Coral Gables Medicaid Fraud Lawyers – Protecting Your Rights

Medicaid fraud allegations can ruin careers and lives if not properly handled. That’s why it’s critical to have an experienced Coral Gables Medicaid fraud defense attorney on your side from the start. I’m Richard Diaz, a former prosecutor turned criminal defense lawyer with over 20 years of experience specifically handling healthcare fraud cases in Miami-Dade County.

In this article, I’ll overview common Medicaid fraud charges, potential penalties, and key defenses our legal team uses to fight allegations. I’ll also discuss why choosing the right lawyer from the start is so important when facing accusations that could land you in prison.

Understanding Medicaid Fraud Allegations

Medicaid fraud covers a wide range of potential criminal offenses – from billing for services never rendered to paying kickbacks for patient referrals. Even unintentional mistakes can trigger severe charges if federal prosecutors believe illegal activity occurred.

Some common allegations my firm defends against include:

• Billing for unnecessary services – Being accused of running unnecessary tests or procedures solely to overbill Medicaid. This often involves allegations of diagnosing patients with conditions they don’t actually have.
• Upcoding services – Billing for more expensive services than were actually provided. For example, billing a basic office visit as a more complex medical exam.
• Billing for services not rendered – One of the most serious Medicaid fraud allegations. Facing claims that you billed Medicaid for patient services that never actually occurred.
• Paying kickbacks – Accusations of paying or receiving bribes/kickbacks in exchange for Medicaid patient referrals. An unfortunately common allegation against healthcare professionals.
• Obstruction charges – Once an investigation starts, prosecutors often pile on charges like obstruction of justice, making false statements, or destroying records.

The key is knowing these charges are just allegations. The government has the burden to prove guilt beyond reasonable doubt. A skilled defense lawyer’s job is making them meet that very high bar.

Penalties for a Conviction Can Be Severe

Medicaid fraud convictions often carry severe sentences under federal law including:

• Up to 10 years in federal prison per offense
• Massive fines – $50,000 or more per fraudulent claim
• Treble damages – Having to pay back 3x any wrongfully obtained Medicaid funds
• Permanent exclusion from Medicaid/Medicare programs
• Loss of professional license and livelihood

Prosecutors often pursue the harshest punishments allowed to “set an example” and discourage others from defrauding Medicaid. It’s critical to fight allegations aggressively from the start – the risks of losing at trial are too great. An experienced defense attorney’s job is putting together the strongest case possible to avoid convictions and limit penalties.

Why the Right Lawyer Matters from the Start

Once we’re retained, our legal team immediately begins reviewing records, meeting with key witnesses, and building defenses. Too often healthcare professionals wait until after charges are filed or make critical mistakes handling the investigation alone. That can permanently sink the chances of winning at trial.

Key reasons having an experienced Medicaid fraud attorney matters so much:

1. Guiding You Through the Investigation – We deal with federal investigators regularly and know the tactics they use to try to obtain damaging statements or records. Before you provide any potentially incriminating information, you need an advocate protecting your rights.

2. Identifying Weaknesses in the Allegations – Prosecutors often move forward based on limited information from disgruntled employees or incomplete records. An experienced defense lawyer spots potential flaws right away.

3. Presenting Your Side of the Story – Criminal investigations are inherently one-sided with prosecutors only focused on building a case against you. Your lawyer makes sure your explanations are properly presented early in the process.

4. Negotiating with Prosecutors – Once charges are filed, quickly negotiating a favorable plea deal or having charges dismissed completely may be the best option versus risking trial. But you need an experienced negotiator – not a pushover – fighting for your rights.

5. Building an Aggressive Defense – If settling isn’t in your best interests, we’ll file motions attacking the indictment and start putting together an aggressive defense for trial. Your freedom and livelihood depend on not taking allegations lightly.

The bottom line? Medicaid fraud investigations can become complex “David vs Goliath” battles with experienced federal prosecutors. Protect yourself with an expert defense lawyer on your side from day one.

Why Choose Richard J. Diaz, P.A.?

I founded Richard J. Diaz, P.A. over 20 years ago with a mission of providing aggressive, client-focused representation. As a former Miami-Dade County prosecutor, I handled dozens of Medicaid fraud cases and saw firsthand how the state builds these types of cases.

That prosecutorial experience is now used to safeguard the rights of healthcare professionals facing fraud allegations. My firm also includes former healthcare industry investigators and auditors who can quickly identify weaknesses in allegations.

If you’re being accused of defrauding Medicaid, I encourage you to schedule a free case review right away. We’ll discuss your situation, answer any questions about the process, and start building an aggressive defense strategy. Your career and freedom may depend on having an expert like us fighting for your rights.

Recent Coral Gables Healthcare Fraud Cases

To give you an idea of some Medicaid fraud cases we’ve handled recently, here are a few examples:

1. Cardiologist Falsely Accused of Running Unneeded Tests

Dr. R was a well-respected Coral Gables cardiologist when a disgruntled former employee reported him to AHCA for fraud. The allegations? That he was running unnecessary cardiac tests on dozens of Medicaid patients solely to overbill the government programs.

