What You Need to Know About False Claims Act Violations in Florida

Experienced Defense Attorneys Serving all of Florida

The Dallas-based The Criminal Defense Firm is a health care law defense firm with significant experience in the areas of regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our firm’s lawyers include the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force. Many of our attorneys graduated with law degrees from the country’s best schools, such as Harvard Law School and Yale Law School. Our firm serves clients from all over the state of Florida.

Health care providers, executives, lawyers, clinics, medical facilities, organizations, and businesses in Florida face a higher-than-average risk of being investigated for violating the False Claims Act. The Criminal Defense Firm serves Florida clients who are facing this serious allegation. We provide vital and strategic defenses for our clients. Our Health Care Fraud Defense Team provides legal advocacy in cases involving the False Claims Act.

Why Does Florida Have a Higher Risk?

In Florida, health care providers, executives, lawyers, facilities, and businesses face a higher risk of investigation. Regardless of your role in Florida health care, you could be investigated for violating the False Claims Act.

The federal government monitors the entire nation for violations. Yet, Florida is more closely watched. It is one of nine areas in the United States that is monitored by the Medicare Fraud Strike Force. This is because Florida has a large number of residents who receive some form of federal health care. Since more claims are filed in Florida to receive reimbursement from the federal government, the government believes that there is a higher chance of fraud. The Department of Justice announced in 2016 that it had investigated more than 300 cases, and recovered over $900 million in claims

False Claims Act investigations are extremely serious matters. You may be contacted by various federal agencies or by the Medicare Fraud Strike Force. This is a team of investigators and prosecutors from multiple federal agencies, such as including the IRS, the DEA, DOJ, DOD, FBI, OIG, and the Department of Health and Human Services. There can be other federal agencies also involved. If you’re involved in Florida health care and you have been contacted about this violation, call The Criminal Defense Firm immediately to schedule your confidential consultation. Initial consultations are free of charge.

What You Should Know About the False Claims Act

The False Claims Act is a federal law. It applies to any person or business that has a direct or indirect contract with and will be paid by the federal government on federal health care claims filed for reimbursement. It establishes criminal and civil liability for contractors, businesses, individuals, or organizations that knowingly submit or cause the submission of one or more false claims for approval of and payment by the government.

In regard to this federal statute, the word “knowingly” doesn’t just pertain to your having actual knowledge of the submission of a false claim. It means that if you didn’t know that the claim wasn’t legal, you should have known. For instance, when you outsource your billing and coding, it is your responsibility to ensure that a person or an organization is using the right codes and legal billing methods. If you don’t know, you should have performed the due diligence research to find out. If they use an obsolete code or if they pad a bill, you could be prosecuted for violating the False Claims Act even though you yourself did not submit the claim.

A Look at Civil and Criminal Penalties

In Florida, health care providers, facilities, and businesses charged with violating the False Claims Act may face serious civil and criminal penalties. Call The Criminal Defense Firm right away. Once you’ve retained our services, we can get answers to the important questions, such as which charges you may be facing. Where appropriate, we can negotiate with the federal government on your behalf.

Civil penalties may include one or more of the following:

• Treble damages paying the government three times the amount of the original claim
• Payment of civil fines of up to $11,000 per false claim
• Recoupment requests
• Non-payment of future submitted claims
• Future exclusion from federal health care programs
• State licensure or disciplinary proceedings
• Loss of hospital privileges

Criminal penalties may include one or more of the following:

• Claims that cost you hundreds of thousands of dollars
• Criminal charges
• Up to five years in federal prison

How Do Most False Claims Act Investigations Start in Florida?

In Florida, most False Claims Act investigations start because someone files a qui tam lawsuit in federal court. The federal court used will depend on where the health care facility, business, clinic, or provider operates. A qui tam lawsuit is meant to encourage private citizens to alert the federal government of fraudulent activity. Because of this, these lawsuits pay out an incentive. Qui tam is Latin for “he who sues for the king and himself.” If the plaintiff is successful, they receive a portion of the recovered funds. Sadly, most qui tam lawsuits in Florida are abusive maneuvers by former employees and competitors who are resentful and are just out to hurt your business.

