Florida Healthcare Fraud Lawyers: Federal False Claims Act Defense(Federal)

Before you talk to anyone else, here’s what actually matters right now. Call our federal healthcare fraud lawyers in Florida

If your practice, pharmacy, home health agency, lab, or hospice just received a target letter, a subpoena, or a Civil Investigative Demand, you don’t need a pep talk. You need three things answered: Am I going to be charged? Am I personally at risk, or just the company? What do I do in the next 48 hours that I can’t undo later?

This page answers those questions directly, in plain language, with the actual law behind each answer — not marketing copy.

One thing up front, because it will save you time: We handle federal healthcare fraud investigations and False Claims Act cases only — DOJ, HHS-OIG, FBI, and CMS matters under statutes like 18 U.S.C. § 1347, the Anti-Kickback Statute, Stark Law, and the federal False Claims Act. We do not handle state licensing disputes, state Medicaid fraud statutes standing alone, or billing disagreements between two companies. If a competitor owes you money or a payer is disputing a claim in the ordinary course of business, that’s not what we do, and we’ll tell you that on the first call instead of taking your retainer. If the federal government is investigating you or your company, that’s exactly what we do.

CALL 1.866.601.5518 — Speak Directly With Theodore Watson

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Who’s Actually Overseeing Your Case

Federal healthcare fraud cases sit at the intersection of two different skill sets: healthcare regulatory law and federal criminal/civil litigation. Most firms have one or the other. You need both because the government will use them both against you.

Theodore Watson leads the firm’s federal healthcare fraud and False Claims Act practice. He is a retired U.S. Air Force veteran, a former federal agency executive with direct government procurement and enforcement experience, and is admitted to practice before the Supreme Court of the United States. He has spent more than 23 years on the federal side of these cases — which means he has seen how DOJ and HHS-OIG build a case from the inside, not just how to react to one.

The firm’s healthcare fraud team also includes Carolyn L. Oliver, Of Counsel, a former DOJ prosecutor and Assistant U.S. Attorney in the Major Frauds Section who has more than 40 years of experience — meaning she has personally built the kind of case the government may now be building against you. Also on the team: Chris Mancini, Counsel, with 45 years of criminal law experience including eight years as an Assistant U.S. Attorney.

That combination — former prosecutors who know how the government decides whether to indict, alongside procurement and healthcare regulatory experience — is what a CEO or practice owner actually needs at this stage. See full attorney biographies →

Set a Time to speak directly to Mr. Watson — not an intake coordinator. Call 1.866.601.5518.

Miami, Florida, Wells Fargo Plaza

333 S. E. 2nd Ave, Suite 2000, Miami, Florida 33131

What is Health Care Fraud?

False Claims Act Healthcare fraud under 18 USC 1347 typically involves a scheme to defraud the federal healthcare program. The federal 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.

What Federal Healthcare Fraud Charges Actually Cover in Florida

“Healthcare fraud” is not one charge. Depending on what investigators believe happened, you could be facing one statute or several stacked together. Here is what federal prosecutors in Florida actually use:

The False Claims Act — 31 U.S.C. §§ 3729–3733. This is the government’s primary civil weapon, and it is almost always the statute lurking behind a healthcare fraud investigation, even when the initial contact appears to be a criminal matter. It applies when a person or company “knowingly” submits a false or fraudulent claim for payment to Medicare, Medicaid, or Tricare. Civil penalties currently range from $14,308 to $28,619 per false claim (adjusted for inflation as of July 2025), plus treble damages — meaning the government’s actual loss is multiplied by three. In a case involving thousands of claims, the penalty exposure alone can exceed the underlying damages by orders of magnitude. The FCA also has a criminal counterpart and frequently runs alongside charges under 18 U.S.C. § 287 (false claims against the United States).

Healthcare Fraud — 18 U.S.C. § 1347. The core federal criminal healthcare fraud statute. It criminalizes knowingly executing, or attempting to execute, a scheme to defraud a healthcare benefit program. Conviction carries up to 10 years per count, up to 20 years if the scheme results in serious bodily injury, and up to life if it results in death. Notably, the government does not have to prove you knew you were violating a specific law — only that you knew the claims or statements you made were false.

