If you’re facing allegations of Medicare fraud, you’re likely feeling overwhelmed. These cases can involve complex billing practices and massive amounts of paperwork. But just because you’re accused doesn’t mean you’re without options. There are several strong defenses that apply under Florida law and federal regulations.
Lack of intent
Intent plays a big role in Medicare fraud charges. Prosecutors must show that you knowingly submitted false claims. Honest billing mistakes, clerical errors, or misunderstandings about coding and documentation don’t equal fraud. If you didn’t act with the purpose of deceiving Medicare, the charges may not hold up.
Insufficient evidence
The government must prove its case beyond a reasonable doubt. That means every part of the accusation must be backed by solid evidence. If the documentation is weak or if the claims can be interpreted in more than one way, that doubt can work in your favor. Sometimes, records are misread or misrepresented by investigators unfamiliar with healthcare billing.
Compliance with regulations
If your practice followed Medicare rules, even complex ones, that can support your defense. Showing that you had a compliance program in place or that you followed guidance from the Centers for Medicare & Medicaid Services (CMS) can demonstrate your commitment to the law. This can help show that any mistakes weren’t intentional.
Delegation and lack of control
In large healthcare operations, not everyone oversees every action. If you didn’t control the billing or didn’t supervise the coding team, that may weaken the argument that you knowingly submitted false claims. Proving your role, or lack of one, in the alleged conduct can shift the spotlight away from you.
When charges don’t mean guilt
Allegations of Medicare fraud sound serious because they are. But an accusation doesn’t mean you’ve broken the law. Many cases involve overreach, flawed audits, or simple human error. Knowing your defenses gives you a stronger position to respond and protect your future.
