As a federal criminal defense attorney specializing in healthcare fraud cases including Tricare fraud, Medicare fraud and Medicaid fraud, my commitment is to zealously represent each client with the utmost professionalism and confidence. I understand the complexities of these serious offenses and am dedicated to providing comprehensive legal counsel tailored to protect our clients' rights while ensuring they receive fair treatment under law.
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Federal healthcare fraud prosecutions target alleged false claims to Medicare, Medicaid, Tricare, and private insurers. These cases often involve billing codes, medical necessity determinations, and complex reimbursement regulations.
Healthcare providers face both criminal prosecution and civil False Claims Act liability. The civil side carries treble damages and per-claim penalties that can reach into the millions — separate from any criminal exposure.
Many healthcare fraud cases center on whether prescribed treatments, tests, or procedures were 'medically necessary.' A good-faith clinical judgment, supported by documentation and peer standards, is a defense — not fraud.
Medicare and Medicaid billing involves thousands of codes, modifiers, and local coverage determinations. Billing errors — even repeated ones — are not fraud unless accompanied by intent to deceive.
Healthcare fraud investigations often begin with data analytics, whistleblower complaints, or audit findings. Early intervention with experienced counsel can prevent indictment.
The government often extrapolates from a small sample of claims to allege millions in overpayments. Challenging the statistical validity and representativeness of the sample can dramatically reduce alleged loss amounts.
Anti-kickback and Stark Law violations require proof of willful conduct. Fair market value compensation, personal service arrangements, and safe harbor compliance all provide defenses to kickback allegations.
Most healthcare fraud cases originate with whistleblowers — disgruntled employees, competitors, or former business partners. Investigating the relator's motives, credibility, and access to information is essential to the defense.
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In my 25 years as a federal prosecutor, I witnessed countless defendants destroy their own cases not through the underlying alleged fraud, but through panicked,
Key Takeaways Immediately preserve all documents and electronic records related to the investigation, as spoliation can trigger separate obstruction charges un
In my 25 years as a federal prosecutor, I witnessed countless investigations where the difference between a declination and an indictment turned on whether the
Key Takeaways The Health Care Fraud Statute, codified as 18 U.S.C. § 1347, is designed to address fraudulent activities that impact the health care system. Thi
Key Takeaways In my 25 years as a federal prosecutor, I know that when defending against Medicare fraud and upcoding billing fraud under 18 U.S.C. § 1347, the
Federal criminal defense analysis: what to expect in a federal healthcare fraud defense prosecution.
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About this site: this resource explains federal healthcare fraud defense, investigation steps, penalties, and attorney selection so readers can understand the site purpose immediately.
If convicted of healthcare fraud, you may face severe penalties including substantial fines, imprisonment, and restrictions on your ability to practice in the medical field.
Yes, intent to defraud or causing a financial loss to any party involved in the healthcare system can lead to charges of healthcare fraud regardless of whether patient harm occurred.
Legal defenses may include proving lack of intent, demonstrating compliance with all regulations, or arguing that there was no actual loss caused by your actions.
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Related: 10 Critical Steps to Take Today If You Are Under Investigation in a Healthcare Fraud Case | Federal Defense Network — 10 Critical Steps to Take Today If You Are Under Investigation in a Healthcare Fraud Case | Federal Defense Network — Federal Criminal