Fraud: Medicare/Medicaid Fraud

Miami Medicare Fraud Lawyers

In the simplest terms, Medicare fraud refers to an individual or corporation that fraudulent bills and collects money from the federal healthcare system under false pretenses. There are several different form of Medicare fraud that are investigated and prosecuted by the federal government. The majority of Medicare fraud cases are prosecuted in federal court. The most significant laws that support criminal prosecutions for Medicare fraud include the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Act, the Exclusion Statute and the Civil Monetary Penalty Law. Violations of these federal statutes are investigated by the Department of Justice (DOJ), the Office of the Inspector General, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services.


The False Claims Act applies to cases where individuals or corporations submit false or fraudulent claims to Medicare for payment. The Anti-Kickback Statue applies to individuals or corporations that offer and pay monies to parties that refer patients to them to receive treatments or care paid for by Medicare. The kickbacks usually come in the form of money, but kickbacks can come in the form of room and board. The element of fraud does not need to be proven by the government to prove this charge. The Physicians Self-Referral Act prohibits doctors from referring patients to facilities in which they have a pecuniary and financial interest. The Exclusion Statute prohibits doctors and others previously convicted of Medicare fraud and other criminal offenses from participating in the federal healthcare system. Under the Civil Monetary Penalty Law, physicians can be required to pay civil penalties and fines for intentionally presenting false claims to Medicare.

The Miami Medicare fraud lawyers at DMT have vast experience in defending health care fraud cases, such as Medicare and Medicaid fraud. Miami Medicare fraud cases are usually brought against owners of doctor's offices, clinics, pharmacies and medical supply businesses. Often doctors, dentists and physicians assistants are also charged in Medicare fraud cases. Generally, a conviction in a Medicare fraud cases carries significant prison time and fines. The majority of the Medicare cases that are prosecuted include; billing for services not performed, billing for medicines not provided to patients, billing for unnecessary or unneeded medical devices or billing for medical devices that are never provided to patients.

The Medicare and Medicaid programs are so complex and confusing that even experienced physicians, physicians' assistants and medical office managers unintentionally violate the current fraud laws. Any simple error may get picked up by a random audit and lead to a state or federal investigation. It is essential to hire a Miami criminal lawyer at DMT at the onset of the investigation. Failure to defend your case properly can result in prison time, monetary forfeitures, civil RICO litigation, and the loss of medical and professional licenses.

The Miami criminal lawyers at DMT have represented clinic owners and doctors and other medical professionals in Miami Medicare and Medicaid fraud cases. Our aggressive and skilled representation will prove to the law enforcement authorities and the prosecution that our clients did not have the requisite intent to defraud and therefore, did not commit the crimes of Medicare and Medicaid fraud. If you or a loved one is being investigated for a Miami medicare fraud case, it is important to consult with the Miami criminal lawyers at DMT, so we can protect and defend your rights.

To speak with a skilled Miami or South Florida Criminal Lawyer at DMT about your Miami Medicare fraud or Miami Medicaid fraud case, or if you have questions regarding Medicare or Medicaid fraud, please contact DMT to schedule your free consultation. You can call our office at (305) 444-0030 or reach us by completing the form on our contact page or by sending an e-mail. We are available every day of the year, 24 hours a day.