Federal Criminal Defense Lawyer

Health care fraud is committed when a deceitful provider or consumer deliberately submits, or causes someone else to present, false or deceptive information for use in determining the amount of health care benefits allocated.

Some examples of provider health care fraud are:

  • Billing for services that were never performed
  • Upcoding – billing for a more costly service than the service that was actually performed
  • Unbundling – billing each stage of a procedure as if it were a separate procedure
  • Waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan
  • Over-prescribing controlled medication
  • Misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic procedures       
  • Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care agreement
  • Falsifying a patient’s diagnosis to give reason for tests, surgeries and/or other procedures that are not medically required
  • Internet Pharmacy Violations
  • Accepting kickbacks for patient referrals


Some examples of consumer health care fraud are:

  • Filing claims for services or medications not rendered
  • Forging or changing bills or receipts
  • Use of someone else’s insurance card or coverage

Possible Penalties

  • Prison
  • Extremely high fines and fees
  • Restitution

The penalties for even minor violations can be extensive, including professional sanctions and the loss of your professional license, alongside criminal charges. Health care fraud cases may involve many difficult financial matters and an extensive amount of investigation. There could possibly be a number of different issues to review, as well as medical and financial records that must be evaluated for any errors or attempted fraud.

It is imperative that your attorney have the experience necessary to handle health care fraud charges. As a former prosecutor and trial attorney, Miami health care fraud attorney Armando Hernandez has the qualifications you should look for in your legal counsel. Mr. Heranndez is skilled in handling all health care fraud cases in and throughout South Florida. If you or your practice is currently under investigation for health care fraud, or if you have already been arrested and charged with this serious crime, it is important to contact attorney Hernandez immediately. 

For more information and your free consultation contact attorney Armando Hernandez today at 305-442-2590.