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Health Care Fraud

In its annual report for the 2014 fiscal year, the United States Department of Health and Human Services (HHS) said Medicare and Medicaid together provide health care insurance for one in four Americans. Spending on health care accounts for more than 17 percent of the United States’ gross domestic product (GDP).

The amount of money involved in American health care makes the industry ripe for fraud. As a result, federal agencies aggressively prosecute cases of suspected fraud, but many alleged offenders can face criminal charges when they were only guilty of accounting errors or other honest oversights.

Health Care Fraud Lawyer in Broward County, Florida

Were you arrested or do you believe that you could be under investigation in South Florida for an alleged federal health care fraud offense? You should refuse to make any kind of statement to agencies or authorities until you have legal counsel. Contact The Hoffman Firm today.

Fort Lauderdale criminal defense attorney Evan A. Hoffman represents clients accused of federal white collar offenses all over Broward County, including Coral Springs, Davie, Plantation, Deerfield Beach, Pembroke Pines, and many surrounding areas. Call (954) 524-4474 right now to have our lawyer review your case during a free, confidential consultation.


Overview of Health Care Fraud Offenses in Fort Lauderdale


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Common Forms of Health Care Fraud in Florida

The federal government utilizes multiple agencies to investigate cases of possible health care fraud. Medicare and Medicaid are popular targets for attempted fraud because the federal system overseeing it generally provides prompt reimbursements or payments for services rendered to eligible patients.

As a result, some individuals or companies falsify medical records to receive money for services that were never rendered, not necessary, or possibly exaggerated. A few of the common types of health care fraud include, but are not limited to:

  • Waiving co-pays or deductibles and over-billing the insurance carrier or benefit plan;
  • Upcoding;
  • Unbundling;
  • Self-referrals (Stark Law violations);
  • Overbilling;
  • Off-label marketing of pharmaceuticals or medical devices;
  • Misrepresentation;
  • Kickbacks;
  • Inadequate documentation;
  • Falsifying a diagnosis to unnecessary procedures;
  • False claims;
  • Co-pay inflation;
  • Billing for unnecessary services or items; or
  • Billing for services that were never rendered.

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Federal Health Care Fraud Penalties

Federal statutes contain multiple offenses relating to health care fraud. A few of the most common violations that lead to federal charges include:

