Medicare fraud defense for doctors in Miami starts the moment you learn of an investigation. If you’re facing healthcare fraud charges in Florida, your medical license is at immediate risk, and the licensing board doesn’t wait for a criminal conviction to act.

Florida medical professionals may face a double threat when accused of healthcare fraud. Here’s what you need to know about how these charges affect your ability to practice and protect your career.

Healthcare Fraud Charges Can Cost You Your License

Healthcare fraud charges put your medical license in immediate jeopardy through multiple pathways.

Under Florida Statute 456.073, the board has grounds to discipline you if you’re convicted of, or plead guilty or no contest to, any felony related to the practice of medicine.

Emergency Suspensions Happen Without Warning

The statute also allows emergency suspension if the board finds an immediate danger to public health, safety, or welfare.

Emergency suspensions happen without a hearing. By the time you receive notice, you may already be locked out of your practice.

Federal Exclusion Ends Your Career

Beyond your state license, federal healthcare fraud charges lead to exclusion from Medicare, Medicaid, and all federal healthcare programs.

The Office of Inspector General (OIG) maintains the List of Excluded Individuals and Entities, and placement on this list is often automatic upon conviction.

Once excluded, you cannot:

• Bill Medicare or Medicaid for services
• Work for any entity that bills federal healthcare programs
• Receive payment for services rendered to federal program beneficiaries
• Hold ownership interest in entities receiving federal healthcare funds

In an OIG exclusion, you cannot:

• Practice at hospitals that accept Medicare patients
• Work for healthcare systems dependent on federal reimbursement
• Can’t bill insurance companies that cross-reference the exclusion list

For most practicing physicians, it means an end to a career.

Convictions Guarantee Discipline

A conviction or plea to any felony involving healthcare fraud under Florida Statute 456.073(1)(c) mandates board action. The board must discipline your license, though it retains discretion over the severity.

What Triggers License Action Against Doctors

Knowing which allegations and charges put your license at risk helps you recognize exposure early:

Federal Healthcare Fraud Charges

Convictions that trigger mandatory discipline:

• Medicare or Medicaid fraud under 42 U.S.C. § 1320a-7b
• Healthcare fraud under 18 U.S.C. § 1347
• False statements relating to healthcare matters under 18 U.S.C. § 1035
• Kickback violations under the Anti-Kickback Statute
• State healthcare fraud charges under Florida Statute 817.234

Even misdemeanor convictions related to healthcare can lead to discipline, particularly if they involve dishonesty or harm to patients.

Emergency Suspension Triggers

What triggers immediate board action:

• Federal indictment for Medicare or Medicaid fraud
• DEA investigation into prescription practices
• OIG exclusion from federal healthcare programs
• State investigation into patient billing
• Arrest for healthcare-related crimes

Common Medicare Fraud Allegations

Billing for more expensive procedures than actually performed (upcoding), billing for services not rendered, ordering medically unnecessary tests or procedures, and kickback arrangements all trigger investigations that threaten your license.

Kickback arrangements include:

• Cash payments for referrals
• Below-market rent to referring physicians
• Free or discounted services in exchange for referrals
• Excessive compensation for minimal medical directorships

The Physician Self-Referral Law prohibits referring Medicare patients for designated health services to entities where you have a financial relationship, unless an exception applies.

How the Florida Board Disciplines Your License

The Florida Department of Health pursues its own investigation while federal prosecutors build their criminal case. The Florida Board of Medicine and Florida Board of Osteopathic Medicine operate under different standards than criminal courts.

They operate as follows:

Lower Standards Work Against You

The board doesn’t need to prove fraud beyond a reasonable doubt. Evidence inadmissible in criminal court, including hearsay and circumstantial evidence, can support board findings.

Florida Statute 456.073 lists over 20 grounds for discipline, including:

• Making false or misleading statements on license applications
• Fraudulent billing practices
• Violations of federal or state healthcare laws
• Failure to maintain adequate medical records
• Being convicted of any crime related to the practice of medicine

The board interprets these grounds expansively.

Penalties Range from Fines to Revocation

The board can impose:

• License revocation
• License suspension (definite or indefinite)
• Practice restrictions (limiting types of procedures, requiring supervision)
• Probation with conditions
• Fines up to $10,000 per violation
• Mandatory continuing education
• Reprimand or censure

These penalties can combine. You might face a one-year suspension followed by five years of probation with practice restrictions and mandatory monitoring.

Timeline for Board Proceedings

Initial investigation (2-6 months):

• Department of Health receives a complaint or referral
• Investigator gathers records and interviews witnesses
• You receive a letter requesting a response
• Investigator prepares a report

Probable cause determination (1-3 months):

• Probable Cause Panel reviews the investigator’s report
• Panel decides whether to file charges, dismiss, or request more investigation
• You can submit a written response before the panel meets

Administrative complaint (30 days to respond):

• If the panel finds probable cause, the Department files formal charges
• You have 21 days to request a formal hearing or accept the stipulation
• Failure to respond results in a default judgment

Formal hearing (6-12 months):

• Discovery period for exchanging evidence
• Depositions and document production
• Administrative law judge conducts a hearing
• Judge issues recommended order to board

Final order (2-4 months after hearing):

• Board reviews the recommended order
• Board issues a final order with a penalty
• Order becomes effective 30 days after filing unless you appeal

From complaint to final order typically takes 12 to 24 months. Emergency suspensions happen much faster, sometimes within weeks.

How to Protect Your License During an Investigation

Once you learn of an investigation, your response determines whether you keep practicing:

Respond to Board Inquiries Carefully

When the Department of Health sends an investigative letter, you must respond. Ignoring it or providing incomplete answers compounds your problems.

But responding without legal counsel is dangerous.

What the board requests:

• Complete medical records for specific patients
• Billing records and fee schedules
• Employment contracts and financial arrangements
• Written explanations of billing practices
• Sworn statements

Every word in your response can be used against you in both administrative and criminal proceedings. Anything you write becomes evidence.

Coordinate Criminal and License Defense

You need attorneys handling both tracks, and they need to coordinate strategy. What helps your criminal case might hurt your license defense, and vice versa.

Consider Voluntary Practice Limitations

If the allegations involve specific services or procedures, voluntarily restricting your practice while investigations proceed shows good faith.

Maintain Impeccable Records Going Forward

During investigations, your current practice receives intense scrutiny. Ensure the following:

• Medical records support every billed service
• Documentation occurs contemporaneously with services
• Coding matches actual services provided
• All required elements appear in progress notes
• Billing reflects only services you personally performed or properly supervised

Your actions during the investigation often matter more to the board than the underlying allegations themselves.

Your Career Depends on How You Respond

Healthcare fraud charges threaten everything you’ve worked for, but doctors do successfully defend their licenses and practices.

Medicare fraud defense in Miami and throughout Florida requires coordinating criminal defense with license protection from day one. Contact Bozanic Law immediately.

Success requires understanding that you’re fighting two separate battles with different rules, different standards, and different strategies.

Call today. We don’t judge. We defend.