Coral Gables Health Care Fraud Lawyers: Protecting Providers and Patients
Health care fraud is a serious issue that affects providers and patients in Coral Gables and across Florida. Health care fraud refers to intentionally deceiving private health care programs and government health care programs like Medicare and Medicaid in order to receive unauthorized payments. Some common examples include billing for services that were never provided, billing for unnecessary services, kickbacks for patient referrals, and identity theft.
Health care fraud can be committed by doctors, nurses, dentists, pharmacists, medical equipment suppliers, health care companies, and even patients. In some cases, it is an intentional act of fraud to make more money. In other cases, it may be an honest mistake in billing or coding. Regardless of intent, health care fraud is illegal and can result in serious penalties if prosecuted.
Recent Health Care Fraud Cases in Coral Gables
There have been several high profile health care fraud cases in Coral Gables and the Miami area in recent years. Understanding these cases can help providers and companies avoid the mistakes that led to prosecution.
In May 2022, Citizens Property Insurance Corp. settled a lawsuit for $1 million with The Strems Law Firm accusing them of racketeering and running an insurance fraud operation over several years. According to the lawsuit, the firm worked with contractors and consultants to inflate water damage claims against property insurers like Citizens. These excessive lawsuits increase rates for homeowners across Florida.
Another case involved Simply Healthcare Plans Inc., based in Coral Gables. A former executive sued the company for $2 million in stock options after Simply Healthcare was sold to Anthem Inc. for $1 billion. However, the judge dismissed the lawsuit after finding the plaintiff fabricated evidence and misled the court, committing fraud against both the company and the judicial system.
Just recently in October 2022, the Florida Attorney General announced charges against two Miami health care workers for alleged fraud in connection with telemedicine and genetic testing. Over 20 individuals were charged nationwide in coordinated law enforcement actions led by the Department of Justice.
Why Providers Need a Lawyer When Facing Fraud Investigations
The penalties for health care fraud can be severe, including huge fines and even federal prison time. That’s why having an attorney is so important from the very beginning of an investigation. An experienced lawyer understands how these types of cases work.
They will advise you not to speak to investigators and let them handle communication. They can work to get charges reduced or even dismissed by scrutinizing the prosecution’s evidence and working with medical experts. For providers that did make honest mistakes, a lawyer can argue for leniency and present mitigating factors to the court. They will also advise you on steps to take to prevent issues in the future and avoid recurrence.
Health care fraud allegations can also affect your professional reputation. An attorney can help mitigate damage to your practice and keep the investigation private until absolutely necessary. Having the right legal defense protects your finances, freedom and career when facing health care fraud charges.
What to Look for in a Coral Gables Health Care Fraud Lawyer
When researching attorneys for health care fraud cases in Coral Gables, there are several important things to look for:
- Specialization in health care law – You want someone who focuses specifically on health care fraud defense, not a general practice lawyer. They should have extensive experience representing doctors, hospitals, pharmacies, etc.
- Knowledge of local courts and prosecutors – Understanding the local legal landscape in Coral Gables and Miami can help in negotiations and building a defense. An attorney experienced with local judges gives you the best chance.
- Resources for investigating cases – Top fraud lawyers have the resources to do deep dives into the prosecution’s allegations and evidence. This can include hiring medical experts, forensic accountants and investigators to review your case.
- Track record of success – Of course, you want an attorney that has a proven track record of getting positive outcomes for clients facing health care fraud charges. Be sure to ask about their past case results.
Some of the top rated health care fraud defense firms in Coral Gables include Izquierdo Law Firm, David M. Trontz, and Donet, McMillan & Trontz. You can research a firm’s experience in this niche area of law to find the best attorney for your needs.
Proactive Steps Providers Can Take to Prevent Fraud
The adage “an ounce of prevention is worth a pound of cure” definitely applies to health care fraud. There are steps providers can take to help avoid billing errors and mistakes that can potentially lead to fraud allegations:
- Careful billing procedures – Have clear written policies for billing, coding and documentation. Regularly train staff on proper protocols. Audit billing practices to catch any issues.
- Compliance programs – Maintain an active compliance program to stay up to date on regulations. Designate a compliance officer to oversee efforts.
- Claims review – Scrutinize claims to catch any outliers, anomalies or suspicious patterns that could signal problems.
- Patient documentation – Maintain thorough documentation of each patient interaction and treatment to substantiate every claim.
- Stay updated – Continuing education on billing rules, documentation requirements, coding changes, etc. can help avoid errors.
Of course, honest mistakes can still happen even when providers try to do everything right. But being proactive reduces fraud risk and puts you in a better position if questioned. Reach out for legal counsel at the first sign of an audit or investigation.
Protect Your Practice with a Coral Gables Health Care Fraud Lawyer
Health care fraud allegations can have severe consequences for providers and practices in Coral Gables and Miami. These complex cases require an attorney experienced in health care law and fraud defense to protect your interests. Be proactive in compliance and record keeping, but know you still may need legal help if investigated. Do your research to find the right lawyer to defend against health care fraud charges. With an attorney guiding you, you have the best chance of a favorable outcome.