Florida Statute 409.920 | Lawyer Caselaw & Research

The 2024 Florida Statutes

Title XXX
SOCIAL WELFARE

Chapter 409
SOCIAL AND ECONOMIC ASSISTANCE

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F.S. 409.920

409.920 Medicaid provider fraud.—

(1) For the purposes of this section, the term:

(a) “Agency” means the Agency for Health Care Administration.

(b) “Fiscal agent” means any individual, firm, corporation, partnership, organization, or other legal entity that has contracted with the agency to receive, process, and adjudicate claims under the Medicaid program.

1. Any particular item, device, medical supply, or service claimed to have been provided to a recipient and listed in an itemized claim for payment; or

2. In the case of a claim based on costs, any entry in the cost report, books of account, or other documents supporting such claim.

(d) “Knowingly” means that the act was done voluntarily and intentionally and not because of mistake or accident. As used in this section, the term “knowingly” also includes the word “willfully” or “willful” which, as used in this section, means that an act was committed voluntarily and purposely, with the specific intent to do something that the law forbids, and that the act was committed with bad purpose, either to disobey or disregard the law.

(e) “Managed care plans” means a health insurer authorized under chapter 624, an exclusive provider organization authorized under chapter 627, a health maintenance organization authorized under chapter 641, the Children’s Medical Services Network authorized under chapter 391, a prepaid health plan authorized under this chapter, a provider service network authorized under this chapter, a minority physician network authorized under this chapter, and an emergency department diversion program authorized under this chapter or the General Appropriations Act, providing health care services pursuant to a contract with the Medicaid program.

(2)(a) A person may not:

1. Knowingly make, cause to be made, or aid and abet in the making of any false statement or false representation of a material fact, by commission or omission, in any claim submitted to the agency or its fiscal agent or a managed care plan for payment.

2. Knowingly make, cause to be made, or aid and abet in the making of a claim for items or services that are not authorized to be reimbursed by the Medicaid program.

3. Knowingly charge, solicit, accept, or receive anything of value, other than an authorized copayment from a Medicaid recipient, from any source in addition to the amount legally payable for an item or service provided to a Medicaid recipient under the Medicaid program or knowingly fail to credit the agency or its fiscal agent for any payment received from a third-party source.

4. Knowingly make or in any way cause to be made any false statement or false representation of a material fact, by commission or omission, in any document containing items of income and expense that is or may be used by the agency to determine a general or specific rate of payment for an item or service provided by a provider.

5. Knowingly solicit, offer, pay, or receive any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind, in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made, in whole or in part, under the Medicaid program, or in return for obtaining, purchasing, leasing, ordering, or arranging for or recommending, obtaining, purchasing, leasing, or ordering any goods, facility, item, or service, for which payment may be made, in whole or in part, under the Medicaid program. This subparagraph does not apply to any discount, payment, waiver of payment, or payment practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or any regulations adopted thereunder.

6. Knowingly submit false or misleading information or statements to the Medicaid program for the purpose of being accepted as a Medicaid provider.

7. Knowingly use or endeavor to use a Medicaid provider’s identification number or a Medicaid recipient’s identification number to make, cause to be made, or aid and abet in the making of a claim for items or services that are not authorized to be reimbursed by the Medicaid program.

(b)1. A person who violates this subsection and receives or endeavors to receive anything of value of:

a. Ten thousand dollars or less commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

b. More than $10,000, but less than $50,000, commits a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

c. Fifty thousand dollars or more commits a felony of the first degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

2. The value of separate funds, goods, or services that a person received or attempted to receive pursuant to a scheme or course of conduct may be aggregated in determining the degree of the offense.

3. In addition to the sentence authorized by law, a person who is convicted of a violation of this subsection shall pay a fine in an amount equal to five times the pecuniary gain unlawfully received or the loss incurred by the Medicaid program or managed care organization, whichever is greater.

