Articles Posted in Fraud

There has been a recent increase in arrests and prosecutions for health care fraud in Florida as a result of increased law enforcement efforts in investigating these crimes. Healthcare fraud largely involves medical providers committing fraudulent billing practices to increase their profits, including submitting charges for reimbursement to insurance companies, Medicare, and Medicaid for services that weren’t provided. Additional investigations include accepting illegal kickbacks for patient referrals and billing insurance companies under incorrect billing codes to increase the payments received.

On July 31, 2017, seventy-seven people were arrested in Florida for their involvement in various health care fraud schemes that totaled over $141 million dollars in fraudulent billing. These arrests were part of a larger investigation by the Medicare Fraud Strike Taskforce that resulted in 412 individuals facing charges for over $1.3 billion in false billings. These investigations involved a multi-agency effort, involving local law enforcement, the FBI, the Department of Health and Human Services, the Medicaid Fraud Control Unit, and the Florida Attorney General’s Office. Continue reading

It’s important to know what happens and what consequences one may face when being accused of insurance fraud in Florida. Although insurance fraud doesn’t seem as heinous as murder or burglary, it is still a crime that can result in a prison sentence of quite a few years. Insurance fraud is not a rare crime either. According to the Division of Insurance Fraud’s annual report, there was a total of 17,392 suspected fraud referrals and the court ordered a total of $51,203,744.42 in restitution in the 2014-2015 fiscal year; that includes health, vehicle, PIP and home insurance fraud, just to name a few. How exactly does insurance fraud affect others? I mean, if you didn’t do the crime, then you have no worries, right? Well, unfortunately this line of thinking is false. When insurance companies are forced to pay out millions of dollars for false claims, insurance premiums can go up. So, if the criminals are attacking the insurance company’s pockets, they are in the long run affecting yours as well.

Legal Definition of Insurance Fraud in Florida

So, what exactly is the legal definition of insurance fraud in Florida? Florida statute 817.234 gives the precise and detailed definition, but insurance fraud is essentially when a person knowingly presents false or misleading information to an insurance company with the intent to defraud or deceive the company. Examples would be a doctor giving a statement that exaggerates on the injuries a patient sustained in an auto accident or a doctor excessively charging the insurance company for services. While doctors found guilty of insurance fraud face the risk of losing their license to practice for about 5 years, a person participating in staging an auto accident could face a minimum of 2 years in prison. Continue reading

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