Qui tam lawsuits against Florida health care providers, executives, facilities, and businesses are sealed. The plaintiff’s identity is also sealed. They are referred to as the “qui tam realtor.” Unsealed documents are only made available to the presiding judge and appropriate federal officials who will be investigating the matter. Since these investigations can take time, extensions are routinely filed and granted to enable the federal government to have enough time to finish its investigation.

Throughout the scope of the investigation, your records will be subpoenaed by the federal government. You may be required to turn over your business, financial, billing, and communication records. That’s not an all-inclusive list. These subpoenas may be issued by various government entities including the DOJ, DEA, DOD, IRS, FBI, OIG, or other federal agencies. The federal government will review your records and decide whether it will support the case or reject it. If they reject the case, it’s not necessarily over. The plaintiff can continue the lawsuit without the government. If they win without government involvement, they are entitled to receive 30 percent of the recovered funds. If the government elects to support the case, this is known as intervention. There is a high likelihood that the lawsuit will be amended to include additional charges. If the lawsuit is successful against you, the plaintiff is entitled to keep 25 percent of the recovered funds.

Integral and Strategic Defenses for Florida Clients

The Criminal Defense Firm uses three integral defenses on each case that we represent. We use these three defenses to also develop a more strategic defense to each client’s extenuating circumstances and facts. We’ve developed our three mainline defenses by utilizing our accrued experience as both former federal health care fraud prosecutors and defense attorneys.

1. The first integral defense is early intervention. We contact the federal investigators right away on behalf of our Florida clients. This is because when the government has a long period of time to investigate without interruption, it is more likely to press criminal charges. We will get answers to your questions, including the purpose behind the investigation, the charges you’re facing, and how the investigation can be resolved. Usually, we can get the answers to these questions within days of our engagement.
2. Where qui tam lawsuits are involved, we take an aggressive approach to protect our Florida clients, because qui tam lawsuits in Florida are very rarely filed for legitimate reasons. This is why we review the allegations and the evidence to discredit it. Our goal is to show the federal government that the case has no merit, and shouldn’t be privy to its support.
3. When we find out from the federal government that our Florida clients are liable for civil damages, we negotiate on their behalf. We’ve successfully negotiated damage amounts to just a fraction of the original demand. Furthermore, none of our clients have ever been forced to close their practice or business.

The Criminal Defense Firm

The Criminal Defense Firm provides legal advocacy and defense to Florida nurses, ARNPs, doctors, clinics, hospitals, practice owners, physician-owned businesses, labs, pharmacies, hospice facilities, and other health care businesses accused of violating the False Claims Act or that were named as defendants in a qui tam lawsuit. We also assist those being investigated for violating Stark Law and the Anti-Kickback Statute, or involved in Medicare, Medicaid, Tricare, or Department of Labor investigations.

Here’s a look at some of our Track Record:

• False Claims Act Investigation (Pharmacy)
  Result: No Liability.

• False Claims Act Investigation (Pharmacy)
  Result: No Liability.

• False Claims Act Investigation (Laboratory Group)
  Result: No Liability.

• False Claims Act Investigation (Laboratory Group)
  Result: No Liability.

• False Claims Act Investigation (Laboratory Group)
  Result: No Liability.

• False Claims Act Investigation (Physician)
  Result: No Liability.

• False Claims Act Investigation (Physician)
  Result: No Liability.

• False Claims Act Investigation (DME Company)
  Result: No Liability.

• False Claims Act Investigation (MSO)
  Result: No Liability.

• False Claims Act Investigation (MSO)
  Result: No Liability.

• False Claims Act Investigation (Physician Syndication)
  Result: No Liability.

• False Claims Act Investigation (Physician Syndication)
  Result: No Liability.

• False Claims Act Investigation (Physician Syndication)
  Result: No Liability.

• False Claims Act Investigation (Device Company)
  Result: No Liability.

• False Claims Act Investigation (Health Care Service Provider)
  Result: No Liability.

If you’re in Florida and you’re being investigated for violating the False Claims Act, or if you’ve been named as a defendant in a qui tam lawsuit, call The Criminal Defense Firm right away. Initial consultations are always free and totally confidential.

False Claims Act Defense Lawyers Serving Florida

We are available to discuss your case. You can call us directly, use our contact form, or send us an email.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. The Criminal Defense Firm is a Texas firm with headquarters in Dallas.