A Strong Defense For Health Care Fraud Investigations

Health care fraud investigations can upend your professional and personal life, especially when they come without warning. Medical professionals often don’t know they’re under scrutiny until they receive a subpoena, a civil investigative demand or an unexpected visit from federal agents. These cases are often built quietly and aggressively, with government agencies gathering months of evidence before making their move.

If you have been contacted or suspect that you are under investigation, now is the time to speak with an experienced health care fraud attorney. At The Law Office of Mark P. Rankin, P.A., attorney Mark Rankin represents physicians, nurses, pharmacists, administrators and other health care professionals across the greater Tampa Bay area and throughout Florida.

What Makes Health Care Fraud Charges So Serious?

Health care fraud charges often lead to more than criminal penalties. In addition to the risk of prison time and substantial fines, licensed professionals may face disciplinary action from state boards, loss of hospital privileges, exclusion from government health care programs and permanent damage to their careers.

As your criminal defense lawyer, attorney Rankin has deep experience defending against a wide range of health care fraud allegations, including:

• Medicare fraud: Billing for services not rendered, submitting false claims or engaging in schemes to defraud the Medicare program can lead to a federal indictment. These cases often involve complex billing data and require a meticulous legal response.
• Medicaid fraud: Similar to Medicare fraud, these charges may involve overbilling, misrepresenting services or unauthorized patient enrollment. Florida’s Medicaid program is closely monitored, and prosecutions are common.
• Upcoding: Charging for a higher level of service than what was actually provided can result in criminal and civil penalties.
• Phantom billing: Submitting claims for services never performed or for patients never seen is a red flag for federal investigators.
• Self-referral violations: Referring patients to facilities or services where the provider has a financial interest can run afoul of the Stark Law and lead to additional scrutiny.
• Medical identity theft: Using or misusing patient information for unauthorized billing or treatments can lead to federal charges and privacy violations.

Because these cases can trigger multiple consequences, it’s critical to have a defense attorney who understands the full scope of what’s at stake.

Understanding The Anti-Kickback Statute

The federal Anti-Kickback Statute (AKS) prohibits the exchange of anything of value to induce or reward referrals for services covered by federal health care programs such as Medicare or Medicaid. This includes cash payments, free rent, lavish gifts or excessive speaking fees.

Violations of the AKS are aggressively investigated by the Department of Health and Human Services, the Office of Inspector General and the Department of Justice. Even if you believe your business arrangement was legitimate, prosecutors may interpret it as an illegal inducement or improper financial relationship.

Proven Strategies In Health Care Fraud Defense

When faced with a health care fraud investigation, it is natural to feel as if the odds are stacked against you. Federal agencies often spend months collecting billing records, interviewing witnesses and analyzing data before you even become aware of their efforts. By the time you receive a subpoena, civil investigative demand or visit from investigators, the government already believes it has a strong case. Despite this, you still have meaningful options for protecting your rights and your career.

At The Law Office of Mark P. Rankin, P.A., the defense strategy begins with a clear understanding of the specific allegations and the unique circumstances surrounding each client’s professional practice and reputation. Some cases call for immediate negotiations with prosecutors to limit the scope of charges. Others require a comprehensive rebuttal through medical records, expert opinions or clarification of billing practices. Attorney Mark Rankin approaches each matter intending to limit exposure, safeguard licenses and prevent unnecessary damage to professional reputations.

The firm’s record demonstrates how these strategies can make a difference. In one case, a client was investigated for alleged multimillion-dollar health care fraud. Through focused representation, the matter concluded without any health care fraud charges being filed. Instead, the client pleaded guilty only to a single count of sending an international wire without the proper license. Even though federal sentencing guidelines suggested 12 to 18 months of prison time, the client received probation.

In another matter, a local medical practice was under investigation for alleged Medicare fraud. After months of advocacy and presentation of mitigating facts, prosecutors declined to bring charges against the practice or any of the physicians involved. What could have been a career-ending ordeal ultimately resulted in no disciplinary or criminal consequences.

Every investigation presents unique risks, but these examples highlight the importance of a defense tailored to your circumstances. With early intervention and the right strategy, it is possible to resolve serious allegations in ways that protect both your future and your professional standing. Strong representation can mean the difference between devastating consequences and outcomes that allow you to continue practicing with confidence.

Health Care Fraud Legislation

Health care fraud is taken seriously at the state and federal levels. Two key laws, Florida Statute 817.234 and the Federal False Claims Act (FCA), define fraudulent activity and set penalties for violations. 

Florida Statute 817.234: False and Fraudulent Insurance Claims

This statute makes it illegal to submit false or fraudulent insurance claims knowingly. This can include: 

• Submitting claims for services not provided.
• Falsifying documents or information to receive insurance payments.
• Assisting others in filing fraudulent claims.

Violations can result in criminal charges, fines and imprisonment. Even unintentional errors in claims can escalate if the investigation is not handled properly. Legal guidance helps ensure that responses to state inquiries are accurate, helps protect your rights and can reduce potential penalties. 

Federal False Claims Act (FCA)

The FCA targets fraud involving government funds, including Medicare and Medicaid. Key points include: 

• Liability for knowingly submitting false claims for government payment.
• Whistleblower provisions allow individuals to report fraud and potentially recover a portion of the funds.
• Significant financial penalties for each false claim submitted.

The FCA applies to activities like overbilling, billing for services not provided or misrepresenting procedures. Investigations under the FCA can be civil or criminal, making experienced legal representation essential to protect your interests and help ensure proper compliance.

If you are under investigation for health care fraud or are concerned about potential exposure, immediate action is vital. Attorney Mark P. Rankin can review your situation, explain your rights and develop a defense strategy tailored to your case. 

Prompt legal involvement can help manage communications with authorities, protect personal and professional interests and minimize the risk of severe penalties.

Facing an investigation under Florida Statute 817.234 or the Federal False Claims Act can have serious consequences. Promptly consulting an attorney helps ensure your rights are protected, helps respond effectively to inquiries and provides a clear strategy for addressing allegations. 

Speak With A Florida Health Care Fraud Attorney Today

If you are under investigation or have been charged with health care fraud, Medicare or Medicaid fraud, or a violation of the Anti-Kickback Statute, don’t wait. The Law Office of Mark P. Rankin, P.A., offers confidential and strategic legal guidance for health care professionals throughout Florida.

Attorney Rankin is available to meet at any of his three offices: Tampa, St. Petersburg or Clearwater. He can even meet you virtually if needed. Call the firm at 877-620-0898 or send a message online to schedule your free consultation with a knowledgeable Florida health care fraud lawyer today.