Miami Medicare Fraud Attorney for Providers Under Investigation
A Medicare fraud investigation rarely announces itself. It arrives as a records request, a subpoena, a visit from agents or a phone call to one of your employees. By the time the government asks you its first question, it often already has a theory. If your practice, clinic or healthcare company in Miami-Dade is under review, you need a Miami Medicare fraud attorney before anyone on your team answers that question.
The Health Law Offices of Anthony C. Vitale, now practicing as Vitale, Suarez & Associates, P.A., has represented healthcare providers in Florida investigations from its office in Miami Lakes since 1982.
How Medicare Fraud Investigations Start
- A UPIC review. A Unified Program Integrity Contractor analyzes claims data, requests records and can recommend a payment suspension or a referral to HHS-OIG.
- An HHS-OIG subpoena for documents.
- A civil investigative demand from the U.S. Department of Justice under the False Claims Act (31 U.S.C. § 3733).
- A qui tam complaint filed under seal, often by a current or former employee, which the government investigates before deciding whether to intervene.
- Agents at the door, with or without a search warrant.
A records request is not always a fraud investigation. It is always a reason to be careful about what you send.
Civil, Administrative and Criminal Exposure Are Not the Same
The same claims can support three kinds of cases at once:
- Civil: False Claims Act liability (31 U.S.C. §§ 3729-3733), with damages and per-claim penalties.
- Administrative: civil monetary penalties (42 U.S.C. § 1320a-7a), exclusion from federal healthcare programs (42 U.S.C. § 1320a-7) and payment suspension.
- Criminal: healthcare fraud (18 U.S.C. § 1347) and the federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)).
A billing error is usually a payment issue. What turns it into fraud is knowledge, intent or a pattern that looks deliberate, and your own documents are where investigators look for all three.
The First 72 Hours
The first response window matters. Preserve every record, including email and EHR audit logs. Do not alter or complete old charts. Do not let staff give informal interviews. Do not contact anyone you believe reported the practice. Call counsel before you produce anything.
An explanation offered in a hallway, such as “we always billed it that way,” can later be cited as evidence of knowledge.
30+ Years of Expertise in Healthcare Law and Compliance
Strategic Legal Solutions for Healthcare Providers
What Counsel Does Before Records Are Produced
- Identifies who is investigating, under what authority and what the request actually covers
- Negotiates scope and timing of the production
- Directs an internal review, so that analysis of legal exposure may be protected by attorney-client privilege where applicable
- Handles communication with agents and government attorneys
- Evaluates whether a disclosure or repayment should be considered, and when
Experience on Both Sides of a Florida Fraud Investigation
- Louis V. Martinez served as Deputy Chief Assistant Attorney General for Florida's Medicaid Fraud Unit, leading more than 50 attorneys, investigators and support staff in Palm Beach, Broward and Miami-Dade counties, and as a Special Assistant United States Attorney for the Southern District of Florida.
- Anthony C. Vitale, the firm's founder and now Of Counsel, served as an Assistant State Attorney in Miami-Dade County from 1978 to 1981. He argued State v. Harden, in which the Florida Supreme Court in 2006 struck down the anti-kickback provision of Florida's Medicaid provider fraud statute, section 409.920(2)(e), because it conflicted with federal law.
- In-house IT and forensic investigations. The firm's own team reviews EHR audit logs, metadata and electronic records before they are produced.
- English and Spanish. The firm's attorneys work with clients in both languages.
Serving Providers in Miami-Dade and Broward
The firm’s office is in Miami Lakes, in Miami-Dade County. It works with providers in Miami, Hialeah, Doral, Coral Gables, Fort Lauderdale and across South Florida. Federal healthcare fraud cases in Miami-Dade and Broward are handled by the U.S. Attorney’s Office for the Southern District of Florida.
Frequently Asked Questions
Should I talk to investigators if I believe I did nothing wrong?
Not before speaking with counsel. A sincere explanation without the records in front of you can contradict the documents, and that contradiction becomes part of the case.
What is a civil investigative demand?
It is a demand from the Department of Justice for documents, written answers or testimony in a False Claims Act investigation. It has deadlines and it is enforceable, so it should be reviewed by counsel as soon as it arrives.
Is a UPIC records request a fraud investigation?
Not always. A UPIC reviews claims for potential fraud, waste and abuse, and its findings can lead to an overpayment, a payment suspension or a referral to law enforcement. How you respond can influence which of those follows.
Do the firm’s attorneys speak Spanish?
Yes. The firm works with providers in English and Spanish.
The owner of a Tampa, Florida-area medical marketing company was sentenced to 70 months in prison today for his role in a $2.2 million Medicare fraud scheme involving the payment of kickbacks and bribes to fraudulent medical clinics in Miami in exchange for the referral of Medicare beneficiaries for expensive genetic tests that were medically unnecessary, and for his role in the illegal structuring of cash withdrawal transactions.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Maria Chapa Lopez of the Middle District of Florida, Special Agent in Charge Michael McPherson of the FBI’s Tampa Field Office and Assistant Inspector General Omar Perez of the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.