Facing Medicare or Healthcare Fraud Allegations? How a Healthcare-Fraud Review Works
Healthcare and Medicare fraud charges are investigated under federal statutes and program rules in Miami and throughout South Florida. The federal government often dedicates significant resources to investigating and prosecuting fraud related to Medicare billing, kickbacks, overbilling, and false claims.
At Beaton Law Firm, we represent doctors, clinic owners, billing professionals, and individuals accused of violating federal healthcare fraud laws. We understand the complexity of these investigations and the criminal, civil, licensing, and financial consequences that may follow.
What Constitutes Medicare or Healthcare Fraud?
Common allegations include:
Billing for services not rendered
Upcoding procedures to receive higher reimbursement
Kickbacks for patient referrals
Submitting false claims to Medicare or Medicaid
Falsifying diagnoses
These charges often arise after an audit or whistleblower complaint, and can result in charges under statutes such as the False Claims Act, Anti-Kickback Statute, and Health Care Fraud Statute.
Questions for a Healthcare-Fraud Case Review
Attorney Marcos Beaton handles federal healthcare and white-collar matters. As a former partner at a nationally recognized defense firm, he has defended high-stakes fraud cases involving complex healthcare and white-collar crimes.
We provide:
Rigorous case analysis and pre-trial strategy
Defense against both civil and criminal fraud claims
Protection of your professional licenses and credentials
Representation in front of federal agencies like the DOJ and HHS
Coordinate the Criminal, Civil, and Licensing Issues
Whether you’ve been charged or are under investigation, consider obtaining advice before responding to an audit, agency request, or interview. At Beaton Law Firm, the defense review addresses the evidence, procedure, and related professional issues.
📞 Call today for a confidential case review. Discuss the notice, records, and next steps.
What the Evidence May Show
Healthcare-fraud allegations may involve claims data, billing records, medical records, referral arrangements, coding decisions, contracts, and communications. Counsel should identify the specific claim or transaction, who created it, what information was available, and whether the evidence supports knowledge and intent. Civil, criminal, and licensing issues may overlap but are not identical.
Preserve the Professional Record
Keep audit notices, subpoenas, policies, billing records, communications, and agency requests in their original form. Do not alter records or provide a rushed response. The Department of Justice Health Care Fraud Section provides general information about federal enforcement; the individual evidence and charging document control the case.
Separate a Record Review From a Criminal Allegation
Healthcare matters may begin with an audit, overpayment question, request for records, civil inquiry, or criminal investigation. These are different processes. Preserve the notice, clinical records, billing data, coding support, communications, and available audit trails in their original form. A record should identify what was billed, what was documented, who created the entry, and the applicable date range.
The Department of Justice describes the types of matters handled by its Health Care Fraud Section. That overview provides context, but a particular matter turns on its statute, notice, and evidence.
If another entity holds relevant records, document the request for the source copy and retain the response.