Private Insurance Fraud

Defending Against Civil and Criminal Actions

Orlando, Florida Private Insurance Company Fraud Defense Attorneys

Private insurance companies take health care fraud seriously. It affects their bottom line, and they devote enormous resources to tracking down perpetrators to recover their losses. If you are facing criminal prosecution or civil litigation, contact the private insurance fraud defense lawyers of the Law Offices of Mark L. Horwitz, a Professional Association.

Based in Orlando, Florida, we defend clients statewide and throughout the United States. Call 407.401.7224 or 866.784.0023 to get our knowledgeable criminal defense team involved early in the investigation. With a certified criminal trial specialist and decades of experience, our firm represents medical providers (individual doctors, hospitals, or their employees), online pharmacies and pharmacists, durable medical supply companies, or employees caught up in fraud investigations.

Private Insurance Company Fraud Defense

We represent clients in civil audits, criminal prosecutions, and civil litigation arising from allegations of bilking private insurers involving alleged conduct such as:

• False claims (services not provided)
• Overcharging for services rendered
• Billing for services not medically necessary
• Conspiracy to over-treat
• Mail fraud/wire fraud

Private insurance companies have their own fraud investigation units (e.g., the Blue Cross/Blue Shield Bureau) trained to detect patterns of subtle over-billing as well as outright fraudulent claims. The industry also shares information and resources through the National Insurance Crime Bureau and the National Health Care Anti-Fraud Association. If they believe fraud has occurred, insurers coordinate with state and federal law enforcement agencies to initiate criminal investigations.

Criminal Prosecution

Our number one concern is to keep clients out of prison. Our private insurance fraud defense lawyers aggressively counter allegations and attempt to show that there was no criminal intent, only an honest error in billing or a justifiable difference of opinion on how services should be reimbursed. In many cases, we have resolved these cases without criminal charges being filed, but we prepare every case for the possibility of going to trial.

Civil Lawsuits

Private insurance companies can bring civil litigation under the federal RICO provisions for conspiracy to commit health care fraud. If the insurer wins a verdict, the individual or the company can be assessed treble damages (three times the amount of demonstrated loss). The possibility of adverse action by state professional licensing authorities exists if a licensed professional, such as a doctor, is found to have engaged in fraudulent billing to insurance companies.

Because the burden of proof is lower in civil litigation, it is critical to have experienced insurance fraud defense attorneys in your corner. The Law Offices of Mark L. Horwitz, a Professional Association, successfully defended a case against a doctor and a mobile diagnostic lab company, in which it was alleged that medically unnecessary ultrasound and electrodiagnostic tests were routinely ordered. We demonstrated that the tests were legitimate services required to detect soft tissue damage, as in back injuries.

Whether you are facing single counts of fraud or possible RICO conspiracies, contact the Law Offices of Mark L. Horwitz, a Professional Association, immediately. Our early involvement in the audit or criminal investigation may make all the difference. Call 407.401.7224 or 866.784.0023 or contact us online.