Miami Health Care Lawyers
The health care industry continues to be one of the most heavily regulated industries with numerous State and Federal agencies providing oversight. As such it has become critically important that practitioners, professionals and healthcare executives have legal counsel experienced in matters related to the health care industry.
The attorneys at the Health Law Group can help identify any potential risks, negotiate corporate transactions and to provide strategic representation and advocacy in complex litigations and potential criminal proceedings.
With experience in all aspects of healthcare law, the attorneys at the Health Law Group represent client interests in a wide array of litigation, regulatory, employment and criminal related matters. Our lawyers have helped many clients resolve some of the most complex legal issues including corporate structure, merger and acquisitions, government regulations and state and federal fraud abuse matters.
Our Miami lawyers provide legal counsel to healthcare providers including hospitals, physicians, treatment centers, clinics, dental offices and more. We understand the unique challenges that pharmaceutical manufacturers and durable medical equipment manufacturers face. Our healthcare lawyers can assist advise you on a number of legal issues including but not limited to:
Internal audits and investigations
Medi-Cal Fraud and other Health Care Fraud issues
As a health care provider in Miami, like other parts of the country you are likely to be accused of health care fraud. Our law firm has a health care group that focuses on legal issues and services involving health care fraud.
Health Care Fraud in Miami
Of the many federal statutes that regulate acts, a major focus has been on the area of health care fraud. Accusations of health care fraud could stem from your various responsibilities as a Miami health care provider.
Your daily tasks and responsibilities as a health care provider are regulated by federal statutes. These responsibilities include: billing for services, determining which services need to be provided to a particular patient, and even making referrals to other health care providers. If these things are done incorrectly and not in line with the federal regulations, you can be prosecuted criminal or sued civilly.
As you will read below, the more popular area for accusations of health care fraud in Miami seem to be in the area of senior care and assisted living. However, these are not the only areas where you can be accused. In fact, Miami and South Florida are seen as one of the biggest areas for health care fraud.
One of the major concerns by the government is that health care providers stop making medical decisions based on the needs of their patients and start focusing on monetary return. Additionally, health care costs are expensive, and health care fraud tends to cost the government a lot of money–taxpayer money that could be spent on real needs.
In response to rising level of health care fraud the United States government changed the way the way they respond to health care providers suspected of being involved in a fraudulent health care practice. Because health care fraud was rising to such high levels specific agencies and tasks forces were created.
One of these newly created tasks force was the health care fraud task force. One of the major responsibility of this task force is to continuously audit health care providers and the submissions that they make.
As a result of the types of documentation that you submit can be viewed and audited for fraud. Accusations can even stem from mistakes in diagnostics, billing, and even incorrect procedures. The United States government has many different methods of detecting health care fraud. Regardless of how you conduct your practice, your mistakes can result in this allegations.
The government’s health care fraud battle has been taken seriously. They have joined up with other federal and state agencies to investigate and combat health care fraud. Because of the many agencies, you could be liable to both the United States government and the state of Florida. Either jointly or separately.
Unlike many other areas of law, the area of health care fraud usually results in both criminal and civil allegations. These cases can be pursued at ether the same or different time. Unfortunately, a resolution in one often does not mean a resolution in the other. Working with a defense attorney who is aware of all of the consequences that you may face will be important to your health care profession.
Our law firm can put you in contact with an attorney from our health care law group. You will speak with an experienced defenses attorney who has been successful in representing health care fraud clients throughout the county.
Miami Health Care Fraud In The News
Mental Health Care Worker Involved In Health Care Fraud Scheme for Kickback and False Referrals
In 2017 a Miami health care worker was federally indicted for health care fraud charges based on his role in relation to individuals facing criminal charges in the state courts.
The indictment against this Miami health care worker specifically alleged that while working as a health care worker, one who dealt with the criminal courts and the defendant with pending cases. His role was getting these individuals into mental health care programs based on an order from the court.
