Federal Healthcare Fraud Defense Attorneys

Federal Healthcare Fraud Defense for Investigations, FCA Cases, and Trials

When federal agents, auditors, or prosecutors turn their focus to your organization, you are no longer in ordinary “compliance” territory. You are in a federal enforcement environment where civil False Claims Act (FCA) liability and criminal healthcare fraud charges are both on the table. At that point, your organization needs healthcare fraud defense attorneys whose work begins at the investigation stage and continues through civil and criminal trial. That is the core of this practice.

Former DOJ Attorneys and Government Procurement Officials: We defend federal healthcare organizations and professionals nationwide in:

• Federal healthcare fraud investigations

• Civil False Claims Act and qui tam cases

• Federal criminal healthcare fraud prosecutions

We are not general billing or compliance counsel. We are engaged when there is a real risk of government enforcement.

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Our healthcare fraud and federal white-collar crime experience focuses on a national audience of doctors, pharmacies, dentists, hospitals, and healthcare facilities who want to aggressively fight back and take charge of their constitutional and statutory rights.   The reality is that when federal agents and prosecutors initiate contact with youor you organization, they are building a case against you. 

• Never try to talk your way out of a meeting with federal agents.
• Never speak to federal agents without legal counsel.
• Start your legal defense – do not wait until the indictment stage.

Our experience suggests that we approach healthcare fraud False Claims Act cases differently than most attorneys. Our law firm believes the Government and federal agents are overreaching and that their case has holes.

• To stand a chance of winning or getting your case dismissed, you have to attack the Government’s case from the beginning. 

Our defense team is comprised of former DOJ prosecutors, who have seen this story play out time and time again. We know the fear, the confusion, and the overwhelming sense of injustice that comes with being targeted by the federal government. 

Our Government Fraud Defense Team Leads

Executives want to know who is actually in the room when things get serious. Key members include:

• Carolyn Oliver, Esq.( Former DOJ Attorney) – Government contracts and compliance lawyer focusing on contract performance, small business program rules, and internal investigations that often sit at the center of government contract fraud cases.

• Chris Mancini, Esq. (Former DOJ Prosecutor)– Federal criminal and white collar federal contractor defense attorney with experience in high‑stakes investigations, parallel civil/criminal matters, and complex evidence cases involving federal contractors.

• Theodore P. Watson, Esq. – Government contracts and government contract fraud attorney, US Supreme Court–admitted, former federal procurement professional, and national practice lead for contractor fraud and False Claims Act defense.

• Robert “Bob” Ayers, Esq. – Of counsel with decades of white collar and regulatory experience defending corporate executives, public officials, and companies in fraud, public corruption, and complex investigations.

• Wise D. Allen, Esq. – Former Lieutenant Commander Judge Advocate and former federal appellate attorney with significant federal criminal and white collar litigation experience, including procurement and fraud matters.

The Statutes Driving Your Risk

Most federal healthcare fraud matters revolve around a common set of statutes. A federal healthcare fraud defense lawyer must be fluent in how these apply to real operations.

Healthcare Fraud – 18 U.S.C. § 1347
Covers schemes to defraud a healthcare benefit program or to obtain money from such a program by false or fraudulent pretenses. It applies to Medicare, Medicaid, TRICARE, VA, and qualifying commercial plans. Penalties can reach 10 years per count, and more if serious injury or death results.

False Claims Act – 31 U.S.C. §§ 3729–3733
Imposes civil liability when false or fraudulent claims are submitted “knowingly,” including deliberate ignorance and reckless disregard. It is often enforced through whistleblower (qui tam) lawsuits. Penalties include treble damages and per‑claim fines, and FCA findings can lead to exclusion and corporate integrity obligations.

Anti‑Kickback Statute – 42 U.S.C. § 1320a‑7b(b)
Prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce or reward referrals for items or services reimbursable by federal healthcare programs. AKS issues frequently arise in compensation structures, joint ventures, and marketing arrangements, and can support both criminal cases and FCA theories.

Stark Law – 42 U.S.C. § 1395nn
Restricts physician referrals for certain “designated health services” payable by Medicare when the physician (or an immediate family member) has a financial relationship with the entity, unless an exception applies. Stark is strict liability and often used as a basis for FCA claims and repayment demands.

