Public Assistance Provider & Administrator Fraud in Miami

Dennis Gonzalez Jr. is a former Miami-Dade prosecutor who has been defending people since 2012. Our office answers 24 hours a day.

Charges Against Administrators and Employees

Misappropriating (Instr. 20.7, § 414.39(3)(a) and (3)(b)) (Elements). The instruction has two versions:

• (3)(a): you had duties in administering or distributing state or federally funded public assistance, or in its authorizations or identifications; by virtue of your position you were entrusted with, or gained possession of, food assistance, an authorization, a certificate of eligibility for prescribed medicine, a Medicaid card, or other public assistance; and you fraudulently misappropriated it, attempted to, or aided and abetted another.
• (3)(b): you had those duties, and you knowingly misappropriated, attempted to, or aided or abetted the misappropriation of funds given in exchange for food assistance benefits, or any form of food assistance benefits authorization.

Failure to disclose (Instr. 20.8, § 414.39(3)(a)) (Elements): you had those duties, you knew someone had misappropriated (or tried to, or helped) the benefits or cards, and you failed to disclose that fraudulent activity.

Charges Against Providers and Others

Receiving unauthorized payments (Instr. 20.9, § 414.39(4)(c)) (Elements): you knowingly received, attempted to receive, or aided and abetted the receipt of an unauthorized payment or other unauthorized public assistance, authorization, or identification.

Failing to credit (Instr. 20.10, § 414.39(4)(b)) (Elements): the statute covers knowingly failing to credit the state or its agent for payments received from Social Security, insurance, or other sources. The instruction frames this as knowingly filing a claim for services without crediting those payments.

Billing in excess (Instr. 20.11, § 414.39(4)(a)) (Elements): you knowingly billed a benefits recipient, or the recipient's family, more than the law or regulation allows.

Filing for services not rendered (Instr. 20.12, § 414.39(4)(a)) (Elements): you knowingly filed, attempted to file, or aided and abetted filing a claim for services to a benefits recipient, and the claim was false, for services not rendered, or for unauthorized items or services.

Penalties

The jury decides the value (for billing in excess, the amount wrongfully billed) in any 12 consecutive months:

• Under $200: first-degree misdemeanor (up to 1 year, $1,000 fine).
• $200 to under $20,000: third-degree felony (up to 5 years, $5,000).
• $20,000 to under $100,000: second-degree felony (up to 15 years, $10,000).
• $100,000 or more: first-degree felony (up to 30 years, $10,000).

Paying the money back is not a defense under the statute. These are maximums, not what every case gets. Separately, a provider who asks for or receives a payment or contribution from a recipient or the recipient's family must report it to DCF within 10 days; failing to do so is a first-degree misdemeanor.

Defense Themes

• Knowledge. Billing errors, coding mistakes, and confusing rules are not the same as knowingly filing a false claim.
• The 12-month value. Felony tiers depend on aggregated amounts. We audit the State's math.
• Who did what. In a clinic or an agency, many people touch a claim. We separate your role from others'.
• Records. Under the statute, a paid state warrant or PIN transaction history is prima facie evidence of receipt, and department investigative records can come in as business records. We test those records.

What to Do First

1. Do not meet with investigators or auditors without a lawyer.
2. Preserve your records. Do not alter, delete, or "fix" billing files.
3. If you hold a professional license, the case can affect it. See Administrative Hearings & License Defense.
4. Call us.

Why Choose Dennis Gonzalez Law, P.A.

• Former Miami-Dade prosecutor.
• Defending people since 2012.
• Super Lawyers recognition and an Avvo Rating of 10.0.
• Bilingual office — se habla español.
• We answer 24 hours a day. Call (305) 209-0384.

Frequently Asked Questions

I'm a caseworker and I didn't take anything. Can I be charged?

Under § 414.39(3)(a), a person with those duties who knowingly fails to disclose another person's misappropriation can be charged.

Is this the same as Medicaid fraud?

They can overlap, but Florida also has a separate Medicaid provider fraud law, and federal charges are possible. See Medicaid Fraud and Healthcare Fraud.

If we refund the overpayment, is it over?

Florida law says repayment is not a defense or a ground for dismissal. It can still matter in how the case is resolved.