(3) The repayment of Medicaid payments wrongfully obtained, or the offer or endeavor to repay Medicaid funds wrongfully obtained, does not constitute a defense to, or a ground for dismissal of, criminal charges brought under this section.

(4) Property “paid for” includes all property furnished to or intended to be furnished to any recipient of benefits under the Medicaid program, regardless of whether reimbursement is ever actually made by the program.

(5) All records in the custody of the agency or its fiscal agent which relate to Medicaid provider fraud are business records within the meaning of s. 90.803(6).

(6) Proof that a claim was submitted to the agency or its fiscal agent which contained a false statement or a false representation of a material fact, by commission or omission, unless satisfactorily explained, gives rise to an inference that the person whose signature appears as the provider’s authorizing signature on the claim form, or whose signature appears on an agency electronic claim submission agreement submitted for claims made to the fiscal agent by electronic means, had knowledge of the false statement or false representation. This subsection applies whether the signature appears on the claim form or the electronic claim submission agreement by means of handwriting, typewriting, facsimile signature stamp, computer impulse, initials, or otherwise.

(7) Proof of submission to the agency or its fiscal agent of a document containing items of income and expense, which document is used or that may be used by the agency or its fiscal agent to determine a general or specific rate of payment and which document contains a false statement or a false representation of a material fact, by commission or omission, unless satisfactorily explained, gives rise to the inference that the person who signed the certification of the document had knowledge of the false statement or representation. This subsection applies whether the signature appears on the document by means of handwriting, typewriting, facsimile signature stamp, electronic transmission, initials, or otherwise.

(8) A person who provides the state, any state agency, any of the state’s political subdivisions, or any agency of the state’s political subdivisions with information about fraud or suspected fraudulent acts by a Medicaid provider, including a managed care organization, is immune from civil liability for libel, slander, or any other relevant tort for providing information about fraud or suspected fraudulent acts unless the person acted with knowledge that the information was false or with reckless disregard for the truth or falsity of the information. Such immunity extends to reports of fraudulent acts or suspected fraudulent acts conveyed to or from the agency in any manner, including any forum and with any audience as directed by the agency, and includes all discussions subsequent to the report and subsequent inquiries from the agency, unless the person acted with knowledge that the information was false or with reckless disregard for the truth or falsity of the information. For purposes of this subsection, the term “fraudulent acts” includes actual or suspected fraud and abuse, insurance fraud, licensure fraud, or public assistance fraud, including any fraud-related matters that a provider or health plan is required to report to the agency or a law enforcement agency.

(9) The Attorney General shall conduct a statewide program of Medicaid fraud control. To accomplish this purpose, the Attorney General shall:

(a) Investigate the possible criminal violation of any applicable state law pertaining to fraud in the administration of the Medicaid program, in the provision of medical assistance, or in the activities of providers of health care under the Medicaid program.

(b) Investigate the alleged abuse or neglect of patients in health care facilities receiving payments under the Medicaid program, in coordination with the agency.

(c) Investigate the alleged misappropriation of patients’ private funds in health care facilities receiving payments under the Medicaid program.

(d) Refer to the Office of Statewide Prosecution or the appropriate state attorney all violations indicating a substantial potential for criminal prosecution.

(e) Refer to the agency all suspected abusive activities not of a criminal or fraudulent nature.

(f) Safeguard the privacy rights of all individuals and provide safeguards to prevent the use of patient medical records for any reason beyond the scope of a specific investigation for fraud or abuse, or both, without the patient’s written consent.

(g) Publicize to state employees and the public the ability of persons to bring suit under the provisions of the Florida False Claims Act and the potential for the persons bringing a civil action under the Florida False Claims Act to obtain a monetary award.

