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Medicaid Fraud

Tallahassee white collar lawyer

Florida enacted § 409.920 of the Florida statutes which generally defines Medicaid fraud as knowingly making any false representation of a material fact in any claim submitted to the agency or its fiscal agent.

Medical fraud is a serious accusation that could have major impacts on your life. If convicted of medical fraud, your business could suffer, as well as your personal life. You need a skilled and experienced attorney to handle your case. The attorneys at Pumphrey Law represent clinics and health care providers, such as doctors and dentists, accused of fraudulent billing schemes. These schemes can include:

  • Overbilling for services performed
  • Phantom billing for services never performed
  • Up-coding or billing for costly medical service when only a less expensive procedure was performed
  • Billing for services or tests that are not medically necessary

Tallahassee Medicaid Fraud Defense Attorney

If you are under investigation by the Medicaid Fraud Control Unit of the Florida Office of the Attorney General, it is important to contact a knowledgeable criminal defense attorney before answering any questions. The MFCU investigates medicaid fraud cases. When wrongdoing is uncovered, the MFCU will aggressively prosecute the case. The outcome could change your life.

By hiring an experienced criminal defense attorney at Pumphrey Law you can appropriately respond to the allegations while mounting an aggressive defense. Our firm represents clients throughout Leon County, including Tallahassee, and throughout the Second Judicial Circuit, including Bristol in Liberty County, Crawfordville in Wakulla County, Monticello in Jefferson County and Quincy in Gadsden County.

Call (850) 681-7777 today to schedule a free consultation with an attorney. A solid legal defense could be the determining factor in your case.


Information About Medicaid Fraud Charges in Florida


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Prescription Drug Diversion in Florida

In 2011, Florida created the Regional Drug Enforcement Strike Forces to investigate prescription drug abuse crimes targeting the wholesaler, physician, pharmacist, and patient. One of the primary interests of the Strike Force was prescription drug diversion schemes.

These schemes represent some of the most common forms of Medicaid Fraud. The fraudulent schemes include:

  • A pharmacist forging documents to fill counterfeit prescriptions for pills
  • A nurse issuing a prescription without the doctor’s approval
  • Physicians illicitly prescribing prescription drugs
  • A health care professional stealing a patient’s prescription pills; and
  • Doctor shopping by the patient.

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Penalties for Medicaid Fraud in Tallahassee

The penalties associated with fraud crimes vary for each offense. The punishments for the crime can be determined based on the amount of money or the value of the property that was taken through the fraud.

Florida Statute § 409.920(7) provides that a person who knowingly uses a Medicaid provider’s identification number of a Medicaid recipient’s identification number to make a claim for items or services that are not authorized to be reimbursed by the Medicaid program and receives anything of value of:

  • $10,000 or less commits a felony of the third degree, punishable by up to 5 years in prison and a fine of up to $5,000
  • More than $10,000, but less than $50,000, commits a felony of the second degree, punishable by up to 15 years in prison and a fine of up to $10,000
  • $50,000 or more commits a felony of the first degree, punishable by up to 30 years in prison and a fine of up to $10,000

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Additional Resources on Fraud Cases in Florida

  • Medicaid Fraud Control Unit
    Since 1994, the Medicaid Fraud Control Unit (MFCU) of the Florida Office of the Attorney General has investigated and prosecuted Medicaid fraud cases. The MFCU is headquartered in Tallahassee and has eight field offices throughout Florida.
  • Public Assistance Fraud
    Website for the Florida Department of Children and Families discussing the problems with public assistance fraud. DCF concocted 33,870 ACCESS fraud investigations in 2013 which saved more than $41 million and recovered $19 million in benefit overpayments. DCF investigates potential public assistance fraud from the State of Florida, retailer food stamp trafficking, and medicaid provider fraud.
  • Medicaid and Abuse Complaint Form
    This form on the website for the Office of the Inspector General allows the public to submit a complain alleging wrong-doing of an Agency employee and suspected fraud and abuse in the Florida Medicaid system. Members of the public who suspect Medicaid fraud or Medicaid Provider Fraud, can also contact the fraud and abuse hotline at (1-888-419-3456).

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Attorney in Leon County for Medicaid Fraud

If you are under investigation for or charged with any form of Medicaid fraud, then contact an experienced criminal defense attorney at in Tallahassee, FL. We represent clients charged with a variety of different white collar crimes throughout Florida. Call today for a free consultation to discuss your case.

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