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Medical fraud in Florida often involves doctors, not patients

| Feb 15, 2019 | Firm News

Public discussion of Medicaid and Medicare fraud usually focuses on individuals gaming the system. Americans seem particularly worried about the idea of somebody getting medical benefits that they should not receive. However, in the grand scheme of medical cost in this country, fraud perpetrated by individuals against government insurance programs is miniscule.

Fraud related to medical professionals, on the other hand, is a major cost. Due to the skewed nature of commentary and coverage on this topic, medical professionals might imagine that they are not under intense scrutiny. In reality, it is very likely for medical professionals and their support staff to face criminal consequences because of fraudulent billing practices.

Florida government insurance fraud takes many forms

As a state with a large percentage of both retirees and immigrants, Florida has a large percentage of residents receiving state insurance coverage. That means that there is more opportunity for medical professionals to engage in fraud. However, because of that increase in government spending, there can also be increased oversight and scrutiny of medical records and billing practices.

Government insurance fraud can take a number of different forms. It can involve billing for procedures a professional didn’t perform. It can also involve unbundling, which means billing individually for a number of procedures that are cheaper when billed as a single procedure.

Eventually, whether through patient complaints, oversight from government offices or concern on the part of an employee, medical practices that engage in large-scale fraud can face serious criminal charges. Those accused of federal insurance fraud will likely face criminal penalties, a requirement to repay some of the money and the loss of their professional medical licensing in Florida.

Fraud allegations can impact your professional licensing

In order to maintain a medical practice in Florida, you have to stay in good standing with the state licensing board. This board verifies both the educational credentials of individuals with licenses, while also ensuring that all licensed professionals meet certain ethical standards.

Making questionable decisions, such as the decision to bill inappropriately, could impact your standing with the licensing board. If you face criminal charges, you will likely also wind up facing review related to your alleged offenses.

That means that it is incredibly important to defend against criminal charges and to have a strategy to deal with potential ramifications with the medical licensing board. Anyone concerned that they could face allegations of medical insurance fraud in Florida needs to consult with an attorney before they wind up in legal and professional trouble.

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