Healthcare Fraud Attorneys – Defense & Medical Fraud Lawyer

Nationwide Medical Fraud and HealthCare Fraud Attorneys and Defense Lawyers – Legal Consultation for Healthcare Law Compliance Fraud – Federal Medical Fraud Lawyers Defending Your Practice, Reputation, and Freedom

Civil and Criminal  Investigations | Healthcare Whistleblower Defense  | Grand Jury Indictment Subpoenas & CIDs | FBI, HHS, OIG Investigations | Search Warrant Defense | Federal Indictments | Criminal Defense & Trials 

If you did not intend to defraud the government, we can help.

We Represent Doctors, Hospitals, Pharmacies and Healthcare Clients Nationwide| 866-601-5518

Are you trying to Get Your Case Dismissed or Get Aggressive Legal Counsel to get a Better Result? Our Nationwide False Claims Act Health Care Litigators Can Help. We understand the difficulties that federal prosecutors may have in proving criminal cases against you or your company. Our federal healthcare fraud lawyers will develop an aggressive defense team to help you fight back.

What Is Healthcare Fraud?

Healthcare fraud involves deliberately misleading a healthcare benefit program to obtain money or services under false pretenses. This could mean submitting false claims, misrepresenting services, or manipulating billing codes—actions that can trigger serious federal investigations.

One of the most critical elements in any healthcare fraud case is intent. The government must typically show that the accused knowingly and willfully engaged in deception. However, in many cases, what the government sees as fraud may actually stem from complex billing systems, clerical errors, or misunderstanding of coding protocols.

Just because a billing mistake occurred does not automatically mean fraud took place. Errors happen, and navigating insurance and federal healthcare regulations is anything but simple. Prosecutors, however, may still bring charges, often leaning heavily on those very errors to build their case.

If you or your organization is under investigation, it’s essential to work with defense attorneys who understand both the technical and legal nuances of the healthcare system. A strong legal strategy can make the difference between clarifying an honest mistake—and defending your career, business, or license in federal court.

• The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) have increased their efforts to investigate and charge healthcare professionals Who have been allegedly violated in healthcare laws.
• Why is it that So Many Companies are Settling Cases ?

If you’ve received a subpoena, target letter, or other notice from federal authorities, it’s crucial to consult a healthcare enforcement action lawyer who understands how to navigate the system. As a healthcare professional, you’ve spent years building your career. Now, that future may seem uncertain.

Accusations of healthcare fraud don’t just threaten your business—they put your license, your freedom, and your livelihood on the line. At Watson & Associates, LLC, our team of experienced anti-kickback violation defense attorneys and health care fraud lawyers helps providers and businesses navigate the complexities of federal investigations.

What is the Government’s Burden of Proof in a Criminal Healthcare Fraud Case?

Our federal healthcare fraud attorneys have defended clients in DOJ, HHS, and OIG cases. False Claims Act Healthcare fraud under 18 USC 1347 typically involves a scheme to defraud the federal healthcare program. The government’s case may tend to argue false or fraudulent representations in exchange for money – health insurance fraud through payment of invoices or something of value.

The prosecutor has to prove every element of the case”beyond a reasonable doubt.”  This is a very high legal standard. The key to defending a False Claims Act healthcare fraud case is to show a lack of intent. This is usually the government’s biggest hurdle in a criminal case and something that the federal Anti-Kickback statute and medical billing fraud law firm, and a criminal healthcare fraud enforcement action defense lawyer at our firm can help.

• bribery,
• kickbacks,
• gratuities, and
• conflicts of interest
• Ghost Patients
• Inflating Cost Reports
• Billing for Services Not Rendered

18 USC 1347. makes it a federal crime to defraud any health care benefit program or obtain, by fraudulent means, any money or benefit from a health care program.

If you are thinking about hiring a health care fraud attorney, Watson & Associates, LLC only Takes On Cases That Our Federal False Claims Act Healthcare Fraud attorneys believe that They Can Help.

Kickbacks vs. Self-Referrals: What Healthcare Professionals Must Know

Understanding the Anti-Kickback Statute (AKS) and Stark Law is critical if you or your healthcare organization interacts with Medicare or Medicaid. Both laws aim to prevent financial conflicts that influence patient care—but they differ significantly in scope, penalties, and how they’re enforced. If you’re under investigation, a healthcare fraud attorney can help you navigate the complex distinctions between the two.