(10) In carrying out the duties and responsibilities under this section, the Attorney General may:

(a) Enter upon the premises of any health care provider, excluding a physician, participating in the Medicaid program to examine all accounts and records that may, in any manner, be relevant in determining the existence of fraud in the Medicaid program, to investigate alleged abuse or neglect of patients, or to investigate alleged misappropriation of patients’ private funds. A participating physician is required to make available any accounts or records that may, in any manner, be relevant in determining the existence of fraud in the Medicaid program, alleged abuse or neglect of patients, or alleged misappropriation of patients’ private funds. The accounts or records of a non-Medicaid patient may not be reviewed by, or turned over to, the Attorney General without the patient’s written consent.

(b) Subpoena witnesses or materials, including medical records relating to Medicaid recipients, within or outside the state and, through any duly designated employee, administer oaths and affirmations and collect evidence for possible use in either civil or criminal judicial proceedings.

(c) Request and receive the assistance of any state attorney or law enforcement agency in the investigation and prosecution of any violation of this section.

(d) Seek any civil remedy provided by law, including, but not limited to, the remedies provided in ss. 68.081-68.092 and 812.035 and this chapter.

(e) Refer to the agency for collection each instance of overpayment to a provider of health care under the Medicaid program which is discovered during the course of an investigation.

History.—s. 50, ch. 91-282; s. 6, ch. 94-251; s. 2, ch. 96-280; s. 6, ch. 96-387; s. 2, ch. 97-290; s. 6, ch. 2000-163; s. 31, ch. 2002-400; s. 8, ch. 2004-344; s. 19, ch. 2009-223; s. 4, ch. 2013-150; s. 43, ch. 2020-156.

