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Health Care Fraud

According to the World Health Organization (WHO), the more than 17 percent of gross domestic product (GDP) that the United States spends on health care is the highest of any nation. Because health care accounts for such a significant section of the American economy, alleged fraud is among the most commonly prosecuted white collar offenses in federal courts.

Health care fraud can carry severe criminal and civil penalties. Because so many mandatory reporting requirements can involve complex paperwork that is subject to honest errors, alleged offenders may be accused of wrongdoing when there was no actual criminal intent.

Lawyer for Health Care Fraud Arrests in Miami-Dade County, FL

If you have been arrested for or contacted by a federal agency or medical insurer about alleged health care fraud, it is in your best interest to immediately have legal representation. The Hoffman Firm defends clients accused of federal white collar crimes in Opa-locka, Miami Beach, Hialeah, South Miami, and several other communities in Miami-Dade County.

Miami criminal defense attorney Evan A. Hoffman is a former Assistant State Attorney who is admitted to the United States District Court for the Southern District of Florida. You can have him review your case and discuss your legal options when you call (305) 249-0090 today to take advantage of a free, confidential consultation.


North Miami Health Care Fraud Information Center


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Types of Health Care Fraud in Florida

Fraud in the health care industry takes various forms that may involve any one of a number of government programs. Some of the most common allegedly fraudulent claims involve popular government programs such as Medicare or Medicaid.

Cases of fraud can be relatively simple submission of false claims or may involve more complex schemes in which other costs, figures, or data have been manipulated. Some of the most common types of alleged health care fraud include, but are not limited to:

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

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Federal Penalties for Health Care Fraud

Alleged offenders accused of health care fraud can face civil and criminal penalties under various federal laws. Some of the most common statutes that federal cases may be prosecuted under include:

  • False, fictitious or fraudulent claims, 18 U.S. Code § 287 — Making or presenting 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 is punishable by up to five years in prison and a fine of up to $250,000 (or $500,000 for an organization) for a felony offense or up to $200,000 for a misdemeanor.
  • Statements or entries generally, 18 U.S. Code § 1001 — Knowingly and willfully falsifying, concealing, or covering up by any trick, scheme, or device a material fact; making any materially false, fictitious, or fraudulent statement or representation; or making or using any false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry is punishable by up to five years in prison and a fine of up to $10,000 per violation.
  • Health care fraud, 18 U.S. Code § 1347 — Knowingly and willfully executing or attempting to execute a scheme or artifice to defraud any health care benefit program or 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, is punishable by up to 10 years in prison and/or a fine of up to $250,000 (or $500,000 for an organization). If the violation resulted in serious bodily injury, the offense is punishable by up to 20 years in prison. If the violation resulted in death, the offense is punishable by up to life in prison.

Additionally, 42 U.S. Code § 1320a–7b establishes criminal penalties for several other acts involving federal health care programs. All of the following violations are punishable up to five years in prison and a fine of up to $25,000:

  • Making or causing to be made false statements or representations;
  • Illegal remunerations;
  • False statements or representations with respect to condition or operation of institutions; or
  • Illegal patient admittance and retention practices.

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Florida Resources for Health Care Fraud

Florida Attorney General | Medicaid Fraud Control Unit — The Attorney General’s Medicaid Fraud Control Unit investigates and prosecutes fraud involving the state's Medicaid program. You can download the Medicaid Fraud Control Unit brochure and learn how to report fraud or abuse on this website. Citizens who blow the whistle on Medicaid Fraud are entitled to share in any funds recovered by the state.

Florida | StopMedicareFraud.gov — The stopmedicarefraud.gov website is a collaborative effort involving the Department of Health and Human Services (HHS), HHS Office of Inspector General, Center for Medicare and Medicaid Services, and U.S. Department of Justice. On this section of the website, you can find recent Florid news relating to Medicare fraud and various fact sheets. You can also learn more about fraud, how to prevent it, and ways to report it.


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The Hoffman Firm | Health Care Fraud Lawyer in Miami, Florida

Have you been contacted about or were you arrested in Florida for alleged health care fraud? You should not make any kind of statement to agents or authorities until you have sought the help of The Hoffman Firm.

Evan A. Hoffman is an experienced criminal defense attorney in Miami who serves the greater Miami-Dade County area, including Coral Gables, Key Biscayne, North Miami, Aventura, and many other surrounding areas. He can provide a full evaluation of your case as soon as you call (305) 249-0090 or complete an online contact form today to schedule a free 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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