Anti-Kickback Statute (AKS) – A Criminal Offense

• What It Prohibits: Offering or receiving anything of value in exchange for referrals for services covered by federal healthcare programs.

• Examples:

  • Financial bonuses for patient referrals

  • Below-market rent for office space

  • Lavish “consulting” fees or speaking engagements

  • Waiving patient copays without legitimate financial hardship

• Penalties:

  • Fines up to $25,000 per violation

  • Up to 5 years in federal prison

  • Exclusion from Medicare and Medicaid programs

AKS violations hinge on intent—prosecutors must prove that the arrangement was knowingly made to influence referrals. These are criminal charges, often pursued aggressively by federal agencies.

Stark Law – A Civil Violation

• What It Prohibits: Physicians referring Medicare or Medicaid patients for designated health services (DHS) to an entity with which they or their family have a financial relationship—unless a legal exception applies.

• Penalties:

  • Denial or refund of payments for improper referrals

  • Civil fines up to $15,000 per prohibited service

  • Treble damages (3x the amount received)

  • Up to $100,000 for schemes designed to evade the law

  • Potential exclusion from government healthcare programs

Unlike the AKS, Stark Law does not require proof of intent. That means even unintentional violations can trigger severe financial consequences.

If you are facing allegations related to kickbacks or self-referrals, the difference between criminal and civil exposure can mean everything. Engaging a seasoned healthcare fraud defense lawyer early can be the key to protecting your practice, reputation, and future.

Upcoding and Unbundling in Healthcare Fraud

Hiring a healthcare fraud lawyer? Among the most scrutinized billing practices in federal investigations are upcoding and unbundling—two forms of healthcare fraud that can expose providers to serious legal and financial consequences. These practices involve inflating or manipulating billing codes to secure higher reimbursement from Medicare, Medicaid, or private insurers. While sometimes misunderstood as mere administrative errors, federal agencies increasingly view these actions as deliberate attempts to defraud public health programs. If your practice or institution has been accused of these billing irregularities, consulting with a skilled healthcare fraud attorney is essential.

Upcoding occurs when a provider submits billing codes for a service that is more severe or complex than what was performed. For instance, a physician might report a comprehensive office visit when the interaction was limited in scope, or list a high-level procedure code for what was a routine intervention. This misrepresentation can lead to significant overpayments from federal programs, and, when detected, can trigger audits, subpoenas, and even criminal charges. An experienced healthcare fraud defense lawyer understands how to differentiate between intentional fraud and innocent miscoding and can craft a strong strategy to protect your license and your business.

ADA healthcare fraud lawyer: Unbundling, also known as fragmentation, involves billing separately for services that should be grouped under a single, lower-paying bundled code. Medicare and Medicaid use bundled payments for procedures that are typically performed together—such as a surgical incision and its closure—to prevent inflated billing. When a provider unbundles these services, they may receive a higher cumulative payment, but also risk civil penalties or program exclusion. In the eyes of regulators, this practice can distort the true cost of care and result in unjustified taxpayer expense.

Both practices are often made easier—or harder to detect—through electronic health records (EHR) systems. Some providers copy and paste outdated patient information into new charts, or restrict dropdown menus to show only high-reimbursement billing codes. This can unintentionally trigger red flags with federal payers and invite audits or whistleblower complaints. If your practice uses EHR technology and has been accused of improper coding, a healthcare fraud attorney can analyze your systems and documentation protocols to assess your legal risk and defend against accusations.

Upcoding is not limited to physicians. Hospitals can also face allegations of fraud if they bill higher inpatient severity codes than medically warranted. For example, hospitals may list a diagnosis-related group (DRG) that includes major complications or comorbidities, such as sepsis or acute respiratory failure, even when such conditions were not clearly documented. Additionally, billing for physician-level care when services were actually rendered by a nurse or physician’s assistant is another common trigger for allegations. These billing issues not only compromise reimbursement integrity but may lead to substantial penalties unless defended against by a knowledgeable healthcare fraud defense lawyer.