Related Fraud and Conspiracy Statutes
Mail fraud (18 U.S.C. § 1341), wire fraud (18 U.S.C. § 1343), and fraud‑related conspiracies (18 U.S.C. § 1349) frequently appear alongside healthcare fraud charges. Each communication used to further a scheme can become a separate count.

National Legal Defense for High-Level Healthcare Professionals

We understand that the needs of a hospital CEO are different from the needs of a solo practitioner. We also understand that the challenges facing a national pharmacy chain are different from the challenges facing a local, independent pharmacy. That is why we provide a bespoke defense for each of our clients. We take the time to understand your business, your goals, and your concerns. We then develop a defense strategy that is tailored to your specific needs.

Our federal healthcare fraud defense lawyers have experience representing a wide range of clients in the healthcare industry, including:

• Hospitals and Health Systems: We represent hospitals and health systems in a wide range of federal healthcare fraud matters, including internal investigations, grand jury investigations, and civil and criminal litigation.

• Physicians and Physician Groups: We represent physicians and physician groups in all types of federal healthcare fraud cases, including those involving allegations of billing fraud, kickbacks, and lack of medical necessity.
• Pharmacies and Pharmacists: We represent pharmacies and pharmacists in cases involving allegations of prescription fraud, drug diversion, and improper billing.
• Laboratories and Diagnostic Companies: We represent laboratories and diagnostic companies in cases involving allegations of kickbacks, medically unnecessary testing, and improper billing.
• Durable Medical Equipment (DME) Companies: We represent DME companies in cases involving allegations of kickbacks, false and fraudulent claims, and other forms of fraud.

No matter what your role is in the healthcare industry, our healthcare fraud lawyer team has the experience and resources to provide you with the most effective defense possible. We are the health care fraud attorney you can trust. A medical billing fraud attorney from our team can help with complex billing cases.

What Kind of Federal Matter Are You Dealing With?

Your decisions should match where you are in the enforcement process. Our healthcare fraud defense attorneys are typically retained in four situations.

1. High‑Risk Audits and Reviews
RAC, UPIC, MAC, ZPIC, or commercial SIU audits that:

• Use large samples and extrapolation to project alleged overpayments

• Center on specific service lines, referral sources, or providers

• Include findings that mirror language used later in FCA complaints and indictments

These audits often feed directly into OIG or DOJ referrals.

2. Civil Investigations, FCA, and Qui Tam Cases

• Civil Investigative Demands (CIDs) requesting documents, written responses, and depositions

• Subpoenas from enforcement agencies for records and data

• Notice that a whistleblower (qui tam relator) has filed a complaint, whether still under seal or unsealed

Here, a healthcare fraud defense lawyer works to shape the record so the matter is treated as a civil dispute and managed strategically rather than sliding toward criminal referral.

3. Criminal Healthcare Fraud Investigations

• Grand jury subpoenas for witnesses, documents, or electronic devices

• Requests by federal agents to “interview” executives or staff

• Target or subject letters identifying specific individuals as at risk of indictment

At this point, the question is whether the government can actually prove intent to defraud under statutes such as 18 U.S.C. § 1347, and what path—trial, negotiated outcome, or parallel resolution—best protects the organization and individuals.

4. Parallel Civil and Criminal Proceedings

The same conduct is often pursued:

• Civilly, under the FCA and related statutes

• Criminally, under healthcare fraud, mail fraud, wire fraud, and conspiracy provisions

• Administratively, through exclusion, civil monetary penalties, or licensing proceedings

Defense strategy must be coordinated across all tracks so that steps taken in one forum do not worsen exposure in another.

First 72 Hours: Practical Steps for Leadership

 

When audits escalate, CIDs arrive, or agents call, the first days matter. Practical steps:

• Do not agree to unsupervised interviews.
  Front‑line staff, clinicians, and executives should not speak with agents or investigators without counsel present. All contact is routed through defense counsel.

• Preserve documents and data.
  Issue a litigation hold on email, EHR data, billing and claims systems, messaging platforms, and backups. This protects against obstruction allegations and preserves the evidence your defense team will need.

• Centralize internal discussion through counsel.
  Instruct teams not to speculate about the investigation over email or chat. Internal fact‑gathering and analysis should occur under the direction of healthcare fraud defense attorneys to maintain privilege and structure.

• Clarify posture and exposure.
  Determine whether the organization and key individuals are likely viewed as witnesses, subjects, or targets, and which statutes are probably driving the government’s interest.