Anti-Kickback Statute — 42 U.S.C. § 1320a-7b(b). Prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals reimbursable by a federal healthcare program. This statute catches a lot of arrangements that were never intended as “kickbacks” in the colloquial sense — medical director agreements, marketing arrangements, space leases, and consulting deals are common triggers. An AKS violation can also serve as the underlying predicate for an FCA claim, which is why a single referral arrangement can turn into both criminal exposure and enormous civil penalty exposure.

Stark Law — 42 U.S.C. § 1395nn. A strict liability statute — meaning intent is irrelevant to a Stark violation itself, though it matters enormously for any related FCA claim. Stark prohibits a physician from referring Medicare or Medicaid patients for certain designated health services to an entity with which the physician (or an immediate family member) has a financial relationship, unless an exception applies. Ownership structures, space and equipment leases, and physician compensation arrangements are the most common sources of exposure.

Conspiracy (18 U.S.C. § 371) and Wire Fraud (18 U.S.C. § 1343). Prosecutors add these charges when more than one person or entity is allegedly involved, or when electronic billing, email, or phone communications were used to carry out the scheme — which, in a modern medical billing operation, is almost always. These conspiracy charges expand exposure well beyond the underlying billing conduct itself.

False Statements — 18 U.S.C. § 1001. Covers materially false statements made to federal investigators or in documents submitted to a federal agency. This is why what you say — or what an employee says — during an OIG interview matters as much as the billing conduct under review.

Common fact patterns we see driving these charges in Florida: upcoding and unbundling, billing for services not rendered, medically unnecessary services or DME, telehealth-to-DME and genetic testing marketing schemes, hospice eligibility and certification issues, home health plan-of-care fraud, compounding pharmacy billing, lab test bundling, and physician-owned entity referral structures that run into Stark or AKS problems.

Where the Government’s Case Actually Has Holes

Federal prosecutors have data analytics, subpoena power, and years of head start. What they usually do not have — and what they need — is proof of intent. That gap is where cases get won.

The government has to prove you knew the claim was false when you submitted it. Not that a reasonable person would have known. Not that your billing system produced an error. That you — the specific person or company charged — actually knew, or acted with reckless disregard or deliberate ignorance of the truth. Genuine coding ambiguity, a documented good-faith interpretation of an unclear reimbursement rule, delegation to trained billing staff, and a functioning compliance program are not just mitigating factors — they go directly at the element the government has the hardest time proving.

The 2023 Supreme Court decision in U.S. ex rel. Schutte v. SuperValu Inc., 598 U.S. 739 (2023), is central to this fight, and it cuts both ways — which is exactly why it matters. The Court held unanimously that False Claims Act liability turns on what the defendant actually, subjectively believed at the time, not on whether the defendant’s later legal interpretation was “objectively reasonable.” The government cannot avoid proving actual knowledge just because a rule was ambiguous. But the same rule protects a defendant who can show they held a genuine, honest, contemporaneous belief that their billing or coding position was correct — even if that position later turns out to be wrong. The case for a defendant is built before the investigation ever starts: the emails, coding manuals, compliance memos, and consultant advice that show what you actually believed at the time you billed. If that record exists, SuperValu is a tool for the defense, not just a warning.

The 2016 Supreme Court decision in Universal Health Services v. United States ex rel. Escobar, 579 U.S. 176 (2016), set a “rigorous” and “demanding” materiality standard — not, as is sometimes claimed, an automatic finding that submitting a claim shows reckless disregard. Under Escobar, the government must show the alleged misrepresentation was material to the government’s payment decision. If the government kept paying claims after learning of the same conduct now at issue, that fact is powerful evidence against materiality — a defense that gets overlooked far too often.