  • Statements or entries generally, 18 U.S. Code § 1001 — An alleged offender who falsifies, conceals, or covers up by any trick, scheme, or device a material fact; makes any materially false, fictitious, or fraudulent statement or representation; or makes or uses any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry can be sentenced to a maximum of five years in prison and a maximum fine of $10,000 per violation.
  • Making or causing to be made false statements or representations, 42 U.S. Code § 1320a–7b(a) — An alleged offender who knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit or payment under a federal health care program; at any time knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining rights to such benefit or payment; having knowledge of the occurrence of any event affecting his initial or continued right to any such benefit or payment, or the initial or continued right to any such benefit or payment of any other individual in whose behalf he has applied for or is receiving such benefit or payment, conceals or fails to disclose such event with an intent fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized; having made application to receive any such benefit or payment for the use and benefit of another and having received it, knowingly and willfully converts such benefit or payment or any part thereof to a use other than for the use and benefit of such other person; presents or causes to be presented a claim for a physician’s service for which payment may be made under a Federal health care program and knows that the individual who furnished the service was not licensed as a physician; or for a fee knowingly and willfully counsels or assists an individual to dispose of assets (including by any transfer in trust) in order for the individual to become eligible for medical assistance under a state plan, if disposing of the assets results in the imposition of a period of ineligibility for such assistance, can be sentenced to a maximum of five years in prison and/or a maximum fine of $25,000. In the case of such a statement, representation, concealment, failure, conversion, or provision of counsel or assistance by any other person, the offense is a misdemeanor punishable by a maximum sentence of one year in prison and/or a maximum fine of $10,000.
  • Illegal remunerations, 42 U.S. Code § 1320a–7b(b) — An alleged offender who knowingly and willfully solicits or receives any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program; or who knowingly and willfully offers or pays any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a Federal health care program, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program can be sentenced to a maximum of five years in prison and/or a maximum fine of $25,000. 
  • Illegal patient admittance and retention practices, 42 U.S. Code § 1320a–7b(d) — An alleged offender who knowingly and willfully charges for any service provided to a patient under an approved state plan, money or other consideration at a rate in excess of the rates established by the state, or charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under an approved state plan, any gift, money, donation, or other consideration (other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient) as a precondition of admitting a patient to a hospital, nursing facility, or intermediate care facility for the mentally retarded, or as a requirement for the patient’s continued stay in such a facility when the cost of the services provided therein to the patient is paid for (in whole or in part) under the state plan, can be sentenced to a maximum of five years in prison and/or a maximum fine of $25,000.
  • Health care fraud, 18 U.S. Code § 1347 — An alleged offender who knowingly and willfully executes, or attempts to execute, a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program in connection with the delivery of or payment for health care benefits, items, or services can be sentenced to a maximum of 10 years in prison and/or a maximum fine of $250,000 (or $500,000 for an organization). If the alleged violation resulted in serious bodily injury, the offense is punishable by a maximum sentence of 20 years in prison. If the alleged violation resulted in death, the offense is punishable by a maximum sentence of life in prison. 
  • False, fictitious or fraudulent claims, 18 U.S. Code § 287 — An alleged offender who makes or presents to any person, officer, department, or agency of the United States any claim for money or property knowing such claim to be false, fictitious, or fraudulent can be sentenced to a maximum of five years in prison and a maximum fine of $250,000 (or $500,000 for an organization) for a felony offense or a maximum fine of $200,000 for a misdemeanor.
  • False statements or representations with respect to condition or operation of institutions, 42 U.S. Code § 1320a–7b(c) — An alleged offender who knowingly and willfully makes or causes to be made, or induces or seeks to induce the making of, any false statement or representation of a material fact with respect to the conditions or operation of any institution, facility, or entity in order that such institution, facility, or entity may qualify (either upon initial certification or upon recertification) as a hospital, critical access hospital, skilled nursing facility, nursing facility, intermediate care facility for the mentally retarded, home health agency, or other entity for which certification is required or a state health care program can be sentenced to a maximum of five years in prison and/or a maximum fine of $25,000.

In addition to criminal penalties, alleged offenders can also become liable for civil monetary penalties that may be up to $100,000 for alleged offenses.


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Florida Health Care Fraud Resources

Florida Attorney General | Medicaid Fraud Control Unit — Providers that intentionally defraud the Florida’s Medicaid program through fraudulent billing practices are investigated and prosecuted by the Attorney General’s Medicaid Fraud Control Unit. Under Florida Statute § 68.085 in the Florida False Claims Act, persons who report and provide information relating to Medicaid fraud are entitled to a percentage of the fun rewards recovered by the state. Learn how to report fraud or abuse and download the Medicaid Fraud Control Unit brochure on this website.

Federal Bureau of Investigation (FBI) | Health Care Fraud — The FBI is the primary investigative agency in health care fraud cases, and the federal agency has jurisdiction over both federal and private insurance programs. On this section of the FBI website, you can learn more about health care fraud, view a report about health care fraud, and find recent news releases. You can also find fraud prevention tips.


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The Hoffman Firm | Lawyer for Health Care Fraud Arrests in Broward County, FL

If you think that you might be the target of a criminal investigation or you have already been arrested for alleged health care fraud in South Florida, it is in your best interest to make sure that you have legal representation before you say anything to authorities or a federal agency. The Hoffman Firm aggressively defends clients in Fort Lauderdale, Sunrise, Hollywood, Hallandale Beach, Pompano Beach, and many other nearby communities in Broward County.

Evan A. Hoffman is an experienced criminal defense attorney in Fort Lauderdale who is admitted to the United States District Court for the Southern District of Florida. He can provide an honest and thorough evaluation of your case when you call (954) 524-4474 or submit an online contact form to take advantage of a free initial consultation.


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Free Consultation

All fields are required. The use of this form for communication with our personnel does not establish an attorney-client relationship.

Evan A. Hoffman

Evan A. Hoffman

Mr. Hoffman’s philosophy is "our knowledge and experience is your best defense." He has been a featured author on criminal law issues such as driving under the influence, domestic violence and illegal searches.

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