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Medicaid Fraud Charges Require Serious Defense

With the massive population of elderly, often poor retirees in Florida, it makes sense Medicaid fraud would be more of a problem here than other states. In fact, the Florida Medicaid Fraud Control Unity (MFCU) is a busy place.

Budget battles at the state and federal level mean less money for fighting Medicaid fraud. Florida’s recent reduction of the MFCU’s budget by $631,290 meant the loss of $1.89 million in federal matching funds to the State of Florida. However, the decrease in budget doesn’t mean the state is pulling back on its commitment.

Common types of Medicaid fraud in Florida include billing for services not performed, and up-coding, where a provider classifies a service as a more costly procedure. Some simply order tests, procedures and equipment that aren’t necessary. Prescription fraud, also common, means obtaining drugs under false pretenses (doctor shopping or forgery) or stealing drugs for sale or personal use. Florida maintains a whistleblower hotline for Medicaid fraud. Citizens are encouraged to call if they spot irregularities in their care.

There is a wide variety of penalties that can result from Medicaid fraud conviction. For example, violations against the False Claims Act, which broadly means submitting a claim knowing it is false, carries huge penalties. Felony conviction can mean up to five years in prison and fines of up to $250,000 for an individual and $500,000 for a corporation per individual occurrence.

Other criminal Medicaid-based proceedings include:

  • Violations against the Social Security Act
  • Federal mail and wire fraud charges
  • Violations against the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • Federal charges of theft or embezzlement in connection with health care
  • Charges of making false statements about health care matters

Civil charges can include violations against the Civil False Claims Act and the Civil Monetary Penalties Law. More information is available on the Florida Attorney General’s MFCU Web page.

The AAPS also offers detailed advice about what to do if you learn you are under investigation. The first item is to call your lawyer. You need assistance from criminal defense attorneys with deep knowledge of this complicated area of the law. The Matassini Law Firm can help.

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