Federal Medicare Fraud Charges Florida

Federal Medicare Fraud Charges Florida: The Strike Force State Where 20-Year Sentences Are Normal

Florida is where the federal government created the Medicare Fraud Strike Force in 2007 because no other state had a problem this severe. The Southern District of Florida prosecutes more healthcare fraud than anywhere else in America. Philip Esformes received a 20-year sentence for orchestrating a $1.3 billion scheme – the largest healthcare fraud conviction in Department of Justice history. If you’re facing federal Medicare fraud charges in Florida, you’re facing the most experienced healthcare fraud prosecutors in the country, backed by 18 years of Strike Force operations, with data analytics that flagged your billing patterns years before anyone knocked on your door.

And here’s what makes Florida different from every other federal district: the investigation almost certainly started before you knew about it. MEDIC contractors and UPICs – Uniform Program Integrity Contractors – analyze every claim submitted to Medicare using sophisticated algorithms. They flag billing anomalies. They identify patterns. By the time the FBI contacts you, they’ve already built the case. They’ve reviewed your claims data, your patient records, your bank accounts. The 2025 national healthcare fraud takedown charged 324 defendants for $14.6 billion in alleged fraud. Seventy-three of those defendants were in the Southern District of Florida alone. More than any other district in the country. That’s not coincidence. That’s Florida.

Understanding federal Medicare fraud charges in Florida means understanding you’re operating in the birthplace of federal healthcare fraud enforcement. The Strike Force model that now operates in Los Angeles, Detroit, Houston, and Brooklyn was invented here because Florida needed it first. The prosecutors handling your case have handled hundreds of cases exactly like yours. They know every defense. They’ve heard every explanation. And they win over 90% of the time.

The Medicare Strike Force Was Created For Florida

Heres the uncomfortable truth about why Miami got its own dedicated federal healthcare fraud unit.

In 2007, healthcare fraud in South Florida had become so endemic that the Department of Health and Human Services Office of Inspector General, the U.S. Attorney’s Office, and the Department of Justice created something new. They didnt send extra agents. They didnt increase funding to existing programs. They created an entirely new enforcement structure – the Medicare Fraud Strike Force – specificaly because Florida’s fraud problem couldnt be handled through normal channels.

No other state in America required its own dedicated federal fraud task force. Only Florida.

Think about what that means for anyone facing charges here. Your not dealing with prosecutors who occasionally handle healthcare fraud. Your dealing with prosecutors who handle nothing but healthcare fraud. There entire career is built on convicting people exactly like you. The agents investigating your case have investigated thousands of similar cases. The data analysts reviewing your billing have seen every pattern, every anomaly, every attempt to hide fraudulent claims.

Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively falsely billed Medicare for over $12.5 billion. Thats not a typo. Twelve point five billion dollars in fraudulent claims – and thats just the cases they’ve charged. The actual fraud they’ve uncovered is far higher.

How Data Analytics Started Your Investigation Years Ago

Heres how the investigation actualy works, and why your probably already in trouble before you know it.

Medicare dosent manually review the billions of claims submitted every year. It uses contractors – UPICs and MEDICs – who employ sophisticated data analytics to identify fraud patterns:

• Algorithms compare your billing to national averages
• They flag anomalies
• They identify relationships between providers that shouldnt exist
• They notice when your billing for services that statistically dont make sense

OK so heres the thing nobody tells healthcare providers. The algorithm flagged your practice years ago. Maybe two years ago. Maybe five. The contractors produced reports. Investigators reviewed them. They started pulling records. They interviewed former employees. They talked to patients. They built there case methodically, quietly, without telling you.

By the time you recieve a subpoena or get contacted by an FBI agent, the investigation is basicly complete. There not fishing. There confirming what they already beleive they know. The 2025 national takedown that charged 324 defendants wasnt the result of investigations that started in 2025. Those investigations started in 2022, 2021, sometimes earlier. The takedown is just the public announcement of years of work.

The Telemedicine Trap That Destroyed Florida Providers

Heres the scheme that caught hundreds of Florida healthcare providers.

COVID-19 expanded telehealth dramatically. Suddenly you could bill Medicare for services provided remotely. This was supposed to help patients access care. Instead, it created the largest healthcare fraud wave in Medicare history.

