Medicare Fraud Defense in Miami

If agents have visited your clinic, a coworker has been interviewed, or you received a target letter or grand jury subpoena, the time to get a lawyer is now, before you say anything.

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 Medicaid Fraud.

The Federal Charges in a Medicare Case

Health care fraud. It is a federal crime to knowingly and willfully carry out, or try to carry out, a scheme to defraud any health care benefit program, or to get its money or property by false or fraudulent pretenses, in connection with health care benefits, items, or services. The penalty is up to 10 years in prison and a fine; up to 20 years if the violation results in serious bodily injury; and any term of years or life if it results in death.

Conspiracy and attempt. A person who attempts or conspires to commit health care fraud, wire fraud, or mail fraud faces the same penalties as the crime itself. Conspiracy charges can reach people who never billed Medicare directly.

False statements in health care matters. Knowingly and willfully falsifying or hiding a material fact, or making a materially false statement or using a false document, in any matter involving a health care benefit program carries up to 5 years.

Kickbacks. Under the federal anti-kickback law, it is a felony to knowingly and willfully offer, pay, solicit, or receive any payment, including a kickback, bribe, or rebate, in cash or in kind, in return for or to induce patient referrals, or the ordering or recommending of items or services, that a federal health care program may pay for in whole or in part. The penalty is up to 10 years in prison and a fine of up to $100,000. That law defines a federal health care program to include any plan or program providing health benefits that is funded directly, in whole or in part, by the United States Government.

Money laundering. Federal law lists offenses involving a "Federal health care offense" among the crimes that can support a money laundering charge. When the government says Medicare money was moved, hidden, or spent, laundering charges can be added. See Money Laundering.

What the Government Has to Prove About Knowledge

Both the health care fraud statute and the anti-kickback law say a person does not need actual knowledge of that statute, or specific intent to violate it. But the government still has to prove the person acted knowingly and willfully. In many Medicare cases, the real question is what each person actually knew about the billing, the referrals, or the paperwork, and when.

Civil Exposure at the Same Time

Medicare cases can run on two tracks. Under the anti-kickback law, a claim that includes items or services resulting from a kickback violation is a false or fraudulent claim for purposes of the federal False Claims Act. That means a criminal investigation and a civil case for money can move side by side, and what you say in one can affect the other.

Common Areas of Investigation

Medicare cases can involve almost any part of health care, including clinics, home health, durable medical equipment, pharmacies, labs, therapy providers, and billing companies. Issues that come up include services billed but not provided, services that were not medically necessary, patients who were paid or recruited, and money moving from a provider to people who sent patients.

Target Letters, Agent Visits, and Search Warrants

If federal agents come to your home or business:

1. Stay calm. Do not resist or block the agents.
2. Ask to see the warrant and what it covers.
3. Do not answer questions. Say you want to speak with a lawyer first.
4. Do not delete, shred, move, or change anything, including texts, emails, or patient and billing files.
5. Do not contact coworkers, patients, or marketers about the investigation.
6. Call us. (305) 209-0384.

If you get a target letter or grand jury subpoena: do not call the agent or prosecutor yourself. A target letter is a serious signal, and the period before indictment is often when a lawyer can do the most. Let us respond for you.

Early counsel. We can find out where you stand, keep you from making statements that fill gaps in the government's case, protect your records, and plan for the possibility of charges, including a voluntary self-surrender and bond. In fraud cases the government may question where bond money comes from; see Bond & Nebbia Hearings.

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

I never submitted a claim to Medicare. Can I still be charged?

Yes. People can be charged with conspiracy or attempt, and those charges carry the same penalties as the underlying fraud. Your role and knowledge are central to the defense.

I was paid to bring in patients. Is that a crime?

It can be. The federal anti-kickback law prohibits paying or receiving remuneration for referrals that a federal health care program may pay for, but the law lists exceptions, such as pay to a bona fide employee. The details matter.

Is there a deadline to respond to a target letter?

Each letter is different. Do not ignore it, and do not respond on your own. Call a lawyer right away.

Will I lose my license or my Medicare enrollment?

Criminal charges can have licensing and program consequences. We consider those from the start.

How fast can you help?

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