A healthcare fraud charge can unsettle several parts of your life at once, from your finances to your professional standing to your sense of security. If you are battling one, you likely want a clear picture of what the law allows and what a conviction could involve.
Fraud under state and federal law
Florida law treats healthcare fraud as a felony, and the penalties vary based on how much money is at issue. The state’s Medicaid fraud law covers false claims, billing for services not rendered and kickback deals linked to government programs.
Federal law also plays a role. The federal healthcare fraud statute makes it a crime to knowingly carry out a scheme to defraud any benefit program. Other laws such as the False Claims Act and the Anti-Kickback Statute give prosecutors more ways to pursue these cases.
The state ranks among the most targeted states for healthcare fraud enforcement. The 2025 National Health Care Fraud Takedown led to charges against 37 defendants in South Florida alone, part of a larger effort that charged 324 defendants across the country.
Criminal penalties upon conviction
Consequences for healthcare fraud include the following:
Third-degree felony, for $10,000 or less: May result in up to five years in prison, plus a mandatory fine equal to five times the financial gain or program loss.
Second-degree felony, for more than $10,000 but less than $50,000: May result in up to 15 years in prison.
First-degree felony, for $50,000 or more: May result in up to 30 years in prison.
Federal healthcare fraud: May result in up to 10 years in prison for each count, or up to 20 years if injury results.
These ranges describe what is possible rather than what is likely, since judges weigh the facts of each case along with any prior record. Courts will also order mandatory restitution to repay the program for the financial loss.
Collateral consequences beyond sentencing
The impact of a fraud conviction can often extend past fines and prison time. These can include:
- Loss or suspension of your medical license or credentials through the Florida Department of Health
- Exclusion from federal healthcare programs, including Medicare and Medicaid, through the Office of Inspector General
- Civil liability under the False Claims Act, where the government may seek treble damages and per-claim fines
- Harm to your standing in the field and loss of hospital privileges or future job prospects
These professional and civil consequences often progress on much faster timelines than the criminal justice system. Since administrative boards use a lower legal standard than criminal courts, an agency can restrict your medical license or federal billing privileges regardless of how the criminal charges ultimately resolve.
Defense options in your case
A healthcare fraud indictment does not make a conviction inevitable. To secure a guilty verdict, prosecutors bear the burden of proving that you acted knowingly and with a specific intent to defraud. In the context of intricate medical billing, satisfying this evidentiary standard can be a challenge for the government.
A primary defense strategy often hinges on negating criminal intent. Good-faith billing errors, coding inaccuracies and administrative confusion regarding complex regulatory frameworks do not constitute fraud.
Constitutional protections also play a critical role. Evidence obtained through unlawful searches or procedural violations may be subject to suppression. An attorney can review how the charge was assembled, examine the records behind it and identify your strongest path forward.