Healthcare / Medicare Fraud

Healthcare fraud usually refers to fraud committed against CMS, or the Centers for Medicare and Medicaid Services. The federal government’s deep pockets attracts fraud in many forms. General types of healthcare fraud include:

  • Billing for tests, treatment, and supplies not actually provided.
  • Conspiracy between a provider and patient to bill for services not provided, with a kickback agreement. Yes, patients can be charged with Medicare fraud too.
  • A healthcare provider might perform unnecessary tests and procedures.
  • Billing for used equipment as if it were new.
  • Upcoding: Inflating costs by using improper billing codes.
  • Unbunding: Billing for a number of tests or treatments separately instead of using a billing code that bundles those items together.
  • “Kickbacks,” or illegal referral fees paid from one provider to another.

Healthcare fraud, Medicare fraud, and Medicaid fraud cost the government billions of dollars each year. South Florida specifically is a haven for this type of activity, so the government is heavily invested in making sure perpetrators are caught and prosecuted.

The Federal Bureau of Investigation (FBI) is the primary police agency investigating these cases. They are proactive and try to target these fraudulent schemes before too much damage is done. That means investigations begin early and may last a long time. Although it’s a federal crime, 18 U.S.C. § 1347, it is also a state crime in Florida too. Florida is a hotbed for all types of healthcare fraud, including Medicare and Medicaid. So much so that the Florida Attorney General’s Office has a special division assigned to these cases, and spares no expense or resource in prosecuting these cases.

Under the federal False Claims Act, a “whistleblower” who turns in someone who is convicted of healthcare fraud can receive a portion of the funds recovered. This is a strong financial incentive for someone who suspects another of Medicare or Medicaid fraud.

State laws. Federal laws. Localized crime. Prosecutorial focus. Whistleblower incentives. For all these reasons and more, healthcare providers in Miami need to understand they are under scrutiny for any potential violation.

Many laws – federal and state, criminal and civil – exist to prohibit many different types of fraud. There are many different laws devoted solely to preventing different types of kickbacks. Some types of kickbacks are very obvious, and others are far more subtle. If you think no one can accidentally run afoul of Medicare fraud laws, think again. And guess what? Prosecutors won’t give you a pass for an unintentional violation. These laws do not require willful misconduct in order to charge you.

Even if you have no reason to believe you’ve opened yourself up to the possibility of Medicare fraud charges, I would still encourage you to contact me. I can help you understand common pitfalls in the law, how to avoid them, and how certain types of activities might be permitted in some circumstances, but prohibited in others.

I hope that after reading this, you understand that healthcare fraud cases are very serious. Regardless of whether you believe you are innocent or guilty, and regardless of the specific charges you face, do not underestimate the importance of choosing the right attorney. If you are charged with Medicare or Medicaid fraud, you need the help of the hardest working criminal defense attorney in Miami. Call me, Jordan Redavid, today, and let me get to work on your case immediately.

We answer calls and emails 24/7. Call or email Jordan Redavid now at 305-938-9939 or

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