Tampa Healthcare Fraud Attorney
Healthcare fraud investigations tend to begin quietly. A billing irregularity flags an audit. An insurance company refers a matter to federal agents. A disgruntled employee files a whistleblower complaint. By the time a physician, clinic administrator, or billing company receives a subpoena or a target letter, investigators have often spent months building a file. Omar Abdelghany of OA Law Firm represents individuals and organizations in the Tampa Bay area who are facing healthcare fraud charges at the state and federal level, starting at the earliest stage of any investigation and carrying through to resolution in court when necessary.
Why Federal Prosecutors Take Healthcare Fraud Cases So Seriously in Tampa
Tampa sits in the Middle District of Florida, one of the federal districts Omar is licensed to practice in. The region also happens to be home to a dense concentration of medical providers, home health agencies, specialty clinics, and pharmaceutical interests. Federal agencies including the Department of Justice, the Department of Health and Human Services Office of Inspector General, and the FBI’s healthcare fraud task force have treated Florida as a priority enforcement state for years. That enforcement focus means Tampa-area providers are more likely to encounter federal scrutiny than counterparts in many other markets.
What prosecutors look for are patterns: billing codes that consistently exceed what procedures warrant, services billed for patients who never appeared, prescriptions written in volumes that don’t match the size of a practice, or ownership structures designed to funnel Medicare and Medicaid reimbursements to individuals who are excluded from those programs. The government uses data analytics to isolate outliers before it ever contacts a target. By the time an investigation becomes visible, the paper record has already been examined.
The Distance Between a Civil Audit and a Criminal Indictment
One thing that surprises many people is how quickly a matter that looks administrative can become criminal. A Medicare audit, a request for records, or a civil investigative demand from the Department of Justice can each serve as a precursor to a criminal referral. They are not the same as criminal charges, but they are not routine paperwork either. Responding to them without legal representation is a serious mistake because the way records are gathered and produced, the way employees are instructed or permitted to speak with investigators, and the way billing practices are characterized early in the process can all influence whether a case moves toward a civil settlement or a criminal prosecution.
Federal healthcare fraud charges are typically brought under the False Claims Act, the Anti-Kickback Statute, the Stark Law, or the general federal healthcare fraud statute at 18 U.S.C. 1347. State charges in Florida most often involve Medicaid fraud under Chapter 409 of the Florida Statutes. The statutory penalties vary considerably across these frameworks, but prison sentences in federal healthcare fraud cases can run into decades when large amounts of money are involved. This is not a category of charge where the distinction between civil liability and criminal exposure is academic.
Who Gets Charged and What the Government Has to Prove
Healthcare fraud charges can reach physicians, nurse practitioners, pharmacists, physical therapists, clinic owners, practice managers, billing company employees, and in some cases patients who participate in schemes. The government does not need to show that every person charged understood every detail of a scheme. Prosecutors look for evidence that a person knowingly submitted or caused to be submitted false claims, or that they received or paid something of value to induce Medicare or Medicaid referrals.
The word “knowingly” carries a lot of weight. The government must show more than that an error was made or that billing practices turned out to be noncompliant. Deliberate ignorance, meaning a conscious choice to avoid learning facts that would be inconvenient, can satisfy the knowledge requirement under federal law. This makes it important for a defense attorney to carefully examine what a defendant actually knew, when they knew it, and what systems or compliance structures were in place at the time the conduct occurred.
Several defenses have real traction in these cases. Billing errors that result from coding complexity, software defaults, or inadequate training present a different picture than deliberate fraud. Documentation that a service was genuinely provided, that a patient relationship was real, or that a referring arrangement was structured to comply with applicable safe harbors can each undermine the government’s case. The credibility of cooperating witnesses, many of whom have their own exposure and have agreed to testify in exchange for consideration, is another area that deserves close scrutiny in any federal healthcare fraud defense.
