The Southern District of Florida leads the nation in federal healthcare fraud prosecutions. Over 75 individuals charged, $308 million in alleged fraudulent billing, and the DOJ isn't slowing down. If you're a target, a grand jury witness, or already indicted, your defense window is narrow.
Federal healthcare fraud cases are among the most complex and fastest-moving prosecutions in the Southern District of Florida. Unlike a drug case or a robbery, the evidence is almost entirely paper, medical records, billing codes, patient files, corporate records, bank accounts, and emails, and the government has often been building its case for years before you know you're a target.
The SDFL's Health Care Fraud Strike Force, operating out of Miami, works alongside the FBI, HHS-OIG, and DEA. Since 2024, over 75 individuals have been charged in the Southern District alone, with alleged fraudulent billing exceeding $308 million. The government's enforcement is data-driven: their billing analytics identify statistical outliers across thousands of providers and flag patterns that trigger investigations.
If you are a physician, nurse practitioner, physical therapist, pharmacist, DME supplier, sober home operator, clinic owner, billing company, or executive in Miami-Dade, Broward, Palm Beach, or Martin County, and your Medicare or Medicaid billing volume is high, you may already be on a watchlist you don't know about.
Medicare and Medicaid billing fraud is the core charge in most cases, billing for services not rendered, upcoding procedures, billing for more time than was spent, or using fabricated patient encounters. Federal prosecutors frequently present side-by-side comparisons of your billing rates against regional averages to suggest fraudulent intent.
Anti-Kickback Statute violations arise from patient referral arrangements that involve compensation. This includes payments to patient recruiters ("cappers" or "marketers"), percentage-based billing arrangements, and any agreement that incentivizes referrals to your facility or service. AKS violations carry 5 years per count and mandatory exclusion from federal healthcare programs.
Telemedicine and DME fraud has been the dominant enforcement priority in South Florida. Federal prosecutors have charged schemes involving telemedicine platforms that generated orders for braces, genetic tests, pain creams, and prescription drugs, without legitimate patient-physician relationships.
COVID-19 and sober home fraud remain active priorities. A $36 million COVID testing fraud scheme and a $19.2 million sober home/patient brokering scheme were prosecuted in SDFL within the past two years.
Federal healthcare fraud is not one charge, it is a family of them, and the government builds each type differently. AMC Defense Law defends the specific schemes prosecutors are charging in the Southern District of Florida and nationwide:
AMC Defense Law has defended clients against federal healthcare fraud charges across Florida and nationally. We know how these cases are built, and where they are weakest.
Pre-indictment intervention. Healthcare fraud investigations take time to develop. If you have received a CID, a subpoena, a government audit, or a visit from HHS-OIG or FBI agents, you may still be in the investigative phase. Early, strategic engagement with the prosecution team, before charges are filed, has resolved cases without indictment. This is the most valuable window in any healthcare fraud case.
Challenging the billing analysis. The government's statistical comparisons are only as strong as their methodology. We retain independent healthcare billing experts who can challenge peer group selection, explain coding variations, and establish legitimate medical necessity for disputed claims.
Intent defense. Healthcare fraud requires proof of knowing and willful conduct. A billing error, a coding mistake, or reliance on a billing company's practices does not equal criminal intent. We build the record that explains the gap between the government's numbers and your actual conduct.
Protecting your license. Federal charges automatically trigger Florida DOH investigations and OIG exclusion proceedings. We defend clients on all fronts simultaneously, because the loss of a medical license or DEA registration can be as devastating as the criminal case itself.
DOJ's National Fraud Detection Center opens health care fraud cases from billing data alone. No whistleblower needed. What Florida providers do before agents call.
A skincare CEO took four to eight years for unapproved devices and an injectable toxin. No patient was harmed. Here is why the buyers are exposed too.
FDA's July 2026 peptide guidances are development standards for manufacturers, not approvals. Selling generic semaglutide is still an unapproved new drug case.
Two inspectors walk in without an appointment and start asking who mixed the IV bags. What that ninety minutes costs a Florida med spa owner later.
The Eleventh Circuit affirmed kickback convictions built on nothing but speaker honoraria and prescription data. What Florida prescribers and reps face now.
DOJ charged a Medicaid billing scheme as a racketeering enterprise carrying a life maximum. Florida clinics and transport vendors are next. Know your exposure.
You saw patients over a telehealth platform, built or ran the platform, or connected doctors to the companies that needed orders, and now the government is calling it fraud. Telemedicine fraud is the connective tissue of modern healthcare enforcement.
You own or run a durable medical equipment company, you marketed for one, or you signed brace orders as a doctor, and now the government is treating that business as a fraud scheme. DME fraud has been one of the Department of Justice's top healthcare enforcement priorities for years.
An Anti-Kickback investigation usually means the government believes money changed hands to influence where patients or healthcare business went. These cases are built quietly, often alongside a sealed whistleblower lawsuit you do not even know exists.
You ran a lab, marketed for one, or signed test orders as a physician, and now federal agents are asking about cheek swabs, Medicare billing, and the people who sent you patients. Genetic testing fraud is one of the most aggressively prosecuted healthcare schemes in the country, and the Southern District of Florida is one of its main stages.