Miami Healthcare Fraud Lawyer

Top-Rated Healthcare Fraud Attorney in Miami, FL

Healthcare fraud law is technical, and a single billing decision can spiral into a federal case. At Jeffrey S. Weiner, P.A., we are dedicated to providing experienced legal representation for individuals facing healthcare fraud charges in Miami and throughout Florida, including physicians and other licensed providers facing federal cases in the Southern District of Florida. With a proven track record of success in defending clients against white-collar crimes, our team is prepared to protect your rights and interests when needed.

Prior results do not guarantee similar outcomes. 

Call Jeffrey S. Weiner, P.A., today at (305) 670-9919 or contact us online to schedule a meeting with our healthcare fraud attorney in Miami.

What is Healthcare Fraud?

Healthcare fraud is the intentional and deceptive act of obtaining improper financial gain from the healthcare system. This can encompass various activities, such as submitting false claims to insurance companies, Medicare, or Medicaid, providing unnecessary medical services or equipment, referral kickbacks, and altering medical records for fraudulent billing purposes. Healthcare fraud affects the financial stability of the healthcare system and undermines the trust between patients, providers, and insurers.

Common Forms of Healthcare Fraud

Our experienced Miami healthcare fraud lawyers are well-versed in various forms of healthcare fraud, including:

• Billing Fraud: This involves submitting false claims or inflating bills for medical services that were never provided by a healthcare professional or facility.
• Prescription Fraud: Illegally obtaining, distributing, or selling prescription medications, often through forged prescriptions or stolen physician identities.
• Medicare/Medicaid Fraud: Fraudulently billing Medicare or Medicaid for services that were unnecessary or never provided or using patient information to make false claims.
• Kickbacks and Self-Referrals: Accepting or offering incentives, such as money or gifts, in exchange for patient referrals or business arrangements, which can compromise the integrity of medical decisions.
• Upcoding/Unbundling: Assigning incorrect codes or billing separately for services that should be billed as a single package, leading to higher reimbursements than deserved.
• Identity Theft: Stealing patients’ personal information to make false claims, order unnecessary medical equipment, or obtain prescription drugs.

We have successfully represented many physicians in Medicare and other healthcare fraud cases in federal court. Some were physicians allegedly part of conspiracies to rip off the federal government by making false diagnoses and prescribing treatment, home health care, home visits, physical therapy, medical devices, and medication when not medically necessary, all to make a profit. Often, these physicians did not properly plan financially for their retirements and found themselves in need of money. It was easy for them to be employed by unscrupulous clinic operators or in their practices, knowing that word would quickly get around that they were available for unnecessary prescriptions, home health care, and other such services.

Licensing Risks and Professional Consequences

Sometimes, physicians, dentists, and veterinarians from foreign countries who move to the United States do not want to take the time and effort to become properly licensed, so they practice without a license, often out of their homes, and in less than ideal conditions for their patients. State courts usually charge these cases, and many are felonies. But practicing on an expired or lapsed Florida health care license for less than 12 months is only a first-degree misdemeanor under Florida law. It only becomes a felony in other situations, such as practicing with no license at all, causing serious injury, or letting the license lapse for a year or more.

A healthcare fraud charge does not stay confined to the courtroom. The Florida Department of Health and the Board of Medicine can open a parallel licensing case as soon as charges are filed, and federal agencies can suspend billing privileges before a case ever goes to trial. In the 2026 national takedown, the Centers for Medicare & Medicaid Services suspended over 1,000 providers and revoked billing privileges for more than 1,400 others, often without waiting for a conviction. 

If you are a physician, dentist, nurse practitioner, or other licensed provider, protecting your license takes immediate legal help alongside your criminal defense. See our Professional License Defense & Disciplinary Proceedings page for how we handle both fronts at once.

Federal Healthcare Fraud Enforcement in South Florida

The Southern District of Florida is one of the most active healthcare fraud enforcement districts in the country. In June 2026, the U.S. Department of Justice announced its largest healthcare fraud takedown in history: criminal charges against 455 defendants nationwide, including 90 physicians and other licensed medical professionals, in schemes totaling more than $6.5 billion in alleged false claims.

Twelve of those defendants were charged here in the Southern District, in cases alleging more than $4 billion in fraudulent claims for durable medical equipment, skin substitutes and wound care products, laboratory testing, and community mental health services.

The same enforcement action suspended 1,079 providers and revoked billing privileges for 1,403 more nationwide, alongside dozens of civil settlements and hundreds of DEA administrative actions targeting prescribing authority. 

For a Miami physician or provider, this means federal investigators are actively using data analytics to flag billing patterns in near real time, often opening a case within days of an outlier claim. Waiting until charges are filed is usually too late to shape how the government builds its case.

Laws That Apply to Healthcare Fraud Cases

Healthcare fraud allegations against Florida providers typically involve one or more of the following laws:

• Federal Health Care Fraud Statute (18 U.S.C. § 1347): Makes it a federal crime to knowingly execute a scheme to defraud a healthcare benefit program. A standard conviction carries up to 10 years in federal prison. If the fraud results in serious bodily injury, the maximum rises to 20 years, and if it results in death, the defendant faces any term of years up to life.
• Anti-Kickback Statute (42 U.S.C. § 1320a-7b): Prohibits paying or accepting anything of value in exchange for patient referrals covered by a federal healthcare program.
• Stark Law (42 U.S.C. § 1395nn): Bars physicians from referring Medicare or Medicaid patients to entities in which the physician or an immediate family member holds a financial interest, unless a specific exception applies. Stark is a civil law, not a criminal one, so a violation can mean repaying money and paying fines, but it doesn’t carry prison time, and prosecutors don’t have to prove intent.
• False Claims Act (31 U.S.C. § 3729): The civil counterpart to criminal healthcare fraud charges. It lets whistleblowers, known as qui tam relators, sue on the government’s behalf and share in any recovery, which is why many healthcare fraud investigations start with an employee or competitor complaint.
• Florida Medicaid Provider Fraud (Fla. Stat. § 409.920): Florida’s state-level Medicaid billing fraud statute. The charge is a third degree felony for amounts of $10,000 or less, a second degree felony between $10,000 and $50,000, and a first degree felony for $50,000 or more.