F.S. 409.920 on Google Scholar

F.S. 409.920 on Casetext

Amendments to 409.920

Arrestable Offenses / Crimes under Fla. Stat. 409.920

Level: Degree
Misdemeanor/Felony: First/Second/Third

S409.920 2a - FRAUD-FALSE STATEMENT - RENUMBERED. SEE REC #s 6965 6966 6967 - F: T

S409.920 2a1 - FRAUD-FALSE STATEMENT - FALSE MEDICAID CLAIM 10K DOLS OR LESS - F: T

S409.920 2a1 - FRAUD-FALSE STATEMENT - FALSE MEDICAID CLAIM MORE 10K LESS 50K DOLS - F: S

S409.920 2a1 - FRAUD-FALSE STATEMENT - FALSE MEDICAID CLAIM 50K DOLS OR MORE - F: F

S409.920 2a2 - FRAUD - UNAUTH MEDICAID CLAIM 10K DOLS OR LESS - F: T

S409.920 2a2 - FRAUD - UNAUTH MEDICAID CLAIM MORE 10K LESS 50K DOLS - F: S

S409.920 2a2 - FRAUD - UNAUTH MEDICAID CLAIM 50K DOLS OR MORE - F: F

S409.920 2a3 - FRAUD - ADDED PAY FROM 3RD PARTY 10K DOLS OR LESS - F: T

S409.920 2a3 - FRAUD - ADDED PAY FROM 3RD PARTY MORE 10K LESS 50K DOL - F: S

S409.920 2a3 - FRAUD - ADDED PAY FROM 3RD PARTY 50K DOLS OR MORE - F: F

S409.920 2a4 - FRAUD-FALSE STATEMENT - ON MEDICAID PAY DOCUMENTS 10K DOLS OR LESS - F: T

S409.920 2a4 - FRAUD-FALSE STATEMENT - ON MEDICAID PAY DOCS MORE 10K LESS 50K DOLS - F: S

S409.920 2a4 - FRAUD-FALSE STATEMENT - ON MEDICAID PAY DOCUMENTS 50K DOLS OR MORE - F: F

S409.920 2a5 - FRAUD - PAY FOR MEDICAID REFERRAL 10K DOLS OR LESS - F: T

S409.920 2a5 - FRAUD - PAY FOR MEDICAID REFER MORE 10K LESS 50K DOLS - F: S

S409.920 2a5 - FRAUD - PAY FOR MEDICAID REFERRAL 50K DOLS OR MORE - F: F

S409.920 2a6 - FRAUD-FALSE STATEMENT - ON PROVIDER INFO 10K DOLS OR LESS - F: T

S409.920 2a6 - FRAUD-FALSE STATEMENT - ON PROVIDER INFO MORE 10K LESS 50K DOLS - F: S

S409.920 2a6 - FRAUD-FALSE STATEMENT - ON PROVIDER INFO 50K DOLS OR MORE - F: F

S409.920 2a7 - FRAUD - UNAUTH USE OF PROVIDER ID 10K DOLS OR LESS - F: T

S409.920 2a7 - FRAUD - UNAUTH USE PROVIDER ID MORE 10K LESS 50K DOLS - F: S

S409.920 2a7 - FRAUD - UNAUTH USE OF PROVIDER ID 50K DOLS OR MORE - F: F

S409.920 2b - FRAUD - RENUMBERED. SEE REC #s 6968 6969 6970 - F: T

S409.920 2b1a - FRAUD - MEDICAID PROVIDER FRAUD 10K DOLS OR LESS - F: T

S409.920 2b1b - FRAUD - MEDICAID PROVIDER FRAUD MORE 10K LESS 50K DOLS - F: S

S409.920 2b1c - FRAUD - MEDICAID PROVIDER FRAUD 50K DOLS OR MORE - F: F

S409.920 2c - FRAUD - RENUMBERED. SEE REC #s 6971 6972 6973 - F: T

S409.920 2d - FRAUD-FALSE STATEMENT - RENUMBERED. SEE REC #s 6974 6975 6976 - F: T

S409.920 2e - KICKBACK - RENUMBERED. SEE REC #s 6977 6978 6979 - F: T

S409.920 2f - FRAUD - REMOVED - F: T

S409.920 2f - FRAUD-FALSE STATEMENT - RENUMBERED. SEE REC #s 6980 6981 6982 - F: T

S409.920 2g - FRAUD - RENUMBERED. SEE REC #s 6983 6984 6985 - F: T

Annotations, Discussions, Cases:

Cases Citing Statute 409.920

Total Results: 19

Ron DeSantis, Governor v. Dream Defenders

Court: Fla. | Date Filed: 2024-06-20T00:00:00-07:00

Snippet: purpose, either to disobey or disregard the law.” § 409.920(1)(d), Fla. Stat. (2023). The more common and less

State of Florida v. Andrew James Jones

Court: Fla. Dist. Ct. App. | Date Filed: 2024-05-01T00:00:00-07:00

Snippet: value of $50,000 or more, pursuant to sections 409.920(2)(a) and (2)(b)1.c., Florida Statutes; and (2)…agent or a managed care plan for payment. § 409.920(2)(a)1., Fla. Stat. (2021). On appeal, the … 4 § 409.920(1)(d), Fla. Stat. (2021). Our reading of this…agent or a managed care plan for payment. § 409.920(2)(a)1., Fla. Stat. (2020). The “agency” is the…the Agency for Health Care Administration. § 409.920(1)(a), Fla. Stat. (2020). Here, “each offense

State of Florida v. Johanna Courts

Court: Fla. Dist. Ct. App. | Date Filed: 2024-05-01T00:00:00-07:00

STATE OF FLORIDA v. JAMES FRANCIS KIGAR

Court: Fla. Dist. Ct. App. | Date Filed: 2019-08-07T00:53:00-07:00

Snippet: holding that section 409.920(2)(e) was unconstitutional was because section 409.920(2)(e) contained no …of a different Florida statute, namely section 409.920(2)(e), Florida Statutes (2000), was unconstitutional…492. However, in this case, unlike section 409.920(2)(e), section 817.505(3)(a) contains “safe harbor…remains constitutional because, unlike section 409.920(2)(e) which lacked any “safe harbor” exemptions

Smith v. State

Court: Fla. Dist. Ct. App. | Date Filed: 2016-12-21T00:00:00-08:00

Citation: 211 So. 3d 176, 2016 Fla. App. LEXIS 18676

Snippet: prosecution for a felony violation of chapter 517 or s. 409.920 must be commenced -within 5 years after the violation

