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White Collar Crime

Crimes for Medicaid Fraud

As more people are participating in Florida’s Medicaid Program during the COVID-19 (novel coronavirus) pandemic and public health crisis, prosecutors are putting more resources into protecting taxpayer funds from fraud.

The attorneys and investigators with the Medicaid Fraud Control Unit (MFCU) in Florida have the task of conducting complex investigations into incidents of suspected fraud. Fraud investigations into suspected Medicaid providers committing fraud might involve:

  • billing for medically unnecessary products, services, or tests;
  • double billing;
  • over billing for services provided;
  • billing for services not rendered;
  • upcoding by assigning inaccurate billing codes to claims in order to increase reimbursements
  • other fraudulent billing practices.

Medicaid providers include pharmacists, dentists, osteopathic doctors, and medical doctors. Many of these schemes used recruiters to find Medicaid patients.

Other criminal investigations involve allegations of patient exploitation, neglect, or abuse, at health care facilities. Those facilities that receive Medicaid funds include assisted living facilities (ALFs), facilities for the physically and mentally disabled, and nursing homes.

Medicaid provider fraud accusations often begin with a complaint by a whistleblower to the statewide hotline at 866-966-7226. The whistleblower complaints for Medicaid Fraud might fall under Florida’s False Claims Act. Under the Act, the whistleblower might be entitled to share in any funds recovered by the state.

Attorney for Medicaid Fraud Prosecutions in Florida

If you are accused of Medicaid Provider Fraud, then you need a focused response from an experienced criminal defense attorney.

If you get a letter from the Attorney General’s Office, an investigative subpoena duces tecum, or if an investigator knocks on your door to interrogate you about provider or recruiter fraud, then contact an attorney immediately.

The attorneys at Sammis Law Firm represent clients charged with Medicaid Fraud at all levels. We understand how these cases are investigated by law enforcement officers and attorneys associated with the Medicaid Fraud Control Unit of the Attorney General’s Office.

We are experienced in representing Medicaid providers accused of fraudulent billing schemes with Florida’s Medicaid Program for services not provided and other fraudulent billing practices.

At the federal law, other types of health care fraud cases can be prosecuted by Assistant United States Attorneys in the Middle District of Florida, Tampa Division.

We fight to protect our clients from accusations of intentionally defrauding the Medicaid program. Those accusations for healthcare crimes come with serious criminal and civil penalties.

Innocent employees might get caught up in criminal fraud investigations.

Call 813-250-0500 to discuss your case.

Additional Resources

Florida’s Medicaid Fraud Control Unit – Crimes for Medicaid Fraud are prosecuted by Attorney General Ashley Moody’s Medicaid Fraud Control Unit (MFCU), with the assistance of the local sheriff’s office or police department or federal law enforcement officers. The unit investigates and prosecutes providers that intentionally defraud the state’s Medicaid program through fraudulent billing practices. The MFCU investigates allegations of exploitation in facilities receiving payments under the Medicaid program, as well as patent abuse and neglect.

Brochure on Medicaid Fraud – Visit the website of the Attorney General’s Office in Florida to find a brochure explain crimes involving Florida’s Medicaid program and criminal investigations by the MFCU. Find the definition “provider fraud” which is the intentional misrepresentation or willful deceit of the truth by a provider or his agent to obtain an improper direct or indirect payment for services reentered or allegedly renders to recipients under the Medicaid program.

This article was last updated on Friday, July 31, 2020.

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