Upcoding Fraud typically occurs when a medical provider bills for a higher
cost procedure or test than was actually performed, taking more payment
than was allowed given what the provider actually performed. Coding itself
refers to the codes which are inputted by medical professionals to determine
how much a medical provider should pay them for the coded procedure or
test, for example. By upcoding, the medical professional essentially tells
the medical provider that a more expensive action was made; demanding
a greater payout than otherwise would be had. Both Federal and Florida
law include heavy fines and severe criminal penalties, including potential
mandatory/minimum sentences of up to 25 years and maximum potential sentences
of up to LIFE. Mr. Petruzzi has represented numerous individuals charged
with, or under investigation for, Upcoding Fraud offenses by both Federal
and State authorities. His experience and knowledge serves as an invaluable
asset to his clients.
To arrange for a free and confidential consultation with respect to any
Federal or State Upcoding Fraud offense, contact our office at (305)-770-6550.
For complete details about Mr. Petruzzi's background, expertise, and
Federal Upcoding Fraud offenses are investigated and prosecuted by various
agencies, including the FBI, IRS, and the Department of Justice. Some
common Federal Statutes criminalizing Upcoding Fraud include:
18 USC Sec. 1347 –
(a) Whoever knowingly and willfully executes, or attempts to execute, a
scheme or artifice -
(1) to defraud any health care benefit program; or
(2) to obtain, by means of false or fraudulent pretenses, representations,
or promises, any of the money or property owned by, or under the custody
or control of, any health care benefit program, in connection with the
delivery of or payment for health care benefits, items, or services, shall
be fined under this title or imprisoned not more than 10 years, or both.
If the violation results in serious bodily injury (as defined in section
1365 of this title), such person shall be fined under this title or imprisoned
not more than 20 years, or both; and if the violation results in death,
such person shall be fined under this title, or imprisoned for any term
of years or for life, or both.
(b) With respect to violations of this section, a person need not have
actual knowledge of this section or specific intent to commit a violation
of this section.
Florida Upcoding Fraud offenses are investigated and prosecuted by various
State and Local law enforcement agencies. Some common Florida Statutes
criminalizing Upcoding Fraud include:
817.50 Fraudulently obtaining goods, services, etc., from a health care
(1) Whoever shall, willfully and with intent to defraud, obtain or attempt
to obtain goods, products, merchandise, or services from any health care
provider in this state, as defined in s.641.19(14), commits a misdemeanor of the second degree, punishable as provided in s.
775.082 or s.775.083.
(2) If any person gives to any health care provider in this state a false
or fictitious name or a false or fictitious address or assigns to any
health care provider the proceeds of any health maintenance contract or
insurance contract, then knowing that such contract is no longer in force,
is invalid, or is void for any reason, such action shall be prima facie
evidence of the intent of such person to defraud the health care provider.
However, this subsection does not apply to investigative actions taken
by law enforcement officers for law enforcement purposes in the course
of their official duties.