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Criminal Defense Lawyer in Orlando, FL

Healthcare Fraud Lawyer in Orlando, FL

Healthcare fraud has reached epidemic proportions in the last decade, leading both federal and state governments to dedicating entire divisions to investigating and stopping it. This aggressive approach, unfortunately, often leads to those who are either innocent or only marginally involved in a fraud scheme to being charged with severe charges. Healthcare workers, especially, can see their entire career ruined for the mere suggestion of healthcare fraud, whether they’re guilty or not. That’s why it’s vital to seek an experienced healthcare fraud defense attorney as early as possible, to combat the charges and secure your future. Contact Hanlon Law in Orlando today to schedule a free consultation.


What is Healthcare Fraud?


18 US Code Section 1347 defines healthcare fraud as the willful execution or attempted execution of a scheme that knowingly defrauds a healthcare benefit program or obtains money or property from any healthcare benefit program by means of false pretenses. 


Basically, healthcare fraud is when you use false information, promises, or pretenses to try and obtain money, property, or services from a healthcare company that you aren’t actually entitled to. While this is generally thought of as only occurring when patients attempt to manipulate the system, in fact both patients and healthcare providers can commit insurance fraud. 


Common examples of healthcare fraud committed by patients include:


  • Filing false claims for services that were not actually performed
  • Altering or forging receipts, bills, or other documentation
  • Using another person’s insurance information 
  • Lying on healthcare applications or contracts to obtain additional coverage or benefits


Common examples of healthcare fraud committed by providers include:


  • False billing for services that have not been performed
  • Falsifying patient diagnoses to justify procedures, surgeries, or testing that are not medically necessary
  • Falsely representing a performed procedure to obtain payment for a service that is not covered under the patient’s policy
  • Billing for a more costly service than what was actually performed (known as upcoding)
  • Waiving co-pays or deductibles for patients and then over-billing the insurer
  • Billing patients for services pre-paid or paid in full by their insurer


What are the Legal Consequences of Healthcare Fraud?


Healthcare fraud is divided into different charges depending on the manner in which the fraud was committed:


  • Conspiracy to Commit Healthcare Fraud
  • False Claims Act Violation
  • Money Laundering
  • Conspiracy to Commit Money Laundering
  • Wire Fraud


Healthcare fraud in the state of Florida generally comes with a maximum of up to 10 years in prison. However, if someone is severely injured due to said fraud, that maximum rises to 20 years. If someone dies as a result of the fraud, you may be charged with a life sentence. 


Generally speaking, healthcare fraud committed by the consumer is considered a third-degree felony, punishable by up to 5 years in prison and a $5,000 fine. However, if someone is severely injured due to your actions, you may be charged with a second-degree felony, punishable by up to 15 years in prison and a $10,000 fine. If someone dies as a result of your actions, you could be sentenced to life in prison.


For Medicaid providers, healthcare fraud charges are divided based on the amount of money or value of property fraudulently obtained. For less than $10,000, the charge is a third-degree felony, punishable by up to 5 years in prison and a $5,00 fine. For between $10,000 and $50,000, the charge is a second-degree felony, punishable by up to 15 years in prison and a $10,000 fine. For anything greater than $50,000, the charge is a first-degree felony, punishable by up to 30 years in prison and a $10,000 fine. 


Additionally, as healthcare fraud is responsible for tens of billions of dollars annually, many healthcare fraud charges come with an astronomical federal fine of $250,000. Violations of the Anti-Kickback Statute may be assessed up to $50,000 per violation, or three times the size of the kickback (whichever is greater). Similarly, violations of the False Claims Act may be assessed at $21,500 per claim, or three times the amount of damages (whichever is greater).


Other consequences for professionals can include loss of license, loss of DEA registration, exclusion from Medicaid and Medicare programs, pay suspension, and loss of staff privileges.


Healthcare Fraud Defense Lawyer in Orlando


As with all fraud cases, healthcare fraud often comes down to intent. The law requires not only that fraud be committed in order to secure a conviction, but also that the defendant acted with the goal of committing fraud in mind. So, for example, putting false information on a Medicaid application by accident, or genuinely believing the misinformation is accurate at the time of filing the application would not constitute healthcare fraud, as there was no intent to defraud in the action. 


Intent can be difficult to prove, however, as you could simply say it was an honest mistake when it was, in fact, intentional. Regardless of what actually happened, the prosecution will quickly develop a theory that will then color their view of the entire case; that’s why it’s vital to have an experienced healthcare fraud defense attorney on your side to help you combat their perception. 


At Hanlon Law, our team has nearly two decades of experience in the courtroom. With our aggressive approach, we’ll start advocating on your behalf immediately to help establish your side of the story as soon as possible. With our dedication and personal attention, we’ll help you secure the best possible outcome for your situation. Contact Hanlon Law today to schedule a free consultation.

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