The allegations go on to allege that the Miami health care worker was receiving payments for the referrals that he made to Greater Miami Behavioral Healthcare Center, Inc. As part of these referrals, it was alleged that the health care worker knew the individuals being referred did not qualify for services.
Regardless of this lack of health care needs qualification, the health care worker was working was falsifying these fraudulent claims. In addition, and as part of his plea, the worker admitted getting into contact with the criminal defendant in the state criminal court and coordinating with them to secure and obtain court orders for mental healthcare treatment rather than being incarcerated.
As part of his guilty plea, the Miami health care worker admitted that this was part of his practice from 2006 to 2012.
In the end, the Miami health care worker pleaded guilty to two counts from his indictment including receiving health care kickbacks. As a result of his guilty plea and admissions to facts, the Miami health care worker was sentenced to five years in prison and was required to pay $9,921,726 in restitution as well as forfeit assets in the amount of $432,829.
Miami Area Doctor Pleads Guilty to Health Care Fraud For Referrals Based On Kickback Scheme
After being charged with multiple federal health care fraud violations, a Miami area docket decided to plead guilty for his role in a health care kickback scheme.
After an investigation by multiple federal and state agencies, Joaquin Mendez had gotten involved in a kickback scheme related to the types of referrals that he made in relation to individuals who were seeking drug and alcohol addiction.
Part of the scheme involved in individuals who referred to addiction treatment when they did not have addiction issues.
There were instances involved referring individuals to the treatment center with the knowledge that the individuals were not actually getting the treatment they needed.
And finally, Mr. Mendez admitted to the fact that when he was referring patients he did not use his medical training to conduct any assessment in order to give the appropriate medical recommendation, rather Mr. Mendez allowed other individuals dictate the type of referral, which was based on the needs of the kickback scheme.
Because of Mr. Medsez’s plea of guilty and his admission to the crimes, he was sentenced to four years in prison and $2 million in restitution.
Operator of around 30 Nursing Homes Charged With Health Care Fraud For Kickbacks
In 017 three individuals out of Miami county were charged with health care fraud due to a kickback scheme that was allegedly implemented amongst the three of them.
As part of the facts against these three individuals, it was found that Defendant PE, operated a network of around 30 nursing homes and assisted living facilities. From this operation, it is alleged that Defendant PE used the personal information that belonged to his residence. This gave him access to information on many individuals, some of which qualified for Medicare and some that did not.
Regardless of these qualifications, it is alleged the Defendant PE referred and admitted them to facilities owned by Defendant PE that would allow them to receive services that were medically unnecessary.
As part of the allegations, it is said that Defendant PE and the others also made referrals to other facilities in return for kickbacks.
These individuals were facing multiple charges, including those charges not directly related to health care fraud. Most specifically, the additional charges included obstruction of justice and money laundering.
$16 Million Medicare Fraud Scheme Between Mother and Son End In Guilty Pleas
A mother and son duo out of Miami have pleaded guilty to their roles and a health care fraud scheme that resulted in $16 million worth of damages to Medicare.
In 2016 various agencies of the United States government teamed up to investigate the businesses run by these individuals. What they found, and was admitted to by the mother in the case, is that the mother owned two pharmacies in the Miami area. The scheme that she was running included paying Medicare beneficiaries and patient recruiters for referring patients for prescriptions that were medically unnecessary.
Even further, regardless of these patients being referred to the pharmacies, many of the prescriptions were not being filled nor dispensed to the patients.
As for the son, he admitted that he was also involved in the scheme. However, his part in the health care fraud scheme was to facilitate the kickback payments to the various beneficiaries. This included writing checks to money launderers to get cash and pay the kickbacks.
After the investigation of these Miami pharmacies, it was found that Medicaid made more than $16 million in payments. This amount is supported by the admissions made by the mother and son while entering into their guilty pleas.
