Healthcare Fraud

Florida Statute section 456.0635 was enacted in order to stop health care fraud. It establishes strict penalties for certain health care activities and can have a big impact on people who hold licenses in Florida. Generally, it prohibits health care professionals from committing Medicaid fraud and requires the Florida Department of Health not to give licenses, permits, or certificates to people who have violated the law. If you are charged with this type of fraud, you should take the charges seriously. At Hanlon Law, St. Petersburg health care fraud lawyer Will Hanlon is dedicated to protecting the rights of the accused, and he understands how important your career as a health care professional is to you.

Health care fraud can include a wide range of criminal activity, including sober homes fraud, drug and pharmacy schemes fraud, prescription drug diversion, home health care fraud, assisted living facility fraud, clinics and managed care fraud, Medicare Advantage fraud, private insurance fraud, unlicensed money transmitting or money laundering, and Medicare Part D schemes. If you are charged with any of these crimes, it is crucial to retain an experienced St. Petersburg criminal attorney. What the prosecutor needs to prove varies, depending on the specific crime at issue.

Under Florida Statute section 817.234, the prosecutor can prove that you committed insurance fraud with the intent to injure if they can show that you presented or caused to be presented a statement as part of a claim for payment or benefits under an insurance policy or health maintenance subscriber or provider contract, knowing that the statement included false, incomplete, or misleading information about a fact material to the claim. You also can be convicted if you prepared or made a written or oral statement intended to be presented to an insurer in connection with a payment claim under an insurance policy or provider or subscriber contract, knowing that the statement included misleading, false, or incomplete information. There are other circumstances that can also give rise to a successful charge of insurance fraud, such as knowingly concealing information concerning any fact material to the application. However, a health care fraud attorney can advise St. Petersburg residents on how to tackle a specific charge and challenge the prosecution’s ability to prove its elements.

For another example, sober homes fraud can occur when a treatment center claims to offer clinical treatment for people suffering from alcohol and drug addiction, but it provides kickbacks and bribes to people who agree to live in the sober home and attend therapy and drug testing that can be billed to their insurance plans. Billings for treatment that never occurred or services provided solely to maximize insurance reimbursement are a form of fraud. Florida law prohibits kickbacks and requires background screenings for people who own, direct, and supervise treatment centers. Although sober homes are not required to get certified in Florida, Florida law bars licensed facilities from referring their patients to sober homes that are not voluntarily certified through the state. Patient brokering is illegal under Florida's RICO statute.

Pharmacy fraud is another form of health care fraud. It could occur, for example, when pharmacies claim to provide prescription drugs to Medicare or Medicaid beneficiaries and make claims for reimbursement that falsely and fraudulently represent that prescription drugs were medically necessary, prescribed by a doctor, and provided by pharmacies. If you are being investigated for this type of crime, a St. Petersburg health care fraud attorney can help you work to keep your license and livelihood intact.

Florida Statute section 456.0635 is a complex law that prohibits health care fraud in a health care professional's practice. It provides that each board within the jurisdiction of the Department of Health, or the Department itself when there is no board, must refuse to admit a candidate to any examination and refuse to issue a license, certificate, or registration to any applicant if the candidate or applicant has been convicted of or pled nolo contendere to a felony under chapter 893, 817, or 409, or a similar felony in another state or jurisdiction, except when the applicant or candidate has successfully completed a drug court program or pretrial diversion for it and provides proof that the plea has been withdrawn or charges were dismissed. The conviction or plea excludes you from being licensed, taking an exam, receiving a certification, or being registered unless the subsequent sentence and probation period ended within a certain time frame.

In Florida, charges of health care fraud are quite serious, as with public assistance fraud or other types of fraud. Legal representation by an experienced and knowledgeable criminal defense attorney can make a huge difference not only to whether you are convicted, but also to whether you can continue in your chosen profession. Our founder, Will Hanlon, is committed to defending the rights of the accused. He has represented criminal defendants since 1994 and is well versed in all criminal defense strategies. You can reach Hanlon Law at 727.289.0222 or via our online form.