Tampa Medicare Fraud Investigations: Counsel for Providers
Many Medicare fraud investigations in Florida do not start with a bad claim. They start with how the patient reached you: a marketing company, a laboratory arrangement, a telehealth order or a referral fee written up as a service contract. If your healthcare business in Tampa Bay is under investigation, or a partner of yours is, you need a Tampa Medicare fraud attorney who reads the arrangement the way prosecutors will.
The Health Law Offices of Anthony C. Vitale, now practicing as Vitale, Suarez & Associates, P.A., is a Florida healthcare law firm founded in 1982. Its office is in Miami Lakes, and it represents providers throughout Florida, including the Tampa Bay area.
Why Referral and Marketing Arrangements Draw Scrutiny
Four laws decide whether an arrangement is a business deal or a crime, and they are not interchangeable:
- The federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) prohibits knowingly and willfully offering or paying anything of value to induce referrals of federal healthcare program business. A claim that results from a kickback is a false claim under the False Claims Act (42 U.S.C. § 1320a-7b(g)).
- The Stark Law (42 U.S.C. § 1395nn) prohibits physician referrals for designated health services to entities with which the physician has a financial relationship, unless an exception applies. Intent does not matter.
- The Eliminating Kickbacks in Recovery Act (18 U.S.C. § 220) reaches laboratories, recovery homes and clinical treatment facilities, regardless of who pays.
- Florida's patient brokering statute (section 817.505, Florida Statutes) applies to arrangements in Florida regardless of the payer.
Safe harbors and exceptions exist, and they are narrow. A contract that pays per patient, per test or per referral can be read as evidence, whatever its title says.
Services Under the Closest Scrutiny
Federal enforcement in recent years has focused heavily on genetic and laboratory testing, durable medical equipment, telehealth-ordered services, home health and hospice, and wound care products such as skin substitutes. If your business is in one of these areas, your referral sources deserve a legal review before anyone else reviews them.
How Investigations Develop in the Middle District of Florida
Cases in the Tampa Bay area are handled by the U.S. Attorney’s Office for the Middle District of Florida, working with HHS-OIG and the FBI. They often start with claims data that does not look normal. They grow through subpoenas, civil investigative demands, qui tam complaints filed under seal and interviews with people who were part of the arrangement. In kickback cases, one of the first witnesses is often the marketer.
Strategic Legal Solutions for Healthcare Providers
When a Business Partner Is Charged
When a marketer, laboratory or supplier you worked with is charged, your name may already be in the government’s records. Do not discuss the case with them. Preserve your contracts, invoices and communications. Have counsel review the arrangement before anyone contacts you, and evaluate whether a disclosure, such as the OIG Self-Disclosure Protocol or, for Stark Law issues, the CMS Voluntary Self-Referral Disclosure Protocol, should be considered.
By the time agents call, the arrangement has already been read. The question is whether you have read it first.
Experience on Both Sides of Florida Fraud Cases
- Louis V. Martinez served as Deputy Chief Assistant Attorney General for Florida's Medicaid Fraud Unit and as a Special Assistant United States Attorney.
- Anthony C. Vitale, the firm's founder and now Of Counsel, served as an Assistant State Attorney in Miami-Dade County and 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.
- In-house IT and forensic investigations, for cases that turn on emails, claims data and EHR records.
- The firm's attorneys work with clients in English and Spanish.
Frequently Asked Questions
Is it legal to pay a marketing company?
It can be, if the arrangement is structured within the law: compensation set in advance, consistent with fair market value and not tied to the volume or value of referrals. Those conditions are easy to miss in practice, so the agreement should be reviewed before it is signed.
What is the difference between the Anti-Kickback Statute and the Stark Law?
The Anti-Kickback Statute requires knowing and willful conduct and applies to anyone. The Stark Law applies to physician referrals for designated health services and does not require intent.
Does Florida’s patient brokering law apply to private insurance?
Yes. Section 817.505 is not limited to Medicare or Medicaid.
Does the firm have an office in Tampa?
The firm’s office is in Miami Lakes. It represents healthcare providers throughout Florida, including the Tampa Bay area.
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.