Ultimately, whether you’re a solo practitioner, a specialty group, or a hospital system, facing allegations of upcoding or unbundling is a serious matter. These claims can result in civil fines, exclusion from federal programs, or even criminal prosecution. The role of a seasoned federal health care fraud lawyer is to help demonstrate that coding errors may be attributable to administrative oversights, not fraudulent intent. With the right legal guidance, providers can navigate audits, protect their reputations, and preserve their ability to serve patients.

HERE IS WHAT YOU NEED TO KNOW IF YOU ARE INVESTIGATED OR INDICTED

Call 1.866.601.6618 if you are seeking to retain a medical fraud lawyer and Speak to Mr. Watson 

How Our National Federal Healthcare Fraud Defense Lawyers Can Fight Back in Healthcare Fraud Cases

Defending Your Case Can Be Simpler Than Many May Think. First Question is – Did You Knowingly Intend to Defraud the Government Under 18 USC 1347? If  not, then you could a strong legal defense.

The government will normally Use the Supreme Court Case of Universal Health Servs.. lnc. v. United States ex rel. Escobar,579 U.S. 176, 180 (2016) to support its allegations that you violated the False Claims Act. Litigation against the federal government in both criminal and civil False Claims Act cases can be very expensive and difficult. The government uses Universal Health Servs.. lnc. v. United States ex rel. Escobar to leverage its allegations that under 3 l U.S.C. § 3729, it has met the FCA’s scienter (knowledge) requirement to argue that by merely submitting or signing a document, you automatically show a “reckless disregard of the truth or falsity of the information.

What the US Supreme Court Said and How We Fight Back

Defending Healthcare Fraud Cases Under the False Claims Act – Help for Doctors, Pharmacies, and Healthcare Providers

Federal prosecutors often lean heavily on the 2016 Supreme Court ruling in Universal Health Servs., Inc. v. United States ex rel. Escobar, 579 U.S. 176, which allowed them to pursue False Claims Act (FCA) cases by showing a provider acted with “reckless disregard” for the truth. This approach has become a cornerstone of the government’s strategy to secure convictions, extract large settlements, and even push for jail time in healthcare fraud cases involving doctors, pharmacies, and healthcare entities.

But in a critical and more recent decision—United States ex rel. Schutte et al. v. SuperValu Inc. et al.—the U.S. Supreme Court clarified and narrowed the standard. The Court emphasized that FCA liability must be judged by a subjective standard: what the defendant actually believed or knew at the time of the alleged false claim, not what a reasonable person should have known. This ruling marks a major shift, favoring defendants when credible evidence can be presented to show there was no intent to defraud.

At Watson & Associates, our healthcare fraud lawyers leverage the Schutte decision to dismantle the government’s narrative in both civil and criminal FCA cases. By showing our client’s honest interpretation of regulatory requirements—or a genuine misunderstanding of complex billing codes—we can undermine the “knowing” element the government must prove. This is especially powerful in criminal prosecutions, where the defense only needs to raise reasonable doubt, and in civil cases, where the burden of proof still rests squarely with the government.

While no case outcome can be guaranteed, our approach is strategic, aggressive, and grounded in the latest legal precedent. We build strong, evidence-backed defenses to protect your professional license, your financial future, and your freedom. If you or your healthcare organization is facing FCA allegations or a government investigation, contact a trusted healthcare fraud defense lawyer at Watson & Associates today.

At Watson & Associates, LLC our Federal False Claims Act defense attorneys understand that the prosecution MUST prove that you knowingly intended to commit fraud, and that the scienter element of the False Claims Act is one of the most difficult for the government’s prosecutor to prove. We aggressively represent you and focus on deconstructing the government’s case against you. With years of experience, our healthcare fraud attorneys and litigation defense lawyer. know how to weaken the prosecution’s strategy.  Call our office immediately to secure aggressive legal counsel and retain a healthcare compliance lawyer and 18 USC 1347 defense. 

Nationwide help in federal criminal cases: The law states that when you can show you never intended to defraud the government, our false claims act medical billing fraud defense attorneys can reduce the chances of being indicted or convicted by a jury at a criminal trial. As federal healthcare fraud defense attorneys, We Focus on Getting Your Case or Investigation Dismissed.

