Healthcare and Medicaid fraud are among the most aggressively prosecuted white-collar crimes in Florida. These cases involve allegations that a healthcare provider, business owner, or individual knowingly submitted false claims, misrepresented services, or improperly received payments from Medicaid or other healthcare programs. Because these offenses involve public funds and government programs, prosecutors pursue them with exceptional intensity.
Unlike street-level crimes, healthcare fraud cases are complex and document-heavy. Investigations often involve audits, billing records, patient files, electronic data, undercover operations, and cooperation between state and federal agencies. Many defendants are charged even when they believe their billing practices were lawful or consistent with industry standards.
If you are under investigation or facing charges for healthcare or Medicaid fraud in Florida, the stakes are extremely high. A conviction can result in prison time, massive fines, restitution, loss of professional licenses, and permanent exclusion from healthcare programs.
Gainesville Healthcare and Medicaid Fraud Defense Lawyer
If you have been accused of healthcare fraud or Medicaid fraud in Florida, you need to act quickly to protect your career and future. These cases often begin as administrative audits and quietly escalate into criminal prosecutions without warning.
Dean Galigani of the Galigani Law Firm has years of experience defending healthcare professionals and individuals accused of complex financial crimes. He understands how Medicaid fraud investigations are conducted, how billing practices are scrutinized, and how to challenge allegations that ordinary administrative errors amount to criminal fraud.
Contact the Galigani Law Firm today at (352) 375-0812 for a free consultation if you are facing healthcare or Medicaid fraud charges in Gainesville, Ocala, Lake City, or surrounding areas.
Information Center
- Definition of Healthcare and Medicaid Fraud Under Florida Law
- Common Allegations Leading to Healthcare and Medicaid Fraud Charges
- Penalties for Healthcare and Medicaid Fraud in Florida
- Defenses to Healthcare and Medicaid Fraud Charges
- Role of a Florida Healthcare Fraud Defense Attorney
- Key Elements the Jury Considers
- Frequently Asked Questions
- Additional Resources
Definition of Healthcare and Medicaid Fraud Under Florida Law
Healthcare and Medicaid fraud in Florida is governed by multiple statutes, including Florida Statute § 409.920 and § 817.234. In general, these laws prohibit knowingly making false statements, misrepresentations, or omissions to obtain payment from Medicaid or other healthcare benefit programs.
Fraud allegations may include:
- Submitting claims for services not rendered
- Billing for unnecessary or non-covered services
- Upcoding or unbundling procedures
- Falsifying patient records or diagnoses
- Receiving kickbacks or improper referrals
- Misrepresenting provider qualifications
To secure a conviction, prosecutors must prove the defendant acted knowingly and intentionally, not merely negligently or mistakenly.
Common Allegations Leading to Healthcare and Medicaid Fraud Charges
These charges often arise from allegations involving:
- Improper billing practices
- Documentation errors interpreted as false claims
- Alleged kickback or referral arrangements
- Duplicate or inflated billing
- Billing under another provider’s credentials
- Use of incorrect procedure or diagnosis codes
- Allegations uncovered during audits or whistleblower complaints
Many cases begin as civil or administrative matters before escalating into criminal investigations.
Penalties for Healthcare and Medicaid Fraud in Florida
Penalties depend on the amount of alleged fraud, the number of claims, and whether the case is prosecuted at the state or federal level.
Third-Degree Felony: Lower-level fraud cases may be charged as third-degree felonies.
Potential penalties include:
- Up to 5 years in Florida State Prison
- Up to $5,000 in fines
- Restitution to Medicaid or insurers
- Permanent felony criminal record
Second-Degree Felony: Larger-scale or repeated fraud may result in second-degree felony charges.
Potential penalties include:
- Up to 15 years in Florida State Prison
- Up to $10,000 in fines
- Substantial restitution obligations
First-Degree Felony: Major fraud schemes or high-dollar cases may be charged as first-degree felonies.
Potential penalties include:
- Up to 30 years in Florida State Prison
- Up to $10,000 in fines
Additional Consequences
Beyond incarceration and fines, convictions may result in:
- Mandatory exclusion from Medicaid and Medicare programs
- Loss of professional licenses and certifications
- Asset forfeiture
- Federal prosecution exposure
- Immigration consequences for non-citizens
- Permanent reputational and career damage
Defenses to Healthcare and Medicaid Fraud Charges
- Lack of intent or knowledge: Healthcare fraud requires proof that the defendant knowingly and intentionally engaged in fraudulent conduct. Billing errors, documentation mistakes, or misunderstandings of complex regulations do not automatically constitute criminal fraud. Defense counsel focuses on distinguishing negligence from intentional wrongdoing.
