Even with many U.S. citizens’ receiving health insurance through employer-sponsored health insurance plans, the federal government still pays thousands of dollars per person on healthcare each year (17.7 percent of GDP and 38 percent of mandatory spending annually). With every large public spending endeavor, there is potential for abuse and fraud. Medicare, Medicaid, and other public health programs are no exception.
To cut down on fraudulent government spending related to Medicare, there is a collection of federal and state laws that exists to prevent healthcare fraud. There are many ways that healthcare fraud can be committed by doctors, nurses, pharmacists, clinics, providers, and even patients. This blog will explore a few of ways that healthcare fraud is perpetrated in Florida as well as its potential consequences on professional licenses.
- Providing stolen personal information to healthcare providers. Billing Medicare for services that were either never performed or medically unnecessary is a common way for bad actors to bilk the state or federal government out of public funds. One way this can happen is by a medical provider receiving Medicare patient information from a patient “broker” and billing the system for unneeded services. When the provider pays the broker for the information, investigators generally need to simply “follow the money” to start developing a solid case.
- Filing duplicate claims for the same service. Fraudsters are frequently caught billing Medicare multiple times for services or products that were, originally, medically necessary.
- Referrals to a particular clinic or pharmacy in exchange for remuneration. This is a classic way that authorities’ interest in physician referrals is piqued. The transaction is quite simple; let’s say, for example, that an internist is steering patients toward a specific specialist, like a podiatrist or dermatologist. In exchange, the referring doctor receives a “cut” of the business created by the referral. Again, the money trail often leads investigators right to the involved parties.
Focusing on Medical Licensing
An especially significant collateral consequence of healthcare fraud is a suspension or revocation of a professional medical or healthcare provider license. In Florida, doctors and healthcare providers are licensed by the Department of Health. If a licensed healthcare provider is the subject of a criminal investigation or prosecution, their professional license and ability to practice in their chosen field is at risk. The administrative procedure that determines what will happen to your professional license is a distinct area in which you will need an attorney to help you successfully challenge an action against your license. That is, it is a separate matter from the criminal case.
As soon as you learn that you have a complaint filed against you with the Florida Department of Health, you need to retain an attorney who can dispute the allegations that form the basis of the complaint. If you do not respond appropriately and within the required time limits, your license may be suspended. Additionally, the complaint could show up in online databases which are accessed by potential employers and the public, causing potential damage to your professional reputation. This consequence should never be ignored.
Contact an Experienced Attorney
If you are dealing with an administrative complaint as a medical professional, Attorney Barry M. Wax is well-equipped to provide legal services to you and protect your professional livelihood and reputation. Get in touch with our firm at 305-373-4400 to receive a free one-hour consultation today.