Healthcare Fraud
Healthcare Fraud which also includes Medicare Fraud, Medicaid Fraud and Insurance Fraud is a complicated area of the law prosecuted by both Federal and State authorities who share jurisdiction in this area of the law.
South Florida, and Miami, in particular, is known as the center of U. S. health care fraud committed by both providers and by patients. Statistics show that somewhere over 75% of all US Healthcare fraud emanates out of South Florida. As a result, the US Government has set up a task force or special agents and prosecutors in Southern Florida to go after the perpetrators of the fraud.
Right now, government auditors are reviewing all Medicare and Medicaid provider submissions over the last five (5) years looking for any evidence of fraud.
The kinds of fraud the authorities are looking for can be summarized as follows:
- Irregular billing services to include:
- Fraudulent double billing for the same service
- Fraudulent billing for medical services or durable medical goods that were not provided
- Fraudulent billing for a physician’s services, including for drugs and/or medicines & durable medical goods that were not medically necessary.
- Fraudulent billing for a different service, usually a more highly reimbursed service, than the actual service that was rendered — also known as “Upcoding”
- Fraudulent billing for individual laboratory services when they were submitted as a group service, in order to get a higher reimbursement, also known as “Unbundling”
- Allowing unlicenced personnel to act on your behalf as if they had a license
- Ordering of unnecessary tests and medical services
- Fraudulent billing schemes where untrained or unqualified personnel were used to perform or provide the service with lack of proper supervision.
- Fraudulently distributing or providing unapproved medical devices or drugs.
- Fraudulently providing diluted medicines or drugs in order to increase the provider’s profit margin
- Kickback arrangements between patients and referring physicians
- Over prescribing controlled substance medicine (usually pain killers and tranquilizers)
These State and Federal Laws affect physicians, nurses, chiropractors, Internet pharmacies, pharmacists, rehabilitation clinics and service providers, durable medical good providers and all of their support staff, assistants, support personnel and all office staff including billing staff that belong to these medical professionals & providers and the companies or organizations that they worked for.
The penalties for health care fraud can be very substantial even for what may be deemed a “minor” violation. Recently, in 2009, a 53 year old, female physician who “signed off” on medical procedures which were ordered by a company that she worked for and later determined to be fraudulent, was sentenced by a Miami Federal Judge to thirty (30) years imprisonment for Medicare fraud, even though the doctor claimed not to be part of the fraudulent scheme and had even passed a polygraph test indicating that she was unaware of the fraud.
It is clear that Federal authorities are cracking down on heath care fraud in South Florida as there is on-going, intensive review of billing practices that have occurred over the past five (5) years.
Only you know what you may have been involved in. If you suspect that your conduct may be under review, or if reviewed, may not be well understood by reviewing authorities, then you need more than ever an aggressive criminal defense lawyer to stand up for your rights and to fight hard on your behalf.
Our professional services include the support of expert medical personnel, and forensic accountants, who can render an independent review of your services and billing practices. Our attorneys have the experience in this highly specialized field to provide you with the best defense possible.
In some cases, unscrupulous medical companies, run by businessmen, not doctors, used and duped medical professionals to sign-off on practices and procedures by deceiving these professionals into believing that they were acting properly. You, yourself, could be an innocent victim of these unscrupulous activities engaged in by companies who hired the medical professional, without disclosing the full facts to the doctor or medical provider. If you acted in good faith without sufficient knowledge of the fraud then you may have a complete defense to the criminal charges and require an attorney with experience in health care fraud defense to defend your case. There is no substitute for experience in the highly specialized practice area of the law.
If we can show that you, as a medical practitioner or provider, acted in good faith or without knowledge of the fraud, then your case is not only defensible — it is winnable. But you must not wait until after you are arrested.
We also represent companies including large and small hospitals, HMO clinics, neighborhood medical clinics and health insurance companies accused of health care fraud or fraudulent billing practices.
If your are aware that an investigation is ongoing or imminent, then the time to consult with the Law Offices of Sam Rabin is now, before it is too late. Let our depth of experience in this highly complicated and sophisticated area of criminal law work to your advantage. An attorney can be most effective for you before criminal charges are filed. If, during our meeting with prosecutors we are able to convince them that you, yourself, are a victim, then it is possible to become a witness and not a defendant! But you must act immediately before criminal charges are filed.
While we handle health care fraud cases all over the United States, we are especially well versed in the kind of activity that is occurring in South Florida. There is no obligation for a free and confidential consultation to evaluate your situation. Make your appointment now by calling (305) 358-1064 and asking for attorney Sam Rabin.
With over thirty years experience as both a prosecutor and a criminal defense lawyer, we feel that we are in the best position to put our expertise to work for you. Sam Rabin will guide you through the criminal justice system with compassion and sensitivity.