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The Federal Agencies Involved

If you are being investigated for healthcare fraud, you’re not just facing one agency—you’re facing an entire system. Investigations may include the Department of Justice (DOJ), Office of Inspector General (OIG), Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and even the FBI or DEA. These agencies work together to uncover alleged fraud under statutes like the False Claims Act, the Anti-Kickback Statute, and 18 U.S. Code § 1347, the federal healthcare fraud statute.

Their tactics can be aggressive. You may have received a subpoena, civil investigative demand, or a letter informing you that you’re the target of an investigation. Many clients feel tempted to cooperate or explain themselves without legal representation. But this can be a critical mistake. As your federal healthcare fraud defense attorney, our job is to handle all communications, protect your rights, and ensure that your words aren’t twisted into evidence against you.

How Watson & Associates’ Healthcare Fraud Attorneys Defend Your Case

Every healthcare fraud case is different. That’s why our approach is never one-size-fits-all. We begin by conducting a thorough review of your situation—what you’ve been accused of, what evidence the government has, and how the case was initiated. From there, we develop a legal strategy to either resolve the matter without charges or prepare for litigation if necessary. Our federal healthcare fraud attorneys examine the government’s evidence closely and build tailored strategies to either resolve or fight the charges in court

As your healthcare fraud attorney, we’ll dig deep into the allegations. If the case involves Medicare billing, we’ll analyze the codes, procedures, and audit trails. If the charges relate to alleged kickbacks, we’ll scrutinize your contracts, referral patterns, and communications. Often, these cases arise from whistleblower complaints or administrative reviews, not hard evidence. We expose weaknesses in the government’s case and advocate for dismissal or reduction of charges.

When facing audits, our healthcare fraud attorneys focus on early case dismissal. Clients often come to us when a Medicare audit turns into something more serious. What begins as a routine records request can evolve into a full investigation. As a skilled medicare audit defense attorney, we respond swiftly and strategically, ensuring that your practice is compliant and that any perceived irregularities are addressed before they trigger prosecution.

Why These Cases Demand Immediate Action

Time is not on your side in a healthcare fraud investigation. The government may have been gathering evidence for months or even years before you knew you were under suspicion. By the time you’re contacted, their attorneys and investigators already have a head start.

Early intervention is critical. As your health care litigation lawyers, we intervene early to disrupt the government’s momentum and work to prevent your case from spiraling into criminal charges. Our goal is to keep the case from escalating, and where possible, avoid charges altogether. If you’re already charged, we build a powerful defense aimed at discrediting the evidence, suppressing improper investigative practices, and protecting your reputation.

We understand how emotionally and professionally devastating these cases can be. That’s why our approach goes beyond just legal strategy. We communicate with our clients clearly and regularly, keeping you informed and empowered throughout the process.

Why You Need HealthCare Fraud Defense Attorneys Right Away – Legal Challenges We Frequently Handle

Our team of healthcare fraud defense lawyers represents clients in a wide array of cases involving federal medical fraud. This includes Medicare fraud, Medicaid fraud, billing fraud, Stark Law violations, and Anti-Kickback allegations. We also handle whistleblower (qui tam) defense, exclusion appeals, and overpayment disputes. Many of our cases involve complex billing practices where intent is difficult to prove, but the government still seeks heavy penalties.

As a seasoned medical billing fraud law firm, we understand how billing systems work—and how prosecutors try to twist normal practices into criminal acts. We’re here to cut through the confusion and advocate for your side of the story.

In addition, we offer representation in healthcare overpayment disputes. If you’ve been accused of receiving improper Medicare or Medicaid payments, we’ll help you respond to audits, appeals, and overpayment demands. As your healthcare overpayment defense lawyer, we ensure that your rights are protected, and that you’re not forced to repay funds based on flawed or incomplete audits.

Potential Penalties and Consequences to Healthcare Fraud

Being found guilty of healthcare fraud can carry serious consequences. Consequences to healthcare fraud may include significant fines, prison time, exclusion from Medicare and Medicaid, and the loss of professional licenses. Even a civil settlement under the False Claims Act can come with treble damages and future compliance obligations that restrict your practice.

