West Palm Beach Healthcare Fraud Attorney

Experienced, aggressive federal defense in Palm Beach County

The rising cost of healthcare in the United States has prompted the federal government to become more aggressive in its pursuit of healthcare fraud offenders. While it may be easy to imagine individual people defrauding the healthcare system, the most common culprits are organized crime rings. In some cases, medical care providers are also perpetrators of fraud.

West Palm Beach healthcare fraud is investigated by the FBI

Considered a top priority offense, healthcare fraud cases are investigated by dedicated personnel from each of the FBI’s 56 field offices. Other agencies that work with the FBI to track down offenders include the Drug Enforcement Agency, Health and Human Services, the IRS, and the FDA. Therefore, if an individual or group in Florida is charged with healthcare fraud, large fines and federal prison are realistic possibilities.

Theft of Florida patient data

Crime rings that orchestrate healthcare fraud schemes have multiple ways of stealing patient data. Criminals sometimes use health fairs to collect information from unsuspecting people who show up for exams and screenings. Criminal organizations also induce or pay medical workers to give them patient data. Alternatively, information can be purchased from other fraudulent companies that pose as legitimate marketing and billing businesses. After obtaining the stolen data, the organization is able to use the patient information to file fraudulent insurance claims.

Arrested on a federal charge?

Speak with an attorney immediately. Don’t say anything that might incriminate yourself.

Fraudulent medical service providers

A small percentage of medical facilities and workers also engage in healthcare fraud. There are several different ways medical practitioners defraud insurance companies:

  • using stolen or entirely fictitious identities to bill for services that were never performed;
  • billing for more expensive services than the services actually performed;
  • performing unnecessary services for the purpose of billing insurance;
  • claiming non-covered treatments are medically necessary to prompt insurance to pay for the service;
  • falsifying patient diagnoses for the purpose of running unnecessary tests and performing procedures the patient does not require;
  • billing each step in a treatment as a separate procedure;
  • receiving kickbacks for patient referrals;
  • waiving copay fees and patient deductibles to bill insurance instead.

Florida healthcare fraud kickback schemes

A kickback is money or any other benefit that is given to a doctor or other healthcare professional with the intent that he or she will deliver a specified service or product. Kickback schemes compromise the integrity of the healthcare system by potentially subjecting patients to unnecessary or inappropriate treatments in the interest of the provider receiving an extra benefit. Because a substantial amount of money is circulated throughout the healthcare industry, the temptation to benefit from directing patients to use certain treatments and therapies based solely on financial gain is great. Therefore, some financially-motivated healthcare providers have become easily influenced by corrupt practices. Meanwhile, patients who visit these practitioners and facilities cannot be sure they are receiving the care they need.

False Claims Act

Under federal law, it is illegal for any person or organization to make a false record or file a false claim regarding any healthcare program that receives funding from the federal government. This law, known as the False Claims Act (FCA), includes Medicaid, Medicare, and Affordable Healthcare plans. Individuals and organizations who violate the FCA may be fined up to three times the amount of the fraudulent claims plus an additional penalty of $5,500 to $11,000 per false claim. Those who knowingly help advance or benefit from the fraud may be sentenced to years in prison for committing related crimes, including forgery, insurance fraud, identity theft, bribery, and money laundering.

Federal healthcare fraud investigations in Florida

Healthcare facilities and providers may be routinely investigated for healthcare fraud. Claims of Medicare billing fraud trigger a large proportion of investigations while others may be compelled by allegations of fraud involving the Department of Defense or other white collar offenses like tax evasion or wire fraud. When the federal government reaches out to ask questions, it is best to preemptively hire a seasoned West Palm Beach healthcare fraud lawyer.

Help for employees

In some cases, an individual may be investigated for fraud as a result of simply working at a facility at which fraudulent practices have taken place. Employees who are wrongfully accused of participating in a fraudulent scheme should contact an attorney prior to discussing the case with their employer, coworkers, or law enforcement. Statements made in a seemingly casual conversation can ultimately be used against a defendant. An experienced Florida healthcare fraud attorney will help his or her client avoid making unnecessary incriminating statements and provide polished, professional counsel and representation throughout the process. In a case that may result in large fines and prison time, it is important to have the support and guidance of an attorney who is well-versed in federal healthcare law and who has the experience and resources to construct a solid case for his or her client’s defense against federal prosecutors. Making the first call to a West Palm Beach defense lawyer is easy. Law firm staff are available to immediately provide a free case evaluation, after which an attorney will follow up to help the potential client understand the implications of the case and determine the best path to move forward. Hiring an experienced healthcare fraud defense lawyer who has a proven track record can be the difference between resolving the situation and moving on with a clean reputation and facing serious financial penalties and/or time in prison.