- Good-faith billing practices: Many healthcare providers rely on billing staff, third-party services, or automated systems. If claims were submitted in good faith based on available information, criminal liability may not exist. Demonstrating reliance on standard practices or professional advice can significantly weaken the prosecution’s case.
- Ambiguous or evolving regulations: Healthcare regulations are complex and frequently change. What prosecutors characterize as fraud may stem from unclear guidance or inconsistent enforcement standards. Defense attorneys highlight regulatory ambiguity to show lack of criminal intent.
- No material false statement: To be criminally fraudulent, a misrepresentation must be material. Minor errors or technical inaccuracies that do not affect payment decisions may not satisfy this element. Without materiality, the charge may fail.
- Insufficient or selective evidence: Prosecutors often rely on audits that sample a limited number of claims. Extrapolating criminal intent from small samples can be misleading. Defense counsel challenges assumptions and statistical methods used by investigators.
- Unlawful searches, seizures, or subpoenas: Healthcare investigations frequently involve broad subpoenas and data seizures. If law enforcement exceeded legal authority, key evidence may be suppressed. Constitutional violations can be case-dispositive.
Role of a Florida Healthcare Fraud Defense Attorney
- Reviewing billing records and compliance practices: A defense attorney conducts a detailed review of billing data, coding practices, and internal procedures. This analysis often reveals lawful explanations for alleged irregularities. Accurate context is essential to counter fraud allegations.
- Challenging intent and knowledge assumptions: Prosecutors often infer intent from billing patterns alone. Defense counsel focuses on what the defendant actually knew and intended at the time claims were submitted. Without proof of intent, criminal charges cannot stand.
- Managing parallel civil and criminal exposure: Healthcare fraud cases often involve administrative audits, civil penalties, and criminal charges simultaneously. An attorney coordinates defense strategy across all proceedings. Missteps in one arena can severely affect another.
- Scrutinizing investigative methods and audits: Defense counsel examines how audits were conducted and whether investigators followed proper procedures. Sampling errors, flawed methodologies, and confirmation bias are common issues. Exposing these weaknesses can significantly undermine the case.
- Negotiating reduced charges or alternative resolutions: When appropriate, an attorney may seek dismissal, reduction of charges, or non-prison resolutions. Many cases resolve favorably once evidentiary weaknesses are identified. Early negotiation is often critical.
- Trial representation in complex fraud cases: If the case proceeds to trial, defense counsel challenges expert testimony, financial assumptions, and regulatory interpretations. Jurors must understand highly technical information. Clear, strategic presentation is essential to establishing reasonable doubt.
Key Elements the Jury Considers
To convict, the prosecution must prove beyond a reasonable doubt that:
- A false statement or misrepresentation was made
- The statement was material to payment
- The defendant acted knowingly and intentionally
- Medicaid or a healthcare program paid or was exposed to loss
- The evidence was lawfully obtained
Failure to prove any element requires acquittal.
Frequently Asked Questions
Can billing mistakes result in criminal charges?
Mistakes alone should not result in criminal liability, but prosecutors may still pursue charges if they allege intent.
Do healthcare fraud cases always involve federal prosecution?
No. Many cases are prosecuted under Florida law, though some involve parallel federal investigations.
Can audits turn into criminal cases?
Yes. Administrative audits often lead to criminal referrals.
Should I speak to investigators or auditors?
You should consult a criminal defense attorney before making any statements.
Additional Resources
Florida Statute § 409.920 – Medicaid Provider Fraud – Defines Medicaid fraud offenses and outlines penalties and enforcement mechanisms.
Florida Statute § 817.234 – False and Fraudulent Insurance Claims – Covers fraudulent claims involving healthcare and insurance benefits.
Florida Department of Law Enforcement – Medicaid Fraud Control Unit – Provides information on how Medicaid fraud cases are investigated in Florida.
Finding a Healthcare and Medicaid Fraud Defense Attorney in Gainesville, Florida
Healthcare and Medicaid fraud allegations can destroy careers and result in severe criminal penalties if not handled properly. These cases require immediate and strategic legal defense.
Dean Galigani of the Galigani Law Firm represents individuals and healthcare professionals charged with healthcare and Medicaid fraud throughout Gainesville, Alachua County, Ocala, Lake City, and surrounding areas of Florida.
If you are under investigation or facing healthcare or Medicaid fraud charges, contact the Galigani Law Firm today at (352) 375-0812 for a free consultation and experienced legal guidance.