The typical scheme works like this:

• Marketing companies – often using call centers in the Philippines or Latin America – cold call Medicare beneficiaries
• They offer free medical equipment – free back braces, free genetic tests
• The beneficiary says sure, why not
• The call center collects there information and forwards it to a telemedicine company
• A doctor who has never met the patient, never examined them, never reviewed there medical history, signs a prescription for durable medical equipment or expensive laboratory tests

That prescription goes to a DME company or lab, often in Florida. They bill Medicare. Medicare pays – becuase Medicare pays first and verifies later. The equipment may or may not be delivered. The patient may or may not have needed it. The doctor may or may not have actually reviewed anything.

Heres were it becomes criminal. The marketing companies paid kickbacks to get those patient referrals. The telemedicine companies paid doctors to sign prescriptions without proper evaluation. The DME companies knew the orders were fraudulent but billed anyway. Every payment, every transaction, every signature becomes a seperate count of healthcare fraud, wire fraud, or Anti-Kickback Statute violation.

The “free back brace” that seemed harmless created a federal fraud trail that leads directly to prison.

In the 2025 enforcement action, prosecutors charged defendants for schemes involving telemedicine and DME that generated over $1.2 billion in losses. Twenty-four individuals charged in that single case. Many of them in Florida.

The Philip Esformes Case: What 20 Years Looks Like

Heres what the largest healthcare fraud prosecution in DOJ history looked like.

Philip Esformes owned and operated assisted living facilities and skilled nursing facilities in South Florida. From 2007 to 2016, he orchestrated a scheme involving approximately $1.3 billion in fraudulent Medicare and Medicaid claims. He bribed physicians to admit patients into his facilities – patients who often failed to recieve appropriate medical services that were then billed to the government. He bribed an employee of a Florida state regulator. He made extravagant purchases with his criminal proceeds, including luxury automobiles and a $360,000 watch.

The government presented evidence at trial. The jury convicted. The judge sentenced him to 20 years in federal prison.

Twenty years. For healthcare fraud. In Florida.

And heres the paradox that should concern every defendant. Esformes’ conviction was later partialy vacated on appeal – not becuase he was innocent, but becuase of prosecutorial issues. He was released from prison. The system that gave him 20 years also let him go. But that dosent change what the initial sentence tells you about Florida healthcare fraud prosecution: the Southern District asks for, and gets, sentences measured in decades, not months.

The Ghost Patient Problem

Heres a scheme that seems impossible until you understand how Medicare works.

Rivera Bermudez operated a DME company called Acqualina in North Miami. In a ten-month period, Acqualina submitted approximately $2.9 million in allegedly fraudulent claims for durable medical equipment that was never provided to patients who never requested it and didnt need it.

Thats the “ghost patient” scheme. You bill Medicare for equipment shipped to patients who dont exist, or who exist but never recieved anything, or who recieved equipment they never requested. Medicare pays becuase Medicare pays first and verifies later.

How do you get patient information for people who never ordered anything? Call centers. Stolen identity lists. Former patient records from other providers. The schemes are sophisticated, and they work – until they dont.

The ghost patient scheme collapses when investigators start contacting the supposed patients. “Did you order a back brace from Acqualina Medical Equipment?” No, I’ve never heard of them. “Did you recieve a wheelchair in November 2023?” No, I dont use a wheelchair. One by one, the ghost patients turn into witnesses against you. Every denial becomes evidence at trial.

The Kickback Cascade That Multiplies Your Exposure

Heres how a single business arrangement creates decades of federal exposure.

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) prohibits paying or recieving anything of value to induce referrals for services covered by federal healthcare programs. Violations carry up to 10 years in federal prison per count.

Notice: per count.

Every payment you made to a marketer for patient referrals is a potential count. Every payment you recieved for referring patients is a potential count. Every kickback – whether its cash, a percentage of billing, free services, anything of value – creates a seperate criminal charge.

Now stack that with healthcare fraud under 18 U.S.C. § 1347. Thats another 10 years per count for standard fraud, 20 years if serious bodily injury resulted, potentially life if someone died.

Add wire fraud (18 U.S.C. § 1343) for every electronic submission. Thats 20 years per count.

Add conspiracy (18 U.S.C. § 371) if anyone else was involved. Thats another 5 years.