Beyond intent and materiality, the recurring weaknesses we look for in every case:

• Statistical extrapolation. Many large-dollar healthcare fraud allegations are built by auditing a small sample of claims and extrapolating the error rate across thousands of unreviewed claims. The sampling methodology itself is frequently challengeable.
• Whistleblower motive and reliability. A large share of qui tam cases originates with a disgruntled former employee, a terminated contractor, or a business competitor. Motive, timing, and firsthand knowledge are all fair game.
• Data-driven false positives. CMS and OIG increasingly flag providers through claims-data analytics before any human reviews the underlying medical record. A statistical anomaly is not evidence of fraud, and it frequently doesn’t hold up once the actual charts are reviewed.
• Search warrant validity. If your practice was raided, the warrant’s scope and the underlying affidavit are subject to challenge. Learn how we evaluate search warrant validity →

Here is what most healthcare executives don’t know: being investigated does not mean you will be charged, and being charged does not mean you will be convicted. The government has to prove every element, in a criminal case beyond a reasonable doubt. Our job is to find where that proof doesn’t exist — and to make that case before it ever reaches a jury.

Read more on the SuperValu decision and honest-mistake defenses →

What To Do in the First 72 Hours

1. Get federal counsel on the phone before you respond to anyone — including your own compliance department. Every conversation with an investigator, every email to staff, and every internal memo can become evidence. Route everything through counsel from this point forward.

2. Preserve records immediately — do not touch anything else. Issue a legal hold the same day you’re notified. Deleting, altering, or even routinely purging records on a normal schedule after notice of an investigation can trigger separate obstruction charges, regardless of what the underlying billing issue turns out to be.

3. Do not answer questions from federal agents without counsel present. A target letter or subpoena does not mean you have to explain yourself. Agents are not there to hear your side — they are building a record. Anything said informally can be used later, and there is rarely a way to “walk it back.”

4. Authorize a privileged internal review before you’re forced into discovery. An internal review conducted under attorney-client privilege lets your legal team find the actual weaknesses (or strengths) in your billing and referral practices before the government characterizes them for you.

5. Control communications — internally and publicly. Don’t comment on the allegations, even informally. Coordinate a single, consistent message with legal counsel for staff, referral partners, and (if needed) media.

6. Keep the business running. Delegate interim decision-making where needed, keep your compliance officer engaged, and don’t let operational panic do more damage than the investigation itself.

DOWNLOAD: Free Healthcare Fraud Defense Strategy Checklist

Penalties You’re Actually Facing

Civil (False Claims Act): $14,308–$28,619 per false claim (2025 inflation-adjusted range), plus treble (3x) damages, plus exclusion from Medicare/Medicaid participation — which can be more financially devastating than the fine itself.

Criminal (18 U.S.C. § 1347): Up to 10 years per count; up to 20 years if the scheme caused serious bodily injury; up to life if it resulted in death — plus criminal fines and mandatory restitution.

Collateral consequences that often matter more than the fine: program exclusion, license board action, loss of hospital privileges, and contract/payer termination. A civil settlement can still trigger an exclusion referral from HHS-OIG, so resolving the legal case is only part of protecting the business.

Frequently Asked Healthcare Fraud Questions From CEOs and Practice Owners

I received a target letter, not a subpoena. What’s the difference, and how worried should I be? A subpoena compels documents or testimony — it doesn’t necessarily mean you’re the focus of the investigation. A target letter means federal prosecutors already believe you committed a crime and are likely close to a charging decision. Both require an immediate response through counsel, but a target letter moves the timeline. If you’ve received one, the priority is intervening with the U.S. Attorney’s Office before an indictment, not after.

Am I personally liable, or is this just a company problem? Both are possible. Executives face personal liability when the government can show they were directly involved in, aware of, or willfully blind to the conduct — particularly if they had signing authority over claims, compliance oversight, or benefited financially from the scheme. Corporate structure alone does not protect an individual decision-maker. This is one of the first things we assess.

Should I cooperate with investigators, or stay silent? There is no blanket answer — it depends on what the government already has and what stage the investigation is at. Speaking without counsel present is almost always the wrong move; it gives the government free discovery. Whether to eventually cooperate, negotiate, or contest the case is a strategic decision made after we understand the government’s actual evidence, not before.

Can I fix this by voluntarily repaying the overpayment? Sometimes — but only if it’s done correctly and at the right time. A voluntary refund made through the proper CMS or OIG channel, before you’re aware of an active investigation, can materially help. The same repayment made carelessly, or after you already know you’re being investigated, can be read by the government as evidence you knew the claims were false. This needs to go through counsel.

