Medicaid Fraud Defense in Miami

Dennis Gonzalez Jr. is a former Miami-Dade prosecutor who has been defending people since 2012, in state court and in federal court in the Southern District of Florida. Our office answers 24 hours a day.

This page is part of our Economic Crimes Defense practice. See also Health Care Fraud and Medicare Fraud.

What Florida's Medicaid Provider Fraud Law Prohibits

Florida law makes it a crime to knowingly:

• Make, cause, or help make a false statement or representation of a material fact, by commission or omission, in a claim to the state Medicaid agency, its fiscal agent, or a managed care plan.
• Bill for items or services Medicaid does not authorize.
• Charge or accept anything of value, other than an authorized copayment, on top of what Medicaid legally pays, or fail to credit Medicaid for money received from a third party.
• Put false material facts in cost reports or other income-and-expense documents used to set payment rates.
• Offer, pay, solicit, or receive kickbacks, bribes, or rebates for referrals or orders paid by Medicaid, subject to an exception for practices the federal anti-kickback law does not prohibit.
• Submit false or misleading information to become a Medicaid provider.
• Use a provider's or a recipient's Medicaid ID number to make unauthorized claims.

The Word "Knowingly" Matters

Florida's Medicaid fraud statute defines "knowingly" to mean the act was done voluntarily and intentionally, and not because of mistake or accident. The term also covers "willfully," which the statute defines as acting voluntarily and purposely, with the specific intent to do something the law forbids, and with bad purpose.

A mistake or an accident is not enough. Billing errors, sloppy paperwork, and coding disputes are not the same as a crime, and the defense is often built around that difference.

But be careful about signatures. The same law says that when a claim containing a false material statement is submitted, unless it is satisfactorily explained, that proof gives rise to an inference that the person whose signature appears as the provider's authorizing signature knew about the false statement. That applies to handwritten, stamped, typed, and electronic signatures. Who actually prepared and submitted the claims is a key question.

Penalties Under Florida Law

The degree depends on the value received or attempted:

• $10,000 or less: third-degree felony (up to 5 years in prison).
• More than $10,000 but less than $50,000: second-degree felony (up to 15 years).
• $50,000 or more: first-degree felony (up to 30 years).

Other important rules in the statute:

• Amounts can be added together. Separate payments received or attempted as part of a scheme or course of conduct may be combined to set the degree.
• A large mandatory fine. On conviction, the person must pay a fine equal to five times the unlawful gain or the loss to Medicaid or the managed care organization, whichever is greater, on top of any other sentence.
• Paying it back is not a defense. Repaying, or offering to repay, Medicaid money does not count as a defense and is not a ground to dismiss the charges. Repayment can still matter in negotiations, but it has to be handled carefully, through counsel.

Who Investigates and Prosecutes

Florida law directs the Attorney General to run a statewide program of Medicaid fraud control. Under the statute, the Attorney General can:

• Enter the premises of a participating health care provider, other than a physician, to examine accounts and records. Participating physicians must make relevant accounts and records available.
• Subpoena witnesses and records, including Medicaid patients' medical records, and collect evidence for civil or criminal cases.
• Ask state attorneys and law enforcement agencies for help.
• Refer cases for prosecution to the Office of Statewide Prosecution or the local state attorney.
• Pursue civil remedies, including under the Florida False Claims Act.

Records of non-Medicaid patients may not be reviewed by or turned over to the Attorney General without the patient's written consent.

Federal charges are possible too. The federal health care fraud statute covers any public or private health care benefit program, and the federal anti-kickback law reaches federal and state health care programs as federal law defines them. Some Medicaid cases are charged in federal court.

If Investigators Contact You or Your Practice

1. Be professional. Get names, agency, and contact information.
2. Ask for any subpoena or written request in writing. Do not hand over records or give interviews before talking to counsel.
3. Do not answer questions about billing or referrals without a lawyer.
4. Do not change, backdate, or "complete" records. Do not delete anything.
5. Do not discuss the investigation with staff, billers, or referral sources.
6. Call us. (305) 209-0384.

Search warrants and target letters. If agents arrive with a warrant, don't block them, don't answer questions, and call us. If you receive a target letter or subpoena, let a lawyer respond. Early counsel can sometimes shape whether, how, and against whom charges are filed. If charges are coming, we can often arrange a self-surrender and plan ahead for bond and a possible Nebbia hold.

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.

You can read about some of our past cases on our Results page.

Frequently Asked Questions

If I pay Medicaid back, will the charges be dropped?

Not automatically. Florida law says repayment, or an offer to repay, is not a defense and not a ground to dismiss. It can still be part of a negotiated resolution when handled through counsel.

My biller submitted the claims under my signature. Am I responsible?

Florida law allows an inference of knowledge from the authorizing signature unless the false statement is satisfactorily explained. Who actually prepared the claims, and what you knew, is central to the defense.

Can the State combine small claims into one big charge?

Yes. Separate amounts received or attempted under one scheme or course of conduct may be added together to set the degree.

Can I be charged in federal court for Medicaid fraud?

It is possible. Federal health care fraud and anti-kickback laws can apply to Medicaid-related conduct.

How fast can you help?

Our office answers 24 hours a day. Call (305) 209-0384.