What Charges Like These Do to a Medical License and a Career
A healthcare fraud conviction does not just carry prison and fines. For licensed professionals, it triggers a separate process with the relevant Florida licensing board. The Florida Department of Health and the Agency for Health Care Administration each have authority to suspend or revoke a license based on a criminal conviction. A conviction can also result in exclusion from Medicare and Medicaid, which for many providers is effectively a career-ending consequence regardless of what happens in the criminal case.
This is why the outcome of the criminal case matters so much, and why resolution short of a conviction, whether through dismissal, acquittal, or a plea to a lesser charge, can make an enormous difference in what a defendant is able to do professionally afterward. Omar handles both the criminal defense and can coordinate with licensing counsel when that becomes necessary. The two tracks of a healthcare fraud case require attention at the same time, not sequentially.
Questions Worth Answering Before You Do Anything Else
I received a subpoena for records from my practice. Does that mean I am personally under investigation?
Not necessarily, but it is not a routine request either. A subpoena for records can be directed at a business rather than any specific individual, but it indicates your practice is relevant to an active investigation. How you respond, what you produce, and whether you take steps to preserve additional records all matter. This is a situation where legal representation before responding is strongly advisable.
Someone from my billing staff is telling investigators things about our practice without my knowledge. What are my options?
If an employee is cooperating with investigators, that person may already be under their own legal obligation or have made a cooperation agreement. You cannot prevent employees from speaking with federal agents, and attempting to influence what they say can create separate legal problems. The appropriate response is to obtain counsel immediately and understand what information is being conveyed and in what context.
What is the difference between a billing error and fraud?
Legally, the difference is intent. Billing errors happen in every practice, and not every overpayment to Medicare constitutes a crime. Fraud requires that the submission of a false claim was knowing and intentional. However, the government will argue that patterns of errors, especially those that consistently favor the provider financially, are evidence of intent rather than mistake. That is a contested factual and legal question that requires careful examination of the record.
Can I negotiate with investigators before charges are filed?
In some cases, early engagement through counsel can lead to a civil settlement rather than a criminal prosecution. The government has discretion over whether to pursue criminal charges, and factors like voluntary disclosure, cooperation, and the nature of the underlying conduct all influence that decision. This is not something to attempt without an attorney, because statements made to investigators can be used against you later.
I was excluded from Medicare years ago. Does that automatically make any future billing criminal?
Excluded providers who arrange to receive Medicare funds indirectly, through other providers or ownership structures, can face criminal exposure under the Anti-Kickback Statute and the general healthcare fraud statute. Exclusion is not simply a civil bar. It is a fact that prosecutors will emphasize when arguing that subsequent conduct was willful.
What federal agencies actually investigate healthcare fraud in the Tampa area?
The most common are the FBI, the HHS Office of Inspector General, the Drug Enforcement Administration in cases involving prescriptions, and the Florida Attorney General’s Medicaid Fraud Control Unit for state-level matters. These agencies frequently work together on the same investigation, which is why a case can involve both state and federal charges simultaneously.
How long do these investigations typically last before charges are filed?
Federal healthcare fraud investigations often run for one to three years before an indictment. The government builds its case extensively before making contact with targets. By the time a target letter arrives or an arrest occurs, investigators may have interviewed dozens of witnesses and gathered years of billing records. This is part of why waiting to retain counsel until charges are filed puts a defendant at a significant disadvantage.
Speak with a Tampa Healthcare Fraud Defense Attorney Before the Investigation Defines Your Options
Omar Abdelghany personally handles every case at OA Law Firm, and he is licensed to practice in Florida state courts as well as the U.S. District Court for the Middle District of Florida, where federal healthcare fraud prosecutions in the Tampa area are filed. If you are a physician, administrator, or other healthcare professional facing scrutiny from federal or state investigators, or if you have already been charged, speaking with a Tampa healthcare fraud lawyer as early in the process as possible gives you the most room to shape the outcome. Contact OA Law Firm to schedule a consultation.
