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Attorney General Announces Arrests of Miami Health Care Workers For Paying Kickbacks in Medicaid Fraud Case

November 10, 2023

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Close-up of Handcuffed Healthcare Professional After Paying Patients with Gift Cards
The Florida Attorney General's Office announced that several Miami-Dade County health care workers were arrested and charged with Medicaid fraud. The defendants are alleged to have paid kickbacks to Medicaid recipients for psychosocial rehabilitation services that sometimes were not needed or ever provided. The defendants paid patients up to $500 a month in the form of gift cards that were redeemable for cash. The alleged Medicaid fraud resulted in losses to the state Medicaid program in excess of $100,000, according to the AG's Office.

Attorney General Ashley Moody said, "These health care workers knowingly solicited and discreetly paid kickbacks to Medicaid recipients for mental-health services. They were so focused on their criminal agenda that they even instructed changes to insurance providers to allow more claims and told all recipients to keep quiet about the kickbacks. This illegal scheme stole from Florida taxpayers and caused more than $100,000 in losses to the state program."

Generally, Medicaid fraud is defined as the intentional providing of false information to get Medicaid to pay for medical care, services, or other benefits. These particular defendants could also have been arrested under the Florida Anti-Kickback Statute Section 456.054 which makes it illegal for any health care provider to pay kickbacks to individuals who refer or solicit patients. Kickbacks are benefits paid by a provider of health care services or items, to any person as an incentive or inducement to refer patients for services or items. Kickbacks can also be paid to patients. The Attorney General's Medicaid Fraud Control Unit (MFCU) investigates and prosecutes criminal fraud in Medicaid cases.

The Feds also have an Anti-Kickback Statute "AKS" set forth in 42 U.S.C. 1320a-7b(b). The AKS is a criminal law that prohibits the knowing and willful payment with the purpose of inducing or rewarding patient referrals with the intent to generate business involving any item or service payable by the Federal health care programs such as Medicare. A kickback includes anything of value and can take many forms besides cash, such as in the case discussed above which involved gift cards. In some industries, it is OK to pay out rewards to those who refer business. However, Federal health care programs do not allow kickbacks, and paying for referrals is a crime.

Person Offering a Gifcards Representing the Allocation of Kickbacks Among Medicaid Recipients
Medicare and Medicaid fraud cases are constantly investigated in South Florida. Companies and employees can be charged in state and federal court for fraud crimes of this nature. Anyone being investigated for or charged with the medical fraud case should contact and seek the advice of a Miami fraud defense lawyer with experience in these types of cases.

The Miami criminal lawyers at DMT have represented clinic owners, doctors, and other medical professionals in Miami Medicare and Medicaid fraud cases. Our aggressive and skilled representation will prove to the law enforcement authorities and the prosecution that our clients did not have the requisite intent to defraud the state or federal government.

If you or a loved one is being investigated for a Miami Medicare fraud case, it is important to consult with the Miami criminal lawyers at DMT, so we can protect and defend your rights.
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