• Set an initial response strategy.
  Decide, with counsel, whether to respond narrowly, make a targeted early presentation, or maintain a more reserved posture until more is known.

How We Dissect a Federal Healthcare Fraud Case

From day one, our national federal healthcare fraud defense attorneys build a team that focuses on dissecting the government’s case and exposing weaknesses.

Data and Statistical Issues

• Reconstruct how claim sets and samples were defined

• Test extrapolation methods used to transform limited sample results into large alleged overpayments

• Identify alternative explanations for patterns, including patient mix, coding changes, and payer policies

Clinical Documentation and Medical Necessity

• Work with clinicians to understand how care was actually delivered and documented

• Compare what documentation standards and coverage rules were in effect at the time of service

• Distinguish documentation imperfections and judgment calls from actual fraud

Regulatory and Policy Context

• Map allegations to the specific text of statutes, regulations, manuals, and program guidance in effect during the relevant period

• Account for changes, waivers, and temporary policies (for example, during the COVID‑19 public health emergency)

• Identify areas where rules were unsettled or reasonably open to different interpretations

Witnesses, Whistleblowers, and Cooperators

• Analyze the credibility and incentives of whistleblowers and cooperating witnesses

• Compare their accounts against documents, data, and other witnesses

• Develop cross‑examination and narrative themes early, so the case is trial‑ready even while negotiations are ongoing

At each step, the question is whether, if this case goes to trial, the government can meet its burden under the specific statutes at issue.

 DOWNLOAD FREE HEALTH CARE FRAUD DEFENSE CHECKLIST

The New Legal Landscape: How the Supreme Court Just Gave You a Fighting Chance

For years, the government has used the ambiguity of complex healthcare regulations to its advantage. They argued that even if you didn’t intend to defraud the government, you could still be held liable under the False Claims Act if your interpretation of a rule was “objectively unreasonable.”

That all changed on June 1, 2023.

In a landmark decision, United States v. SuperValu Inc., the U.S.Supreme Court unanimously rejected the government’s position. The Court held that the False Claims Act’s “knowingly” standard is subjective, not objective. This means the government must now prove what you actually knew or believed at the time you submitted the claim, not what a “reasonable person” would have known.

This is a game-changer for healthcare providers. It means that if you had a good-faith, reasonable interpretation of an ambiguous billing rule, you cannot be held liable under the False Claims Act, even if your interpretation was ultimately incorrect. This is the kind of nuanced legal argument that only a sophisticated health care False Claims Act defense attorney can effectively deploy.

We Focus Exclusively on Federal Healthcare Fraud Defense

We are not a general criminal defense firm. We are a team of federal healthcare fraud defense attorneys who focus exclusively on defending healthcare providers in federal investigations and prosecutions. This is all we do. This narrow focus gives us a deep understanding of the complex legal and factual issues that arise in these cases, and it allows us to provide our clients with the most effective defense possible.

Civil False Claims Act and Criminal Healthcare Fraud: One Defense Strategy

We defend both civil FCA matters and criminal healthcare fraud cases, using a unified strategy.

In FCA and Qui Tam Cases, We:

• Challenge whether alleged conduct meets the FCA’s “knowing” standard

• Contest damages and penalty models, especially those driven by extrapolation

• Present evidence of reasonable interpretations, reliance on guidance, and good‑faith compliance efforts without automatically conceding liability

In Criminal Healthcare Fraud Cases, We:

• Analyze the indictment, identify legally deficient counts, and bring appropriate motions

• Litigate suppression and evidentiary issues related to data, expert methodology, and witness testimony

• Prepare and try cases where necessary, focusing on intent, context, and credibility

Our Role: Federal Enforcement Defense Only, from Investigation Through Trial

To avoid confusion about scope:

• We represent healthcare organizations and professionals after federal enforcement risk has emerged—in high‑risk audits, investigations, FCA and qui tam cases, and criminal prosecutions.

• We provide legal defense from the investigation stage through any civil or criminal trial.

• We do not market this practice as general compliance, coding, or routine reimbursement work.

If your organization is under scrutiny under statutes like 18 U.S.C. § 1347, the FCA, the Anti‑Kickback Statute, or Stark Law, this is the point at which engaging dedicated healthcare fraud defense attorneys can materially affect how the matter proceeds.

