Healthcare Fraud Attorney In Tampa, FL
A Tampa healthcare fraud lawyer can help you if you have been accused of wrongdoing related to medical billing, insurance claims, or other healthcare billing and financial records. Healthcare fraud allegations can involve very detailed records and regulatory review, as state and federal agencies review the case.
At Amarosa Law Firm P.A., we take pride in representing people who are facing these and other serious or complex criminal allegations in Tampa, Hillsborough County as a whole, and many other counties throughout Florida. Understanding the process by which healthcare fraud cases are built can help individuals determine their legal options and how to build a solid defense.
Hire a Healthcare Fraud Lawyer From Our Firm
Amarosa Law Firm P.A. has represented individuals in Tampa and throughout Florida for years, applying the legal skill and knowledge of our entire team to every case we take on, both at the state and federal levels.
Our founding attorney is familiar with the methods of investigation and evidence analysis in criminal cases as a former professor of criminal justice. You can be confident in his ability to represent you effectively during negotiations or a trial at the Tampa division of the Middle District of Florida US District Court.
What Is Considered Healthcare Fraud Under Federal Law?
Fraud cases typically involve allegations that an individual knowingly submitted false or misleading information related to the provision of health care, billing for health care, or health care insurance claims.
Federal healthcare fraud laws are codified under 18 U.S.C. § 1347 and typically involve a scheme to defraud a healthcare benefit program. In practice, these cases most often involve claims to Medicare, Medicaid, or private insurance companies.
Investigators will often review billing practices, requests for reimbursement, and supporting medical records when investigating possible violations. Since healthcare billing is a complicated system of record keeping and reporting requirements, these investigations generally center around whether the billing claims match up with the services provided and recorded.
How Healthcare Fraud Investigations Often Begin
In certain cases, investigations may be triggered through routine audits or reviews conducted by insurance providers or government agencies. Data analysis tools can also play a role in identifying abnormal billing trends across different healthcare providers or facilities.
Upon identifying potential issues, investigators may continue to review supporting documentation and financial records to determine whether further investigation into billing practices is warranted in Tampa.
The Role of Medical and Billing Records in Healthcare Fraud Cases
Patient medical and billing records are common points of focus in healthcare fraud investigations. Records pertaining to a patient’s treatment, as well as the submissions made to billing departments and insurance carriers, may be examined to determine whether the services that were provided, as noted in medical records, were the same as those that were reported for billing purposes.
Payment and billing records, including those submitted to insurance providers and carriers, may also be of interest to investigators. A meticulous review of medical and billing records can provide important insights during an investigation.
Federal Agencies That Investigate Healthcare Fraud
Different federal agencies may be involved in the investigation of healthcare fraud allegations in Florida, depending on the nature of the claims. When fraud involves federal healthcare programs such as Medicare and Medicaid, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) is often involved.
The Federal Bureau of Investigation may also get involved in healthcare fraud investigations if the matter involves complex financial activity or large-scale billing schemes.
These agencies may also work in conjunction with federal prosecutors and other investigators when reviewing allegations related to healthcare billing and insurance claims.
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FAQs
Every year, government enforcement agencies recover billions of dollars through investigations into healthcare fraud. The United States Department of Justice announced that it had achieved over $2.68 billion in settlements and judgments under the False Claims Act in fiscal year 2023.
Many of these cases involve healthcare fraud, as violations often include billing for Medicare or Medicaid. Investigators often spend considerable time reviewing financial records and paperwork to verify the legitimacy of submitted claims.
Private insurance companies can be implicated in health care fraud allegations. When conducting claim reviews, investigators look at claims that were submitted to private health insurance plans. Insurers will usually perform their own audits and compliance reviews.
During this process, insurers attempt to verify that what was billed correlates with what is noted in a medical record. When a claim or reimbursement looks off, the insurance company might then dig into the supporting medical records.
Investigations into healthcare fraud can include professionals who work within the healthcare system. Accusations can stem from those who work in medical billing, administration, or clinical areas when investigators assess the submission and documentation of a claim.
Investigators may review bank statements, bill submissions, and medical health documentation to see how these services were written down. Prosecutors may investigate whether healthcare services were improperly billed as insurance claims.
Federal healthcare fraud enforcement actions can involve investigations conducted across multiple states and agencies. In a news release, the U.S. Department of Health and Human Services Office of Inspector General noted that one national healthcare fraud enforcement action in 2023 consisted of charges against 78 defendants in 17 federal districts and allegations of roughly $2.5 billion in false billings to federal healthcare programs.
Examples of these joint investigations show how federal agencies track billing related to government healthcare programs.
Contact a Tampa Healthcare Fraud Lawyer
Healthcare fraud charges can be quite technical due to the complicated medical billing records, insurance documents, and financial paperwork involved in these cases. Our skilled legal team at Amarosa Law Firm P.A. has experience defending people all over Florida who have been accused of healthcare fraud.
Schedule a no-obligation consultation with our law firm today to hire a healthcare fraud lawyer you can trust to handle your case with care.