Greater Miami Area Doctor Pleads Guilty To Health Care Fraud Relating To False Diagnoses
Prior to being sentenced to 46 months in prison followed by two years of probation and being ordered to pay $2,114,332.33 in restitution, Dr. Thompson was a practicing physician.
As part of Dr. Thompson’s practice, he diagnosed patients with various conditions. While many of them were honest and true, there were also some that the United States government found to be false.
In pleading guilty, Dr. Thompson admitting that during a period of four years, from 2006 to 2010, he misdiagnosed patients with a rare chronic inflammatory disease of the spine. In response to those diagnoses, he then reported the services to a Medicare program.
Part of the concern with this case was the type of diagnosis that Dr. Thompson was making. When a person is enrolled in a Medicare program, their rate of coverage depends on their health care needs. The more serious the medical condition, the higher their coverage rate. In this case, Dr. Thompson was diagnosed with a rare disease of the spine. This placed the patients at a higher rate.
Because of the type of diagnosis by Dr. Thompson, Medicare pad around $2.1 in fees, most of which went to Dr. Thompson.
Health Care Fraud Statutes That Apply To Miami Health Care Providers
Health Care Fraud 18 U.S.C. § 1347
As a health care provider in Miami, health care fraud accusations can stem from you being suspected to have committed fraud on a health care benefit program by falsely making a claim for a benefit or good without providing any services.
To prove that the allegations for health care fraud are true, your accuser must prove that you:
- Purposely and voluntarily,
- Either succeed or attempt to defraud a health care benefits program
- And that your fraudulent act was to obtain a benefit from the health care program.
Penalties For Health Care Fraud
As a health care provider in Miami, health care fraud ca cause you your to face various penalties, usually, this will be in the form of a range of penalties. For example, in instances of guilt for health care fraud accusations, you could possibly serve a prison term and that term can be for up to ten years. Additionally, there is a fine that you could have to pay. In many instances, you could be ordered both a prison term and a fine to pay. However, this limit can be enhanced to 20 years in the event that you cause any of your patients to suffer injuries from your care that is directly related to your health care fraud, and those injuries resulted in serious bodily injury or death.
Anti-Kickback 42 U.S.C. 1320a-7b(b)
As a health care provider in Miami, certain business deals and referrals you make could be prohibited and you could be charged with violating the anti-kickback statute. This violation would stem from you making a referral to another person with whom you have a financial relationship. This statute applies to both making a referral for the receipt of money and paying money for a referral.
The elements of anti-kickback include that you:
- Solicited or received any numeration
- For the purpose of arranging services (including goods and equipment) that are part of a health care program or exchanging a referral of a patient.
Penalties For Anti-Kickback
As a health care provider in Miami, if you are found guilty of the anti-kick statute you will face a term of prison that could be up to 5 years. There is also a fine that could apply, in which you could face up to $25,000. In many cases, you could be both fined and given a prison sentence.
False statements relating to health care matters 18 U.S.C. § 1035
The types of statements that you maken in relation to your health care services as a Miami, health care providers are regulated. 18 U.S.C. § 1035 requires that the statements you make be true statements. Generally, this statute focuses on the entries that you make in relation to health care benefits programs. These entries could be on patient information sheets, prescriptions, and even claim.s The statute will look at whether you falsified any material fact or made any fraudulent entries in relation with the delivery or payment of a health care benefit.
Penalties For False statements relating to health care matters 18 U.S.C. § 1035
A violation of 18 U.S.C. § 1035, will cause you to be subject to criminal penalties. These criminal penalties could be either a term or imprisonment of up to five years or a fine or both.
If you are a health care provider in Miami, you can also be subject to civil lawsuits alongside criminal charges.
False Claims Act – 31 U.S.C 3729-3733
The false claims, which is very close to the health care fraud statute, is a civil statute.. As a health care provider in Miami, if you are sued for the false claims act you will be sued on a civil basis and in the civil courts. Miami health care providers can be civilly sued by the United States government, generally this would stem from a whistle blower which accuses you of making a false claim of providing services.