False Claims Act FAQs

1. Am I personally liable, or just the company?

Executives can face personal liability if they were directly involved in, knew about, or benefited from fraudulent activity. Even if the company is the primary target, prosecutors often pursue individual accountability when evidence shows an executive had decision-making authority or ignored signs of misconduct.

2. What laws might I have violated?

Healthcare fraud charges typically arise under federal statutes such as the False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties Law. These laws prohibit false billing, paying or receiving kickbacks for referrals, and providing unnecessary medical services billed to federal programs like Medicare and Medicaid. Our healthcare fraud defense attorneys can help you assess any potential violations.

3. What evidence does the government rely on?

Investigators may use claims data, internal communications, and witness statements to support allegations. Whistleblower complaints and record audits are common starting points. Prosecutors often try to show a pattern of intentional overbilling or misrepresentation rather than isolated billing errors.

4. Should I cooperate with investigators or remain silent?

The right strategy depends on case details. Speaking with federal agents or investigators without legal counsel can be risky, as statements can later be used in court. A healthcare defense attorney can guide whether to cooperate, negotiate, or exercise your right to remain silent.

5. What penalties could I face?

Penalties vary depending on the severity of the alleged conduct. They can include large monetary fines, restitution payments, exclusion from government healthcare programs, or prison sentences. Civil penalties are often tripled under the False Claims Act, while criminal convictions carry imprisonment and substantial fines.

6. What should I do immediately after being charged?

The most important step is to hire experienced legal counsel specializing in healthcare fraud defense. Preserve all relevant documents and communications, avoid discussing the matter with employees or investigators without counsel present, and ensure the company cooperates legally and transparently with any federal inquiries.

 Nationwide Medical Defense Lawyers for Doctors, Hospitals & Healthcare Providers in All 50 States

Former Federal Prosecutors Defending Doctors Against Criminal Charges & License Suspensions – federal jurisdictions, with offices in Colorado, Florida, Houston, Los Angeles, and Washington, D.C. The law firm protects healthcare clients nationwide.

Our 18 USC 1347 federal healthcare fraud attorneys are available 24/7 for healthcare providers in Alaska, Arizona, Arkansas, Alabama healthcare fraud law firm; California healthcare fraud defense lawyers, Colorado, Connecticut, Delaware, Florida criminal defense attorneys healthcare fraud, Georgia, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine criminal defense, Maryland healthcare fraud attorneys and federal medical fraud defense lawyers, Massachusetts, 18 USC 1347 Michigan federal health care fraud lawyers Minnesota healthcare fraud defense attorneys, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire healthcare fraud attorneys, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas healthcare fraud defense lawyer, U.S. Virgin Islands, Utah healthcare fraud defense lawyer, Vermont, Virginia, Washington, Washington DC HealthCare fraud attorneys and False Claims Act defense lawyer, West Virginia, Wisconsin pharmaceutical fraud defense lawyer, and Wyoming healthcare fraud lawyer. Looking for federal healthcare fraud lawyer near me?

Our law firm Can represent clients and assist federal healthcare providers, manufacturers, hospitals, providers, and CEOs including Anchorage, AK; Atlanta, GA; Baltimore health care fraud attorney,, MD; Austin, TX; Chicago, IL; Colorado Springs healthcare fraud attorneys, CO; Dallas criminal defense attorneys healthcare fraud, TX; Denver, Colorado; Indianapolis, IN; Las Vegas, NV; Los Angeles, CA; Miami, FL; Philadelphia, PA; Dallas healthcare fraud defense attorneys and Houston healthcare fraud defense attorney, San Antonio, TX; Fort Lauderdale health care fraud False Claims Act defense attorneys, FL; Sacramento 18 USC 1347 federal healthcare fraud defense lawyers, San Diego health care fraud False Claims Act attorney, CA criminal defense attorneys healthcare fraud; San Francisco federal medical fraud lawyers, CA; San Jose federal healthcare fraud defense lawyer, CA; Santa Clara, CA; and Tampa, FL. 

Facing a Healthcare Fraud Issue? Avoid Critical Mistakes with Our Free Defense Strategy Checklist” DOWNLOAD NOW.

For a FREE Initial Consultation, call 1.866.601.6618 and speak to Mr. Watson. When you’re under federal investigation, time is not on your side.

If you are ready to hire a federal healthcare fraud defense lawyer, we are ready to help. Contact us online or Call us today to schedule a confidential consultation. We are the healthcare fraud attorneys you need to protect your future.