A single healthcare fraud scheme involving kickbacks and electronic billing can generate dozens of counts across multiple statutes. The theoretical maximum exposure often exceeds 100 years. Actual sentences in Florida healthcare fraud cases routinely reach 10-20 years for major schemes.

The Sentencing Reality Nobody Wants to Hear

Heres what actualy happens when your convicted of Medicare fraud in Florida.

The average sentence for federal healthcare fraud nationally is approximately 27 months – just over two years. But thats the national average. Florida cases are different becuase Florida fraud amounts are larger.

When the fraud loss exceeds certain thresholds under the sentencing guidelines:

• Exceed $1 million: sentences increase substantially
• Exceed $3.5 million: guideline ranges start at 4-5 years
• Exceed $9.5 million: guidelines push toward 8-10 years
• The Philip Esformes $1.3 billion scheme generated a 20-year sentence

And heres the uncomfortable math. Theres no parole in the federal system. Whatever sentence you recieve, your serving at least 85% of it. A 10-year sentence means aproximately 8.5 years of actual incarceration. A 20-year sentence means aproximately 17 years.

The 2024 enforcement data shows criminal recoveries at $961 million – the highest amount in ten years and more then double the rolling five-year average. The government is recovering record amounts, which means there imposing record sentences. Judges in 2025 are not more lenient then judges in 2015. There harsher.

What Triggers a Florida Medicare Fraud Investigation

Heres how cases actualy start.

Data analytics is the primary trigger. UPICs review claims data continuously. They compare your billing patterns to national averages. They identify statistical anomalies. A practice billing three times the national average for certain procedures gets flagged. A provider with unusual referral patterns gets flagged. A DME company shipping to addresses that dont match beneficiary records gets flagged.

Whistleblowers are the second major trigger. The False Claims Act allows private citizens to file qui tam lawsuits on the governments behalf. Successful whistleblowers can recieve 15-30% of recovered funds. This creates financial incentive for employees, competitors, and former business partners to report suspected fraud.

Think about who knows about your billing practices:

• Current employees who are unhappy
• Former employees who were terminated
• Competitors who wonder how your doing so well
• Business partners who had a falling out

Any of them can file a sealed whistleblower complaint. You wont know about it for years – until the investigation becomes public.

Patient complaints trigger investigations to. Medicare beneficiaries who recieve equipment they didnt order, or who see charges on there Medicare statements for services they didnt recieve, can report directly to the OIG hotline. One complaint might not start an investigation. Ten complaints about the same provider will.

The FBI Interview Trap

Heres a seperate crime most defendants dont know there committing.

The FBI contacts you about billing practices from 2020 or 2021. Your asked questions about transactions you dont clearly remember. You answer honestly based on what you think happened. Except your memory isnt perfect.

The agent documents everything in an FD-302 report. Months later, your attorney reviews the actual records – the claims data, the patient files, the financial records. Some details you provided to the FBI dont match the documents.

Now prosecutors have options. Either you lied to the FBI – making you look guilty of the underlying fraud. Or your changing your story now – making you look like your obstructing the investigation. 18 U.S.C. § 1001 makes false statements to federal agents a felony carrying up to 5 years.

The interview creates a new crime seperate from whatever happened with the billing. This is why every healthcare provider facing investigation needs an attorney before speaking to any federal agent. Every answer becomes potential evidence. Every memory lapse becomes potential perjury.

Common Mistakes in Florida Medicare Fraud Cases

Defendants make predictable mistakes in federal healthcare fraud cases.

Mistake 1: Assuming your billing company handled everything. The government dosent care who submitted the claims. Your the provider. Your name is on the enrollment. Your responsible for every claim submitted under your provider number.

Mistake 2: Thinking small amounts dont matter. They do. Defendants who billed $50,000 in fraudulent claims have gone to prison. Amount affects sentence length, not wheather you serve time.

Mistake 3: Talking to federal agents without an attorney. Every answer creates evidence. Every inconsistency becomes a potential false statement charge.

Mistake 4: Voluntary cooperation without understanding the consequences. Cooperation that seems helpful can build the case against you. Consult an attorney before producing any documents or providing any statements.

Mistake 5: Beleiving your too small to prosecute. The Strike Force prosecutes schemes of all sizes. The 2025 takedown included defendants who billed millions and defendants who billed hundreds of thousands.