Penalties For Violating The False Claims Act
Violating the False Claims Act also comes with penalties. These penalties will be in the form of a fine. Usually, this fine will have a range from $5,000 to $10,000. However, depending on the facts of your particular case. There could be multiple fines that range from $5,000 to $10,000 if you have violated the False Claims Act multiple time. Therefore, you could pay a lot more than $10,000. In addition to this fine, you will likely have to pay some form of restitution. Restitution will depend on the damages that you have caused. You could either pay restitution to individuals or refund the government for the benefits you received.
Physician Self-Referral / Stark Law – 42 U.S.C. 1395nn
In the criminal realm, this statute is referred to as the anti-kickback statute. In the civil realm, the statute is called The Stark law. Essentially this law prohibits Miami health care providers from referring patients to other health care providers or individuals with whom you are closely related either by blood or financially.
The Stark Law comes with four types of sanctions: 1) refunding payments, 2) denial of payment, 3) Civil monetary penalty for helping with a referral scheme, and 4) monetary penalty for the improper claims.
Refunding payments – If you received payments that violated the Stark Law statute because of a prohibited referral, the payments received from that referral you will be required to refund those payments to the individual who paid them.
Denial of payment – when you make a claim for reimbursement for services that are related to an improper referral, then the Stark Law statute will prohibit you from receiving that payment.
Civil monetary penalty for helping with a referral scheme – If you are involved in a referral scheme, the penalty is often a larger amount than the other penalties. This section of the statute focuses on the number of different times that you were involved in an arrangement.. The statute looks at each violation and will order a civil monetary for the total amount and for up to $100,000 for each violation.
Monetary penalty for the improper claims – If you present a bill or claim for services when and have the knowledge that the claim should not be made you could face a penalty of up to $15,000. This statute does not just apply to the government, it also applies when you present bills to most entities related to health care services.
Defenses to Allegations of Health Care Fraud Miami Health Care Providers
Because of the multiple types of health care fraud charges and lawsuits that you could be facing, the penalties will likely be severe. Damages and restitution in health care fraud cases usually result in large amounts due to the ability to calculate amounts from all of your different actions including those against patients, state government, and the federal government.
Having a defense to fight your health care fraud case will be necessary. Working with an experienced defense attorney can help you do find your best defense. An experienced defense attorney will be in constant contact with you and thoroughly research your case. Because having a clear understanding of your case is necessary for your defense.
One of the most important elements of establishing guilt or innocence of a crime is establishing the state of mind requirement. Generally, but not always, in health care fraud, you must have purposely and intentionally performed a fraudulent act. Every case is different and actions that contribute to guilt or innocence can also include whether or not you should have known that your acts were fraudulent. It could be that your acts had not fraudulent intent in them at all. Rather, you made assessments based on your training.
There can many different types of defenses for your case. Some will work better than others, and some may not work. Finding the best defense for you can minimize your penalties or get your case dismissed. That is why it is important to consult with an attorney experienced in health care fraud cases and can help you create a defense taking into account the facts and the unique circumstances of your particular case.
What To Do If You Are Accused Of Health Care in Miami
If you are accused of health care fraud in Miami, you will need to act fast. Find legal representation from a health care defense attorney and contact them right away.
Being accused of health care fraud can result in some unforeseen penalties without a finding that you actually committed health care fraud. This includes loss of licensures and certifications, and even the loss of your job. A quick reaction and defense can help to minimize or eliminate these things from happening.
In the long run, you should be taking proactive steps to help avoid allegations. If you are accused, review your practice and compare it to the allegations against you. Try to pinpoint the practices that have caused the allegations against you in order to discontinue that practice.
Finally, contact a defense attorney. Our law firm has health care fraud attorneys who can review your case and help you to make the appropriate steps in defending your case.