That’s why hiring the right healthcare fraud defense lawyer is not a luxury—it’s a necessity. With our firm in your corner, you don’t have to face these penalties without a fight. We’ll work to either dismantle the case against you or negotiate a favorable outcome that protects your ability to continue practicing.

A National 18 USC 1347 Federal Healthcare Fraud Defense Law Firm

Watson & Associates is proud to serve clients across the United States in complex 18 USC 1347. federal healthcare cases. Our attorneys are deeply experienced in criminal defense, regulatory compliance, and litigation. When you work with our team, you’re getting more than just legal knowledge—you’re getting strategic advocacy tailored to your profession.

If you are looking for a federal medical fraud lawyer who understands how to fight back against powerful agencies, you’ve found the right team. We represent physicians, nurses, pharmacists, hospitals, home health providers, billing companies, and more.

Federal Pharmaceutical Fraud Defense Attorneys

At Watson & Associates, LLC, our federal pharmaceutical fraud defense attorneys provide aggressive legal defense for companies, healthcare providers, and executives facing federal investigations and criminal charges. Whether you’re being targeted for off-label marketing, kickback schemes, fraudulent billing, or violations of the False Claims Act, our team understands how to navigate the complex web of pharmaceutical regulations and government enforcement actions.

With decades of combined experience in healthcare fraud defense, our medical fraud lawyers. represent clients during DOJ and OIG investigations, audits, and federal court proceedings. If you’re under scrutiny or have been charged with pharmaceutical fraud, contact our law firm today to protect your rights and business.

Speak with a Healthcare Fraud Defense Lawyer Today

If you’re being investigated or charged with healthcare fraud, don’t wait. Every conversation you have and every document you hand over can influence the direction of your case. You need a skilled health care fraud attorney who can help you take control before it’s too late.

Contact Watson & Associates, LLC today for a confidential consultation. Call 866-601-5518 or use our secure form to get in touch. Our healthcare fraud defense lawyers are ready to help you protect your future, defend your name, and restore peace of mind.

See our healthcare fraud alert.

Common Legal Issues Handled by Our Health Care Fraud Attorneys

Whether you’re facing allegations involving Medicare, Tricare, or need a skilled Medicaid fraud lawyer, our team is ready to defend your rights. Our health care fraud attorneys also represent clients as their Medicaid fraud lawyer, especially in cases involving billing discrepancies, prior authorization issues, or accusations of upcoding. Several federal statutes govern healthcare fraud and are frequently used in criminal and civil cases including:

The False Claims Act (31 USC 3729–3733):  This law allows the federal government to pursue you or your company if you knowingly submit false or fraudulent claims to government healthcare programs.

Civil and Criminal False Claims Act Penalties can include treble damages and civil fines exceeding $25,000 per claim.*

Anti-Kickback Statute (42 USC 320a-7b).  This federal criminal statute prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals or generate federal healthcare program business. Criminal convictions can result in felony charges, exclusion from federal programs, and up to 10 years in prison.

Stark Law (42 U.S.C. § 1395nn).  This is a strict liability statute that prohibits physicians from referring patients for certain designated services payable by Medicare or Medicaid if the physician has a financial relationship with the entity. Penalties include fines and exclusion.

Healthcare Fraud (18 USC 1347)  A criminal statute that makes it illegal to knowingly execute a scheme to defraud any healthcare benefit program. It carries up to 10 years in prison, or 20 years if it results in serious bodily injury.

Conspiracy (18 USC 371). Frequently added to fraud indictments, conspiracy charges involve two or more persons working together to commit healthcare fraud.

Wire Fraud (18 USC1343). Use of email, telephone, or internet to commit fraud can trigger additional felony charges.A single healthcare fraud investigation can implicate multiple statutes, significantly raising the stakes for a defendant.

