Tampa Health Care Fraud Defense Lawyers
Health care fraud can take many forms and is illegal under both federal and state law. Those accused face criminal penalties in addition to the possible loss of their license. If you have been accused of fraud, contact O’Mara Law Group today. Our Tampa health care fraud defense lawyers will identify the best defense possible.
Common Examples of Health Care Fraud
The types of health care fraud today are almost too numerous to list. However, most fraud consists of using some scheme or misinformation to obtain benefits from a health insurer, including government insurance programs like Medicaid.
For example, Florida Statute § 817.234 prohibits providing a false, misleading, or incomplete statement with the intent to injure as part of an insurance claim. For example, a doctor cannot lie about the severity of a person’s injuries when providing testimony or medical statements for an insurance claim.
Federal law also prevents paying for referrals, called kickbacks. Offering money or anything of value in exchange for a referral undermines the integrity of the health care profession and can lead to unnecessary medical procedures.
The Stark Law also prevents doctors from referring patients to practices in which they have an ownership stake. For example, a doctor cannot refer a patient to see an ophthalmologist whose practice the doctor co-owns.
Prescription drug fraud has also increased over the past decade and is a focus of investigators. It consists of unnecessary prescriptions with the purpose of defrauding an insurer. Sometimes, pharmacists prescribe pills so they can be sold or distributed to the public for profit. This type of fraud also runs afoul of federal narcotics laws.
Insurance Fraud and Professional Licenses in Florida
Any insurance fraud can cost a professional his or her license. Florida Statute § 456.0635 states that licensing boards must refuse to admit or issue a license to any applicant who has been convicted or pled guilty to various felonies, including health care fraud.
Losing a license has a devastating impact. Defendants lose the ability to support themselves but also see their reputations ruined. The law does not bar someone from a license forever, however. For example, someone convicted of a first-degree felony loses their ability to obtain licensure for 15 years, but someone with a third-degree felony only loses it for five.
Why Insurance Fraud Cases Are Complicated
Because the law also prohibits omissions of material facts, many innocent people can be charged with health insurance fraud. What counts as “material” is often in dispute. Some insurers aggressively reject claims and might complain to regulators that your statements in support of an insurance claim were misleading.
A conviction for health care fraud requires that a defendant know their statements were false or misleading. Knowledge is hard to prove, but this fact doesn’t prevent prosecutors from bringing fraud charges.
Medical Professionals Need a Tampa Health Insurance Fraud Attorney By Their Side
O’Mara Law Group has the skills and experience needed to fight back against health insurance fraud claims. Please contact us today to schedule a consultation.