Health care fraud is an increasingly scrutinized criminal activity that invites constant attention from Federal and State prosecutors and regulatory agencies. When health care fraud makes the news, it is often in a big way, with defendants charged for collecting tens of millions in fraudulent profits and kickbacks.

In 2007, the FBI established a Health Care Fraud Strike Force that has charged over 4,600 defendants nationwide for scams against private insurers and Federal health care programs alike. It should be no surprise, either, that Florida is one of the nation’s leading states for health care and Medicare fraud. Law enforcement agencies are constantly on the lookout for ongoing and potential health care scams in Florida. These investigations catch perpetrators but can also leave some innocent people caught in a legal mess due to mistakes and billing errors.

Examples of Health Care Fraud in Florida and Nationwide

What is “health care fraud”, exactly? Health care fraud can include any of the following schemes and more:

  1. Fraud by Medical Providers
  • Double billing for the same service
  • “Phantom” billing for supplies or service never given to a patient
  • “Upcoding” – billing for a more expensive service or supply than was given to the patient
  • Unbundling – submitting more than one bill for the same service
  1. Fraud Committed by Individuals 
  • False marketing – using fabricated communications to obtain identification numbers and other personal information to steal identities, falsify enrollments, and bill for non-rendered services and supplies
  • Identity swapping – allowing others or asking others to exchange personal information for insurance or billing purposes
  • Impersonating health care professionals – billing for or rendering services or supplies without a proper license
  1. Prescription Fraud
  • Forgery – falsifying prescription information to obtain medications not prescribed by a doctor
  • “Doctor shopping” – scheduling appointments with more than one doctor or provider to obtain multiple prescriptions for the same drug. This often includes some level of unethical or illegal practice by the providers themselves.
  • Diversion – taking legal prescriptions and “diverting” them for improper purposes. This may include selling prescriptions or bartering them for other drugs.

Since 2020, COVID-related health care fraud has emerged as yet another method for scammers to commit fraud through false billings, kickback schemes, sale of fake vaccination cards, and fraud against the Provider Relief Fund (PRF) – part of the CARES Act. The Department of Justice recently announced a targeted enforcement effort against COVID-19 fraud schemes, with charges against Defendants that have received over $149 million in false billings to Federal programs.

With the spotlight on health care fraud and law enforcement resources dedicated to combating these forms of fraud, health care providers must maintain rigid compliance and monitoring procedures to avoid potential problems.

When to Call a Tampa Criminal Defense Attorney

Any potential investigation or charge against a health care provider requires a quick and careful response – preferably with an experienced Florida fraud defense attorney. Having a superior legal team at your side to provide guidance and protect your rights is essential in a health care fraud case, whether it is brought by State or Federal agencies.

The Tampa Criminal Defense Team at Trombley & Hanes Can Defend You in a Health Care Fraud Case 

At Trombley & Hanes, our Tampa criminal lawyers are familiar with the various legal approaches used in a health care fraud case, and the techniques prosecutors may use against you. Knowing your rights and how to protect them is an important part of our job. If you face any type of investigation related to alleged health care fraud, contact us today.


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