudulent claims.