Health Care Fraud

Health care fraud is a white collar crime. Lawmakers enacted Florida Statute section 456.0635 in 2009 in order to prevent this type of fraud through the establishment of penalties for specific offenses. Among other things, it requires that the Florida Department of Health not provide a license, certificate, or permit to somebody who violates the law. It also prohibits Medicaid fraud. If you are facing health care fraud charges, it is important to obtain representation from a Sarasota health care fraud lawyer. Your professional future may depend on it. At Hanlon Law, we fight for the rights of the accused.

Health care fraud is a bucket term used to refer to many different white collar offenses, prohibited by various statutory sections. What must be proven depends on the particular offense being charged. Among the offenses that constitute health care fraud are Medicare Advantage fraud, private insurance fraud, Medicare Part D schemes, sober homes fraud, drug and pharmacy schemes fraud, assisted living facility fraud, managed care fraud, and money laundering. When electronic communications or the mail system are used, you may also face mail and wire fraud charges.

Among the health care fraud statutes is Florida Statute section 456.0635. This law covers many different violations, including those that are believed to show a propensity to commit health care fraud, including non-health care related fraud or drug convictions. It requires that the Department of Health and every board within its jurisdiction refuse to issue certificates, licenses, or registrations to an applicant when that person has pled nolo contendere to or been convicted of certain felonies (those under chapters 893, 817, or 409) or similar felonies in other jurisdictions. Chapter 893 deals with drug crimes. Chapter 817 deals with fraudulent practices. Chapter 409 deals with social welfare. The exception for denials or refusals is when an applicant successfully concluded a drug court program or pretrial diversion, and the charges were dismissed or the plea withdrawn. A health care fraud attorney can help Sarasota defendants determine if an exception may apply in their case.

The statute also requires health care practitioners to report allegations of Medicaid fraud against themselves. It is important to retain an experienced Sarasota criminal attorney. In some cases, we may be able to get the prosecutor to charge you under different code sections so that you can avoid having your license or ability to take an exam necessary to obtain a license denied.

Insurance fraud is a large area that falls under health care fraud. A prosecutor can establish insurance fraud under Florida Statute section 817.234 if they can prove that (1) you presented a statement as part of your claim for a payment or benefit under an insurance policy, (2) knowing that the statement was false, incomplete, or misleading regarding a material fact. A prosecutor can also establish insurance fraud under this code section if they can prove that you: (1) prepared or made a statement, written or oral, that (2) you intended for presentation to an insurer in connection with a claim for payment or benefits under an insurance policy, (3) knowing that the statement included misleading, incomplete, or false information about a material fact. Similarly, this code section prohibits making false statements about material facts when applying for insurance. Concealment of material facts can also be a basis for insurance fraud, although a Sarasota health care fraud attorney often can build a strong defense.

Drug treatment center fraud and sober home fraud are also on the rise in Florida. Lawmakers heightened requirements for starting out as a sober home in 2016. There is a voluntary credentialing entity that must approve or deny certification for sober home residences. Additionally, no licensed substance abuse treatment center is permitted to refer current or discharged patients to a particular sober home unless the sober home has a valid certificate of compliance under section 397.487 or is owned and operated by a licensed service provider or its subsididary. One kind of sober home fraud could involve a kickback scheme in which patients are persuaded to live in sober homes free of charge in order to bill their insurance plans. Their insurance plans are then billed for treatment that does not occur, or services are provided only to maximize reimbursement.

Health care fraud charges are serious, with the penalties varying based on the particular charge. They can result in not being able to obtain a license or certification that you need for your career, or they can result in losing a license or certification. Our firm's founder, Will Hanlon, has defended people accused of white collar crimes, such as public assistance fraud or health care fraud, since 1994. You can call us at 941.462.1789 or complete our online form.