Does a civil investigation ever turn criminal? Yes, and it happens more often in Florida than almost anywhere else in the country — Florida hosts several of the federal government’s highest-priority healthcare fraud task force regions. A civil audit or Civil Investigative Demand can escalate to a parallel or full criminal referral once agents believe the conduct was intentional. Early legal intervention is what keeps a civil matter civil.

What’s the real difference between civil and criminal exposure here? Civil FCA cases result in monetary penalties, treble damages, and program exclusion — serious, but not incarceration. Criminal cases under 18 U.S.C. § 1347 or related statutes carry federal prison time and a permanent record. It is common for the same underlying conduct to be investigated on both tracks simultaneously, which is why a defense strategy has to account for both from day one.

What happens to my medical or business license during an investigation? A federal investigation alone doesn’t automatically trigger state licensing action, but an indictment, conviction, or program exclusion typically does. Coordinating the federal defense with licensure protection early avoids a second front opening up while you’re still fighting the first one.

How long do these investigations usually take? Federal healthcare fraud investigations commonly run one to three years before a charging decision, sometimes longer for complex, multi-defendant schemes. That length is not incidental — it’s often your best opportunity. The earlier defense counsel engages, the more chances there are to resolve the matter before an indictment is even drafted.

What’s the government’s burden of proof if this goes to trial? In a criminal case, the government must prove every element — including that you knowingly executed a scheme to defraud — beyond a reasonable doubt. In a civil FCA case, the standard is preponderance of the evidence, but the government still has to prove actual knowledge, deliberate ignorance, or reckless disregard under SuperValu. Mere billing errors, coding disagreements, or documentation gaps, without more, do not meet either standard.

Will a compliance program actually help my defense? Yes, materially. A documented, functioning compliance program — not just a policy binder no one follows — is direct evidence against the intent element in both civil and criminal cases. It shows the organization was actively trying to bill correctly, which cuts against a finding of knowing or reckless conduct.

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.

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.

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.

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

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.

How does being charged affect my company? Healthcare fraud charges can disrupt operations, damage your reputation, and cause contracts or reimbursements to be suspended. Employees may lose their jobs if business operations halt. Companies often implement compliance overhauls or restructuring as part of settlement negotiations.

Can the corporate veil protect my personal assets? The corporate veil typically separates personal and corporate liability. However, courts may “pierce the veil” if corporate funds are misused or if fraud was intentional. Maintaining proper governance, documentation, and separation of finances is vital to protecting your personal assets.

What should I do immediately after being charged?

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

Is This Firm the Right Fit for Your Situation

We built this practice around federal cases specifically because that’s where the stakes and the strategy are different from anything at the state level. To be direct about scope:

We handle: DOJ and HHS-OIG healthcare fraud investigations, federal False Claims Act (civil and criminal) matters, qui tam/whistleblower defense, Anti-Kickback Statute and Stark Law investigations, federal grand jury subpoenas and Civil Investigative Demands, and federal healthcare fraud indictments and trials — for providers, practice groups, hospitals, pharmacies, labs, DME companies, home health and hospice agencies, and their executives, nationwide.

We do not handle: state-only Medicaid fraud statutes standing alone, state licensing board matters that aren’t tied to a federal case, or billing/payment disputes between private companies or with commercial insurers that don’t involve a federal fraud allegation. If your matter falls outside federal fraud enforcement, we’ll tell you plainly and point you toward the right kind of counsel.

If federal agents, the U.S. Attorney’s Office, or HHS-OIG are involved, this is exactly the work we do every day.

Florida Federal Jurisdictions We Cover

Federal healthcare fraud cases in Florida are prosecuted by the U.S. Attorney’s Offices for the Southern District of Florida (Miami, Fort Lauderdale, West Palm Beach), the Middle District of Florida (Tampa, Orlando, Jacksonville, Fort Myers), and the Northern District of Florida (Tallahassee, Pensacola, Gainesville). We represent healthcare providers, executives, and companies across all three districts, and nationwide with appropriate court admission.

Talk to Theodore Watson Directly

If you’ve received a target letter, subpoena, Civil Investigative Demand, or search warrant related to a federal healthcare fraud investigation, the time between now and your first move matters more than almost any decision that follows. Call and speak directly with Mr. Watson — not an intake line.

Call 1.866.601.5518 for a confidential consultation with a Florida healthcare fraud lawyer.

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