State v. Rubio

Court: Fla. | Date Filed: 2007-10-18T00:00:00-07:00

Citation: 967 So. 2d 768

Snippet: knowingly" in section 409.920(1)(d) applies to both sections 409.920(2)(a) and 409.920(2)(e). In Harden, …quot; language from section 409.920(1)(d) as it pertains to section 409.920(2)(a). We have long recognized…Medicaid provider fraud, in violation of section 409.920(2)(a), Florida Statutes (2002); (56-129) split-…decision that the Medicaid provider fraud statute, § 409.920(2)(a), is unconstitutional. Rubio, 917 So.2d at…Fifth District's determination that section 409.920(2)(a) is unconstitutional. However, both the State

Prosper Diagnostic Centers, Inc. v. Allstate Insurance Co.

Court: Fla. Dist. Ct. App. | Date Filed: 2007-08-29T00:00:00-07:00

Citation: 964 So. 2d 763, 2007 Fla. App. LEXIS 13401, 2007 WL 2428541

Snippet: Florida’s Medicaid anti-kickback statute, section 409.920(2)(e), Florida Statutes (2000), was preempted by…District contrasted section 817.505 from section 409.920 on the grounds that section 817.505 contained a

State v. Harden

Court: Fla. | Date Filed: 2006-05-18T00:53:00-07:00

Citation: 938 So. 2d 480

Snippet: District Court of Appeal declaring invalid section 409.920(2)(e), Florida Statutes (2000), the "anti-…racketeering, and Medicaid fraud under section 409.920(2)(e), Florida Statutes (2000). The State alleged…undefined term "remuneration" in section 409.920(2)(e) was unconstitutionally vague as applied to…the unlawful remuneration provision of section 409.920(2)(e) was preempted by federal law and thus unconstitutional… held that the mens rea requirement in section 409.920(1)(d) was preempted by federal law and unconstitutional

State v. Sachs

Court: Fla. Dist. Ct. App. | Date Filed: 2006-04-12T00:53:00-07:00

Citation: 926 So. 2d 440

Snippet: So.2d 352 (Fla. 3d DCA 2004) (finding section 409.920(2)(e), Florida Statutes, unconstitutional), appeal

State v. Rubio

Court: Fla. Dist. Ct. App. | Date Filed: 2005-12-30T00:00:00-08:00

Citation: 917 So. 2d 383

Snippet: section 409.920(2)(a) is unconstitutional. The defendants argued that the version of section 409.920 applicable…times in 1999-2002 in violation of section 409.920(2)(a): 409.920. Medicaid provider fraud (2) It is unlawful…violated section 409.920(2)(e), the "anti-kickback" provision of section 409.920, by paying drivers… aware" language in section 409.920(1)(d). Under section 409.920(1)(d), "knowingly" may…quot;knowingly" in section 409.920(1)(d) rendered section 409.920(2)(a) unconstitutional and counts

Lawrence v. State

Court: Fla. Dist. Ct. App. | Date Filed: 2005-12-15T23:53:00-08:00

Citation: 918 So. 2d 368

Snippet: violation of the Medicaid fraud statute, section 409.920(2)(e), Florida Statutes. He was also charged with… Medicaid fraud, again in violation of section 409.920(2)(e). We reverse because, subsequent to Lawrence

Brister v. Dept. of Children and Families

Court: Fla. Dist. Ct. App. | Date Filed: 2005-07-13T00:53:00-07:00

Citation: 906 So. 2d 1187

Snippet: necessary to comply with or administer ss. 409.901-409.920 and all rules necessary to comply with federal