The Questions You Should Be Asking

“Was my billing compliant” is the wrong question for assessing your exposure in Florida.

The right questions are:

• Have I recieved any contact from OIG, FBI, DOJ, or HHS?
• Have any of my employees been interviewed by federal agents?
• Has Medicare suspended any of my payments?
• Are there former employees who might file whistleblower complaints?
• Have any patients complained about services or equipment?
• Do my billing patterns match national averages for my specialty?

These questions lead to realistic exposure assessment. The “I didnt know my billing was wrong” perspective ignores how Florida healthcare fraud prosecutions actualy work – were intent is established through patterns, not just individual claims, and were the investigation started years before you ever knew.

The Multi-Agency Investigation Machine

Heres how the investigation actualy operates behind the scenes.

Medicare fraud investigations in Florida dont involve a single agency working alone. There coordinated operations involving multiple federal agencies working simultaniously:

• The HHS Office of Inspector General initiates many cases through data analytics
• The FBI provides investigative resources and conducts interviews
• IRS Criminal Investigation traces financial flows and analyzes bank records
• The Department of Justice Fraud Section coordinates prosecution strategy

These agencies share information freely – what one agency discovers, all agencies know.

The Medicare Fraud Strike Force was designed specificaly for this kind of coordination. It harnesses data analytics and the combined resources of federal, state, and local law enforcement entities. Strike Force teams include prosecutors, agents, analysts, and auditors all working together on healthcare fraud cases.

And heres what makes Florida different. The Florida Medicaid Fraud Control Unit – a state agency – joined the Strike Force in 2013. So your not just facing federal investigators. Your facing a combined federal-state task force with access to both Medicare and Medicaid claims data, state regulatory information, and local law enforcement resources.

Whistleblowers add another layer. The False Claims Act qui tam provisions create financial incentive for informants. Successful whistleblowers recieve 15-30% of recovered funds. In healthcare fraud cases, thats potentially millions of dollars. Former employees, business partners, competitors – anyone with inside information has financial motivation to report you. The investigation might have started with a sealed whistleblower complaint filed three years ago that you still dont know about.

The Exclusion Consequence That Ends Careers

Heres the punishment that continues after prison.

Federal healthcare fraud conviction results in mandatory exclusion from all federal healthcare programs. Medicare. Medicaid. TRICARE. Veterans Administration. Every federal healthcare program – your excluded.

This isnt a temporary suspension. For felony healthcare fraud convictions, the mandatory minimum exclusion is 5 years. But in practice, exclusion is often permanent. The Office of Inspector General maintains an exclusion list. Once your on it, no federal healthcare program will pay for services you provide. No healthcare organization receiving federal funds will hire you. Your career in healthcare is effectively over.

Think about what that means for a physician. Even after serving a 5-year sentence, even after paying restitution, even after completing supervised release – you cant bill Medicare for treating patients. You cant work for a hospital that accepts Medicare. You cant prescribe medications covered by federal programs. The exclusion destroys your ability to practice medicine even after the criminal sentence is complete.

For practice owners and administrators, exclusion means you cant own or manage any healthcare entity that bills federal programs. You cant be a silent partner. You cant provide consulting services. The exclusion follows you permanently.

This is why healthcare fraud convictions are career-ending in ways that other white-collar convictions are not. Securities fraud defendants can eventually return to finance. Tax fraud defendants can eventually start new businesses. Healthcare fraud defendants are permanantly locked out of the industry – not by there conviction directly, but by the administrative exclusion that automaticaly follows.

Strike Force operations since 2007. Over 3,500 defendants charged for $12.5 billion. The 2025 takedown charged 324 defendants for $14.6 billion – 73 of them in Florida alone. Philip Esformes got 20 years for $1.3 billion. Jesus Garces got 12.5 years after they found $2.5 million cash in PVC pipes under his house. Average sentence 27 months nationally, but Florida cases run longer becuase fraud amounts run higher. No parole means your serving 85% of whatever sentence you get. The Strike Force was created for Florida becuase Florida needed it. If your facing federal Medicare fraud charges in the Southern District, your facing the prosecutors who invented modern healthcare fraud enforcement. Thats the reality – were the investigation started before you knew, were the algorithms already flagged you, and were 90% of defendants are convicted.