A federal investigation ensued with prosecutors demanding medical records and interviewing staff and patients. Thankfully Dr. R hired us immediately upon learning of the probe. We worked with his records team to provide properly formatted records and helped prepare statements countering the allegations.

Our own auditors reviewed a sample of supposedly unnecessary tests and found proper medical justification existed in nearly every case. We quickly presented those findings to investigators showing the allegations were likely baseless. Within months the US Attorney’s Office dropped the case completely sparing Dr. R a lengthy legal battle.

2. Home Health Care Agency Accused of Services Never Rendered

A Coral Gables home health agency faced serious allegations of billing Medicaid for care plans never actually provided to patients. This sort of fraud is unfortunately common and carries heavy prison sentences upon conviction.

In this case, a disgruntled nurse reported to AHCA that the agency was billing for skilled nursing and aide hours that were never actually staffed. As typical in these cases, investigators demanded rosters, timesheets, and other records to try proving fraudulent billing occurred.

After we were retained, our team moved swiftly to gather properly formatted records refuting the allegations. We assisted agency management with responding to records demands and interviewed staff to understand exactly what occurred.

Our subsequent presentations to state and federal investigators highlighted the lack of evidence of any intentional fraudulent conduct. Ultimately prosecutors declined to press charges sparing the agency and staff from potential criminal convictions.

Why Waiting to Hire a Lawyer Can Be Costly

In another recent South Florida home health case, agency leadership attempted to handle the investigation themselves without proper legal guidance. That proved to be a costly mistake.

Initially, the owners cooperated fully with investigators by providing requested records and statements. However, their records were not properly formatted per complex Medicare/Medicaid guidelines. And the owners statements to investigators were used as alleged “admissions” of unlawful conduct.

Within months the US Attorney’s Office filed a sweeping 56 count Medicare fraud indictment. The owners now face decades in prison and millions in fines if ultimately convicted.

This case highlights why having experienced counsel guiding you early in fraud investigations is so critical. We know federal prosecutors and AHCA officials well and handle these cases regularly. Don’t let allegations spin out of control – protect yourself and your business by engaging strong legal counsel immediately.

The Investigation and Defense Process Explained

If you’re currently facing Medicaid fraud allegations, having a clear understanding of the process and timeline can provide some peace of mind. While every case has its unique aspects, here is a general overview of how these cases proceed:

1. Investigation Starts – The investigation typically starts with a complaint being filed with AHCA or federal HHS-OIG. Depending on the severity, it may then get referred to the US Attorney’s Office for criminal investigation.

2. Records Demands Issued – Investigators start by demanding medical billing records, patient files, and other documentation. This is where having an experienced attorney guide your response becomes critical.

3. Interviews Conducted – Investigators will want to question you and your staff early in the process to understand your side of the story. Declining to be interviewed can sometimes be wisest decision.

4. Subpoenas Issued – We start seeing grand jury subpoenas seeking additional records. For example, they may subpoena phone records, bank statements or employee emails later in the investigation.

5. Charging Decision Made – After gathering all their evidence, prosecutors decide whether to file formal charges or decline the case. Your defense presentation can heavily influence whether charges are filed.

6. Plea Negotiations (If Charged) – An experienced defense lawyer will pursue negotiations with prosecutors to minimize charges or penalties. Oftentimes charges can be reduced or avoided completely through effective negotiations.

7. Motions Filed (If Charged) – We immediately file motions to dismiss attacking procedural flaws or lack of evidence in the prosecution’s case. For example, we may allege your rights were violated in how evidence was collected.

8. Trial (If No Plea) – If a reasonable plea deal can’t be reached, we’ll aggressively defend your case at trial. We routinely defend complex white collar cases and know how to present compelling defenses to juries. An acquittal after trial is always our ultimate goal if negotiations fail.

The most critical times to have strong legal guidance are during the early investigation (to avoid charges being filed) and during plea negotiations (to minimize penalties if charged). Don’t assume you can just wait to hire a lawyer until after charges are filed. That mistake can lead to far worse outcomes.

Why Our Team Is Uniquely Positioned to Defend Your Rights

Facing Medicaid fraud charges isn’t easy. The government often pursues harsh punishments to discourage others from defrauding health care programs. But complex cases also come with holes ripe for an experienced defense lawyer to exploit.

After over 20 years exclusively handling healthcare fraud cases in South Florida, I’ve seen just about every type of allegation and government tactic. I founded Richard J. Diaz, P.A. with a focus on protecting the rights of healthcare professionals facing fraud investigations and charges.

My firm has the expertise and resources to build an aggressive defense against allegations including:

• Former Healthcare Fraud Prosecutors – As a former prosecutor, I know exactly how federal and state investigators develop these cases and where weaknesses can be exposed. Your defense strategy is led by a true insider.
• Industry Experience – Our team includes former healthcare executives, auditors, and investigators who quickly identify flaws in allegations and records demands. We understand the complexities of medical billing and documentation.
• Forensic Accounting Experts – Our auditors can review billing/medical records to prove alleged fraud is unsupported or simply the result of mistakes.