Tampa Bay Medicare Fraud Defense Attorney

Representing Medical Professionals in the Tampa Bay Area – Tampa, St. Petersburg, Clearwater, Dade City, New Port Richey, Sarasota, Inverness, Ocala, The Villages

Every single day doctors and other medical professionals are subject to intense government scrutiny. Healthcare providers are constantly exposed to investigations and enforcement actions by both federal and state officials.

Our Medicare Fraud Defense Attorneys at Whittel & Melton are knowledgeable about the business and politics that go hand in hand with healthcare in the United States. Medicare fraud is a felony offense and a conviction carries enormous criminal and civil liabilities that can cause you to lose the business you worked so hard to create. The mere accusation of being tied up with a Medicare, Medicaid, Tricare, and other health care fraud scheme should urge you to seek legal help right away to keep your record clean.

What is Medicare Fraud?

Medicare fraud is when a person knowingly submits a false or fictitious claim to a governmental health care program. According to government statistics, $50 billion per year in claims are considered suspicious and subject to Medicare fraud investigation. So really, no matter how well you have organized your staff and procedural operations, the chances of being audited are very real, especially if you have a busy practice submitting high volume claims to the Centers for Medicare and Medicaid Services (CMS).

The following statutes form the basis for Medicare investigations:

  • False Claims Act
  • Stark Law
  • Anti-Kickback Statute
  • Criminal Fraud Statute
  • Civil Monetary Penalties Law

Examples of Medicare fraud include:

  • Submitting false claims to CMS
  • Billing for services or supplies that were not provided to the patient
  • Submitting claims for services or supplies for a “ghost patient” or a patient who does not exist or who the provider has no physician-patient relationship
  • Billing for low quality services that are virtually worthless
  • Billing for medical equipment not prescribed by doctors
  • Unbundling or billing for tests or treatment separately when there is an ICD-10 procedure code that covers or bundles the services
  • Up-Coding or billing a higher code (CPT, ICD-10, E&M, HCPCS) than the service actually performed
  • Performing additional treatments or tests which are not deemed medically necessary
  • Duplicate billing
Who Is Investigated for Medicare Fraud?

Health care fraud statutes apply to any individual or business that directly or indirectly contracts with and is paid for services by the United States government. The industries at highest risk include:

  • Hospitals
  • Home Health Centers
  • Physician Owned Entities
  • Physicians
  • Toxicology labs
  • Biologics labs
  • Pharmacies
  • Medical Device Companies
What are the Penalties of a Conviction?

Medicare fraud is investigated by numerous agencies, including:

  • Office of Inspector General (OIG)
  • Department for Health and Human Services (HHS)
  • Department of Justice (DOJ)
  • Federal Bureau of Investigation (FBI)
  • Medicaid Fraud Control Units (MFCUs)
  • Health Care Fraud Prevention and Enforcement Action Team (HEAT)
  • General Services Administration (GSA)
  • Centers for Medicare and Medicaid Services (CMS)

If found guilty, targeted individuals could face restitution, hefty civil monetary penalties up to $250,000 per false claim, exclusion from federal health care programs, treble damages, attorney fees, criminal fines, criminal indictment, or incarceration in a federal prison up to 20 years.

Liability does not require a specific intent to violate the law. The government only has to prove the transaction was wrong. A person can be convicted if they are found to have acted with intentional ignorance or complete disregard of the truth or falsity of the claim. Most Medicare fraud cases boil down to whether the individual acted knowingly and/or willfully, but these cases can all have their unique set of complexities.

How We Defend Medicare Fraud

Early intervention is of the highest importance in these cases. Our Tampa Bay Medicare Fraud Attorneys at Whittel & Melton have a firm understanding of health law as well as criminal defense, which is what is needed to form a strategic line of defense. Medicare fraud prosecutions are highly specific prosecutions lead by the U.S. Attorney’s Health Care Fraud Division. Your defense requires analyzing a copious amount of health data and the specific understanding of billing practices, compliance issues, and medical necessity.

We will mount your defense around three key abilities, industry knowledge, government experience and fighting to keep investigations civil, not criminal, whenever possible. If you have been arrested, charged or are aware of an investigation into your practice regarding Medicare fraud, we urge you to contact us today for a free consultation. You can reach us 24/7 by phone at 727-823-0000 or contact us online to request a complimentary confidential consultation.

Tampa Bay Medicare Fraud Defense Lawyers Whittel & Melton - 727-823-0000

Your freedom is at stake, please contact us today!

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