Healthcare Fraud Attorney in Miami

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Healthcare 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 healthcare benefits allocated.

Acts which may be considered healthcare fraud include:

• 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 a reason for tests, surgeries, and/or other procedures that are not medically required
• Internet pharmacy violations
• Accepting kickbacks for patient referrals
• 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 include:

• Prison
• Restitution
• Extremely high fines and fees

The penalties for even minor violations can be extensive, including professional sanctions and the loss of your professional license, in addition to criminal charges. Healthcare fraud cases may involve many difficult financial matters and an extensive 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. This is why it is imperative that you retain an experienced healthcare fraud attorney in Miami to fight on your behalf.