During the past 25 years Florida and the Federal government have grappled with the issue of fraud in the Medicare/Medicaid system. In the past few years, Florida even expanded its law to include not only these types of fraud, but “health care fraud” generally.
Section 456.0635, Florida Statutes, prohibits fraud in the practice of health care professions. This law prohibits the Florida Department of Health and the medical boards within the DOH from allowing any person to sit for an examination, who has been:
- Convicted of, or enters a plea of guilty or nolo contendere to, regardless of adjudication, a felony under chapter 409, chapter 893, 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396; or
- Terminated from any state Medicaid program or the federal Medicare program.
The DOH and the health care boards must refuse to issue or renew a license, certificate, or registration to an applicant, or person affiliated with that applicant, who has violated any of the same provisions. The law also requires that licensed health care practitioners shall report allegations of health care fraud to the department, regardless of the practice setting in which the alleged health care fraud occurred.
What I am noticing as an experienced health care attorney in Florida is that DOH and the professional boards are taking a hardline approach to any allegations of “health care fraud” and leveling serious penalties. Aside from an obvious scheme or scam by someone to actually defraud Medicare, Medicaid, or an insurance company many routine billing or reimbursement problems that are encountered by doctors and other health care professionals are mistakenly thought by government investigators to be health care fraud. Oftentimes, they are not.
It cannot be overemphasized how important it is for a clinic to have an office manager or billing assistant who is up to date on the rules regarding billing and reimbursement. I often recommend to my client that they seek out a private Medicare/Medicaid/Insurance billing audit consultant who is up to date on the latest rules & regulations. Many of the problems a physician or licensed health care professional faces are directly traceable to the training his or her billing staff and office manager receives.
Just like a patient should seek a yearly check up, health care professionals should have their business practices reviewed annually. An ounce of prevention……the old saying goes….goes a long way.
If you have received an Administrative Complaint against you it is important to
seek experienced legal advice before proceeding. I represent licensed health
care professionals. More information can be found atwww.floridahealthcareattorney.com
Or contact me at 850-877-7776. The initial consultation is free.