Uncertainty

When you stall and wait, government attorneys have already been on your case for years or months. Your life can become a nightmare without getting the legal help you need. One of the most significant pain points for those facing a False Claims Act investigation is the overwhelming uncertainty. You might wonder, “Will I lose my business? Will I face jail time?“ These are critical concerns, but rest assured that not every investigation leads to criminal charges or extreme penalties. Our team of Qui Tam Defense Attorneys and government fraud investigation lawyers is adept at building robust defenses, from questioning the intent behind the alleged false claims to challenging the government’s evidence. We provide comprehensive representation for all types of Federal Fraud cases, including Medicare and Medicaid fraud, procurement fraud, and allegations related to the Trade Agreements Act or Buy American Act.

Are You Facing HealthCare Fraud Charges? Learn How to Protect Yourself Here

Potential Consequences of Healthcare Fraud Convictions

Being found guilty of healthcare fraud can lead to severe penalties, including:

• Civil Penalties: Substantial fines and restitution payments.
• Criminal Penalties: Imprisonment, probation, and criminal fines.
• Professional Repercussions: Loss of medical licenses, exclusion from federal healthcare programs, and damage to professional reputation.

What Are False Claims Act Healthcare Fraud Penalties Under 18 USC 1347?

A knowledgeable health care fraud defense attorney will know how to challenge the government’s burden of proof under statutes like 18 USC 1347 and the False Claims Act A violation of 18 USC 1347 for federal healthcare fraud and False Claims Ac violation is punishable by:

• a maximum of 10 years in federal prison and/or
• the imposition of a fine
• Additional charges of federal conspiracy charges
• Additional wire fraud charges

Who Are Our Clients?

Watson & Associates, LLC Medical Fraud Defense Attorneys and Pharmaceutical Fraud Defense Attorneys Provide Nationwide False Claims Act Healthcare Enforcement Action Defense Lawyers for Providers, Hospitals, Pharmaceutical Companies, Licensed Pharmacists, Doctors, and Pharmacies,  Manufacturers, and More.

We are nationwide federal healthcare fraud attorneys and pharmaceutical fraud defense lawyers: If you are being investigated or have received a civil investigative demand or subpoena from DHHS, DOJ, FBI, or some other federal law enforcement agency, do not waste time trying to see “how the case goes.” Call our medical billing fraud defense attorneys, healthcare fraud law firm, and False Claims Act health care fraud attorneys immediately at 1.866.601.5518.

How Our Healthcare Fraud Legal Counsel & Medical Billing Fraud Defense Strategies Provide Peace of Mind

What is The Prosecution’s Biggest Problem in Your 18 USC 1347 HealthCare Fraud Case – Can They Prove You Intended to Defraud the Government?  This is where Your Case Gains Traction If You Have the Right Facts: The level of intent you must have in a criminal case – called mens rea, or intent, is probably the most contested issue in a criminal prosecution of a federal healthcare fraud defense case. The government attorney must show that you acted “knowingly” or “intentionally”. Challenging the prosecution’s evidence is where you can potentially win a criminal healthcare fraud case. The level of intent can separate wrongful from innocent conduct.

View This Video For Crucial Healthcare Fraud Information

The federal government, its enforcement, and investigative teams are aggressively seeking out companies involved in health care fraud. However, despite protecting the industry from fraud, the government still has a legal obligation to prove its case. Many corporations, providers, and individuals find themselves in the government’s crosshairs through allegations of 18 USC 1347 violation. They don’t know what to do or the next steps to take.

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How Does Proving You Lacked the Intent to Defraud Help Your Health Care Fraud Case?

The US Supreme Court in Ruan and United States ex. rel. Schutte v. SuperValu  ruled that the FCA’s scienter element refers to a criminal defendant’s knowledge and subjective beliefs—not to what an objectively reasonable person may have known or believed.

The False Claims Act in a government procurement or healthcare fraud case sets out a three-part definition of the term “knowingly” that largely tracks the traditional common-law scienter requirement for claims of fraud: Actual knowledge, deliberate ignorance, or recklessness will suffice. See §3729(b)(1)(A). Each term focuses on what the defendant thought and believed: “Actual knowledge” refers to what the defendant is aware of. “Deliberate ignorance” encompasses defendants who are aware of a substantial risk that their statements are false, but intentionally avoid taking steps to confirm the statements’ truth or falsity. And “[r]eckless disregard” captures defendants who are conscious of a substantial and unjustifiable risk that their claims are false, but submit the claims anyway.

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