State v. Wolland

Court: Fla. Dist. Ct. App. | Date Filed: 2005-05-25T00:53:00-07:00

Citation: 902 So. 2d 278

Snippet: payment." § 409.920(2)(a), Fla. Stat. (2001). Rather, the language of subsection 409.920(2)(a) reflects…Health Care Administration ... in violation of s. 409.920(2)(a) Florida Statutes." Count 116 alleged…filed a motion to dismiss, arguing that subsection 409.920(2)(a), Florida Statutes (2001) of Florida's…because it is preempted by federal law. Section 409.920 provides in relevant part: (2) It is unlawful to…affirming a trial court's order finding subsection 409.920(2)(e)[2], the anti-kickback provision of Florida

State v. Harden

Court: Fla. Dist. Ct. App. | Date Filed: 2004-03-09T23:53:00-08:00

Citation: 873 So. 2d 352

Snippet: requirement in section 409.920(1)(d), Florida Statutes (2000), as applied to section 409.920(2)(e), Florida Statutes…Florida's Medicaid Provider Fraud Statute, § 409.920(2)(e), Fla. Stat. (2000), unconstitutional. We …Florida's Medicaid Provider Fraud Statute, § 409.920(2)(e), Fla. Stat. (2000), by paying drivers, who…unlawful "remuneration" barred by Section 409.920(2)[(e)], the wages paid by Harden's *354 business…conflict preemption analysis and found that section 409.920(2)(e), Florida Statutes (2000), was unconstitutional

Community Healthcare Centerone, Inc. v. State

Court: Fla. Dist. Ct. App. | Date Filed: 2003-07-30T00:00:00-07:00

Citation: 852 So. 2d 322, 2003 Fla. App. LEXIS 11714, 2003 WL 21750273

Snippet: records relating to Medicaid recipients” to section 409.920(8)(b). As a result, the statute addressed in its…the Department of Legal Affairs pursuant to s. 409.920. Section 409.907(3)(e), entitled “Medicaid provider…investigation for fraud,” unless the patient consents. § 409.920(7)(f). The only other issue we find it necessary…that they operate only in Broward County. Section 409.920(7), Florida Statutes (2002), entitled “Medicaid

Butterworth v. X Hospital

Court: Fla. Dist. Ct. App. | Date Filed: 2000-06-14T00:00:00-07:00

Citation: 763 So. 2d 467, 2000 Fla. App. LEXIS 7240, 2000 WL 763740

Snippet: program of Medicaid Fraud Control[.] Fla. Stat. § 409.920 (1997). The office of the Attorney General investigates…throughout *468the state of Florida. Fla. Stat. § 409.920(8)(b). On January 15, 1999, the Fort Lauder-dale…No. 99-010. LEGAL ANALYSIS Florida Statute § 409.920(8)(a) sets forth the authority of the Attorney …General without the patient’s written consent. § 409.920(8)(a), Fla. Stat. (1997). The Respondent argues….1974). Thus, the court must attempt to construe § 409.920(8)(a), which sets forth the Attorney General’s

Bonner v. Department of Health & Rehabilitative Services

Court: Fla. Dist. Ct. App. | Date Filed: 1997-08-19T00:00:00-07:00

Citation: 698 So. 2d 880, 1997 Fla. App. LEXIS 9478, 1997 WL 528294

Snippet: Program as authorized by sections 409.026, 409.901-409.920, Florida Statutes (1995). This program is designed

Medicaid, Program Integrity, Department of Health & Rehabilitative Services v. Conval-Care, Inc.

Court: Fla. Dist. Ct. App. | Date Filed: 1994-04-19T00:00:00-07:00

Citation: 636 So. 2d 117, 1994 Fla. App. LEXIS 3543, 1994 WL 133528

Snippet: Auditor General is then required, under section 409.-920, to refer criminal activity to the appropriate

Morris v. State

Court: Fla. Dist. Ct. App. | Date Filed: 1993-07-21T00:53:00-07:00

Citation: 622 So. 2d 67

Snippet: records does not extend to physicians. Section 409.920(10)(a), Florida Statutes (1991) states in relevant… Id. Initially, we do not believe that section 409.920(10)(a), and its exclusion of a physician's