What happens if you become the target of a healthcare fraud investigation?

No healthcare provider wants to become the target of a healthcare fraud investigation. But, as we have seen, it happens more often than we would like to think. Not only does a healthcare fraud investigation come with the potential for criminal penalties, but the state also can impose harsh consequences resulting in the loss of your professional license and ultimately your livelihood.

In 2009, Florida lawmakers passed a bill creating Florida Statute section 456.0635, which establishes penalties for healthcare professionals involved in fraud.

In 2012, the legislation underwent some revisions and covers a wide range of violations including non-healthcare related fraud and drug-related crimes.

For providers and practitioners who spent years obtaining a medical education, and even more years continuing their training, or for those who have invested significant amounts of money in their healthcare-related business, the consequences can prove to be personally and financially devastating.

The statute is complex and has a number of subsections. For example, Chapter 817 addresses fraudulent practices, such as making false statements, mortgage fraud, and fraudulent use of credit cards. Chapter 893 addresses drug abuse prevention and control such as unlawful use, possession, manufacture, delivery, or transportation of controlled substances. And, Chapter 409 addresses social and economic assistance, which includes oversight of the integrity of the Medicaid program.

Generally speaking, this statute prohibits healthcare professionals from engaging in Medicaid fraud and requires the Department of Health to refuse to admit to exams and to deny licenses, permits, or certificates to anyone who has engaged in the prohibited acts. The statute requires healthcare practitioners to report allegations of Medicaid fraud, and specifies that the relinquishment of a license in anticipation of charges relating to Medicaid fraud constitutes permanent revocation of a license.

Those convicted, or who enter a nolo contendere plea, can face a period of probation ranging from five to 15 years, depending upon the seriousness of the conviction. And, that’s the least of your problems. Convictions can come with long-term prison sentences, fines and demands for repayment.

Ignorance is not a defense in today’s healthcare environment. Our team of highly skilled attorneys and consultants are here to help you before you become the focus of an investigation and we will aggressively defend you should you become the target of one.

The Health Law Offices of Anthony C. Vitale represents clients facing allegations of fraud and abuse, compliance counseling and the defense of civil, administrative, regulatory and criminal healthcare fraud, including internal/defense investigations; False Claims Act litigation; settlement negotiations; withholding of Medicaid/Medicare payments; Overpayments; exclusion from participation in Medicare/Medicaid programs; licensure and certification; DEA registration, anti-kickback violations; medical necessity issues; Qui Tam investigations (whistleblower), prosecutions and defense; healthcare contracts, and physician self-referral (Stark).

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The Health Law Offices of Anthony C. Vitale