Many healthcare fraud cases involve overlapping federal and state charges, plus a parallel civil case under the False Claims Act. Knowing which statutes the government is using, and why, shapes the entire defense strategy.

What are the Penalties for Healthcare Fraud in Florida?

The specific penalty depends on which law prosecutors charge and the dollar amount involved. The penalties for healthcare fraud convictions in Florida can be severe, ranging from substantial fines to lengthy prison sentences. Individuals convicted of healthcare fraud may also face restitution orders requiring them to repay the defrauded funds. In addition to legal consequences, a healthcare fraud conviction can irreparably damage one’s professional reputation and result in the loss of medical licenses or exclusion from government healthcare programs.

Defenses Against Healthcare Fraud Charges

A strong defense against healthcare fraud charges requires a comprehensive understanding of healthcare laws and regulations. Our skilled attorneys employ a variety of strategies to protect our client’s rights and interests:

• Lack of Intent: Healthcare fraud charges often require proving fraudulent intent. We may argue that the accused lacked the intention to deceive or defraud, which is a crucial element of the offense.
• Mistaken Billing: In some cases, billing errors or administrative mistakes can lead to unfounded healthcare fraud accusations. We work diligently to uncover evidence that supports our client’s innocence.
• Insufficient Evidence: Prosecutors must present solid evidence to prove their case beyond a reasonable doubt. We scrutinize the evidence, identifying weaknesses and inconsistencies that could lead to a favorable outcome.
• Procedural Violations: If law enforcement or regulatory agencies violated the accused’s rights during investigations or arrests, we can challenge the evidence obtained through these violations.
• Whistleblower Retaliation: Healthcare fraud allegations arise from whistleblower retaliation in some situations. We work to expose ulterior motives that may have contributed to the accusations.

It is essential that physicians, like everyone, understand that attempting to prove their innocence to investigators or law enforcement officers without consulting with competent federal criminal defense counsel is almost always a mistake, sometimes so serious that their license to practice medicine is placed in greater jeopardy than if they simply stated, “Under the circumstances, I respectfully decline to make a statement until I consult with counsel.”

Contrary to popular belief, such action will not make you appear “guilty.” Rather, it will let the investigators and law enforcement officers know that you are intelligent, that you care about your license and profession, and that you are smart enough to insist upon counsel to guide you through the horrible experience of being accused of something that could irreparably damage your reputation and result in your being prevented from practicing your learned profession or, worse, place you at risk of losing your freedom by being convicted of a crime, almost always a felony, the most serious category of crimes.

Frequently Asked Questions

Will I lose my medical license if I am charged with healthcare fraud?

Not automatically, but the Florida Board of Medicine and Department of Health can open a licensing case as soon as charges are filed. A defense that addresses both the criminal case and the licensing case gives you the best chance to keep practicing.

What is the difference between civil and criminal healthcare fraud?

Criminal healthcare fraud can lead to prison time and is prosecuted under statutes like 18 U.S.C. § 1347. Civil False Claims Act cases seek repayment and penalties and can be brought by the government or a whistleblower.

Can a billing mistake really lead to criminal charges?

Prosecutors generally must prove intent to defraud, so an honest billing or coding error is a defense rather than a crime. Investigators still ask questions first, so early legal help matters.

What triggered the 2026 national healthcare fraud takedown?

Federal and state agencies used data analytics to flag outlier billing in areas like wound care, genetic testing, telemedicine, and behavioral health, then moved quickly on charges, license suspensions, and payment seizures..

Do I need a lawyer if I am only being audited, not charged?

Yes. A payment audit or an Agency for Health Care Administration inquiry can lead directly to a criminal referral, so it helps to have counsel involved before that happens.

What is the Anti-Kickback Statute?

It is a federal law making it a crime to pay or accept anything of value in exchange for patient referrals covered by Medicare, Medicaid, or another federal healthcare program.

Can I be charged even if I did not personally submit the false claim?

Yes. Physicians, practice owners, and office managers can face charges for directing or knowingly benefiting from a fraudulent billing scheme, even without personally entering the claim.

What should I do if federal agents contact me about a billing investigation?

Do not answer questions or explain your side before speaking with a criminal defense attorney. Politely decline to make a statement and ask to have counsel present for any further conversation.

Contact Our Miami Healthcare Fraud Attorney Today

When facing healthcare fraud charges in Miami, having a dedicated legal team with extensive experience in white-collar defense is crucial. At Jeffrey S. Weiner, P.A., our Miami healthcare fraud lawyers are committed to providing strategic, personalized representation to protect your rights, freedom, and future. We understand the complexities of healthcare fraud cases and are here to guide you through every step of the legal process.

Contact Jeffrey S. Weiner, P.A., today to schedule a consultation with our healthcare fraud lawyer in Miami: (305) 670-9919 | Request a free consultation