False Claim Act (FCA) laws exist to prevent fraud and save taxpayers money. Numerous state and federal laws aim to prevent abuse within the United States medical system. Sadly, some folks continue to break the law for financial gain. Fortunately, honest people come forward and expose criminal activity within the healthcare field. These brave individuals are known as whistleblowers. So, if you suspect healthcare fraud in Florida, or another State, contact an experienced healthcare fraud attorney to ensure to ensure your legal rights are protected and you understand your options before taking action.
Florida False Claims Act: Key Takeaways
For individuals considering reporting healthcare fraud in Florida, here are the key points to understand about the Florida False Claims Act:
Law: The Florida False Claims Act is codified at Florida Statutes §§ 68.081–68.092 and addresses false or fraudulent claims involving State of Florida funds.
Healthcare Application: The law can apply to fraudulent claims involving Florida Medicaid and other healthcare payments involving state funds.
Qui Tam Lawsuits: Private individuals, commonly called whistleblowers or relators, may bring qualifying lawsuits on behalf of the State of Florida to recover money obtained through false claims.
Whistleblower Rewards: Successful relators may be entitled to receive a percentage of the government’s recovery, with the amount depending in part on whether the government intervenes in the case.
Government Intervention: Florida may investigate the allegations and determine whether to intervene and proceed with the action or allow the relator to continue the case.
Retaliation Protections: The Florida False Claims Act provides protections and potential remedies for qualifying individuals who experience retaliation because of lawful efforts to stop violations of the Act.
Federal Claims: When healthcare fraud involves federal funds, including Medicare or the federal portion of Medicaid funding, the federal False Claims Act may also apply.
Legal Guidance: Qui tam cases involve specific filing, confidentiality, and procedural requirements. Potential whistleblowers should consider speaking with an experienced healthcare fraud attorney before publicly disclosing allegations or confronting the suspected wrongdoer.
Healthcare Fraud Examples
Numerous types of healthcare fraud and abuse may occur at any medical facility or supply center. Some examples include:
- Receiving kickbacks, bribes, or cash for referrals, medical services, or supplies
- Billing for services never received
- Providing fake information to Medicare or Medicaid
- Performing unnecessary procedures
- Overprescribing drugs
- Overcharging for a procedure, medication, or equipment
- Changing medical coding to receive more money
Florida False Claims Act Laws
Laws exist at the federal and state level regarding fraudulent medical claims.
- Federal Law- the U.S. False Claims Act (31 U.S.C. 3729-3733) targets fraud against federally funded healthcare programs. The federal FCA allows private citizens with knowledge of a false claim to bring a civil suit on behalf of the U.S. Government. The person bringing the claim is known as a “whistleblower” under this “qui tam” provision. Sometimes the Government joins the suit. If that happens, the whistleblower’s reward may be lower; but, it will still be significant. This occurs in very large cases. Your experienced attorney will guide you through this type of complicated case.
- Florida State Law – Florida Statutes, Sections 68.081–68.092 comprise the Florida False Claims Act, which allows the state to pursue false or fraudulent claims involving state funds, including qualifying claims involving Florida Medicaid. Florida’s False Claims Act is similar to the federal statute. Like the federal statute, violators receive fines per false claim. Once again, your attorney will discuss the financial implications of your case.
The Florida False Claims Act also allows qualifying private individuals, known as relators, to bring qui tam actions on behalf of the state and potentially receive a portion of the funds recovered. The law provides protections and potential remedies for qualifying whistleblowers who experience retaliation because of lawful efforts to stop violations of the Act.
Healthcare fraud involving Florida Medicaid may also be investigated by the Florida Attorney General’s Medicaid Fraud Control Unit, which investigates and prosecutes Medicaid provider fraud throughout the state.
Define “Qui Tam”
The Latin term “qui tam” comes from the phrase “qui tam pro domino rage quam pro se ipso in hac parte sequitur” which translates to “he who sues on behalf of the king as well as himself.” Simply put, qui tam provisions allow an everyday citizen to file a lawsuit on behalf of the U.S. government or the state of Florida. Of course, anyone filing a lawsuit must have firm knowledge of healthcare fraud. Fortunately, there are laws and provisions to protect whistleblowers. As always, discuss matters only with your attorney.
Recent Florida Healthcare False Claims Act Cases
FCA cases generally involve large amounts of money. Any monies obtained fraudulently must be returned to the government. When a whistleblower (relator) files this type of case, the relator receives a percentage of the funds recovered. Some examples include:
- Oglethorpe Inc. – $32 Million False Claims Act Settlement – In May 2026, Tampa-based Oglethorpe Inc., an operator of psychiatric hospitals, along with several of its executives, agreed to pay $32 million to resolve allegations that they violated the federal False Claims Act by knowingly failing to return Medicare overpayments. The government alleged that the overpayments involved patients admitted to inpatient psychiatric facilities even though they did not qualify for inpatient psychiatric care. The settlement resolved allegations only, with no determination of liability.
- Florida Cardiology – $2 Million Medicare and Medicaid Settlement – Florida Cardiology, P.A. and 10 physicians agreed to pay $2 million to resolve allegations that they violated the False Claims Act by submitting improper claims to Medicare and Medicaid. The government alleged, among other things, that claims were submitted for more intravascular stents than were actually inserted and that certain services were billed while physicians were outside the United States. The case originated from a qui tam lawsuit brought by whistleblowers Holly Graham and Donnamarie Frauenhofer. The whistleblowers received $420,000 as their share of the recovery. The settlement resolved allegations only, with no determination of liability.
Florida Healthcare Fraud by Area
Healthcare fraud can potentially occur in any city or region, but certain areas might be more susceptible due to population size, the concentration of healthcare facilities, and other socio-economic factors. In Florida, the main cities where healthcare fraud might be more prevalent include:
Miami: Miami is known for its large healthcare sector and has been a hotspot for healthcare fraud in the past. The city has a high concentration of Medicare and Medicaid recipients, making it a target for fraudulent activities.
Tampa: With a significant population and numerous healthcare providers, Tampa is another area where healthcare fraud can occur.
Orlando: As a major city with a large population and a thriving healthcare industry, Orlando is also at risk for healthcare fraud.
Jacksonville: Jacksonville is the largest city in Florida by area and has a substantial healthcare network, which can be susceptible to fraud.
Fort Lauderdale: Close to Miami, Fort Lauderdale also has a significant healthcare presence and has seen cases of healthcare fraud.
West Palm Beach: This area has a high percentage of elderly residents, making it another target for fraudulent healthcare schemes.
Naples: Known for its affluent population, Naples has seen instances of healthcare fraud, particularly targeting its older residents.
These cities have larger healthcare systems and more extensive use of Medicare and Medicaid services, which can increase the risk of healthcare fraud.
What Should I Do If I Suspect Healthcare Fraud in Florida?
If you suspect healthcare fraud in Florida, it’s crucial to remain discreet. Your first step should be to contact an experienced Florida healthcare whistleblower lawyer. An attorney will guide you through the legal process, ensuring your actions are both effective and protected. If your attorney determines that you have a viable case, they will help you gather the necessary evidence.
During this time, it’s important to keep the matter confidential and avoid discussing it with anyone. This confidentiality period allows you to make necessary arrangements, such as finding new employment if needed. Ultimately, hiring a skilled healthcare law attorney is key to achieving a successful outcome.
(Note: While this guidance is tailored for Florida, the principles apply nationwide, making it relevant for others facing similar situations across the country.)