Why You’re Being Targeted — And What’s at Stake

Federal agencies like HHS-OIG, DOJ, and CMS are aggressively pursuing healthcare fraud — often based on automated billing data, whistleblowers, or vague referral patterns. Innocent billing mistakes or unclear business relationships can now trigger full-blown criminal investigations.

If you’re under investigation, here’s what’s at risk:

• Suspension of Medicare and Medicaid payments
• Exclusion from federal healthcare programs
• Criminal charges, fines, and potential prison time
• Loss of your medical license and board certification
• Irreparable damage to your professional reputation

You don’t have to be guilty to be treated like a criminal. The government moves fast. You have to move faster.

FAQs for CEOs and Owners Charged With Federal Healthcare Fraud

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.

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.

Healthcare Fraud Defense for Your Profession

IMMEDIATELY REDUCE THE CHANCE OF JAIL TIME OR HUGE FINES – DOWNLOAD FREE HEALTH CARE FRAUD DEFENSE CHECKLIST

Medical Billing Fraud Attorney

Complex billing codes and changing regulations can easily lead to errors that the government may flag as fraud. Our medical billing fraud attorneys can help you demonstrate that these were honest mistakes, not intentional deception. Common medical billing fraud allegations include:

• Phantom billing: Billing for services never provided
• Upcoding: Billing for more expensive services than actually provided
• Unbundling: Billing separately for services that should be billed together
• Duplicate billing: Billing multiple times for the same service
• Modifier abuse: Improper use of billing modifiers to increase reimbursement

Anti-Kickback & Stark Law Violations

The Anti-Kickback Statute and Stark Law prohibit offering or receiving remuneration for patient referrals. These laws are complex, and many seemingly innocent financial arrangements can be misconstrued as illegal. Our federal healthcare fraud attorneys defend cases involving:

• Physician compensation arrangements
• Medical directorships and consulting agreements
• Equipment leases and office space rentals
• Joint ventures and investment opportunities
• Marketing and referral fee arrangements

Unlike most other industries, healthcare laws prohibit certain types of referral incentives to protect the integrity and independence of a physician’s professional judgment. Even though virtually anything of value may qualify as a kickback (not just straight payments, but also indirectly through physician distributions in MSOs or medical directorship agreements etc.), most kickback cases are surprisingly defendable.

Pharmaceutical & Prescription Fraud Attorneys

We defend pharmacists, doctors, and pharmaceutical companies against allegations of prescription fraud, including:

• Billing for non-existent prescriptions
• Dispensing generic drugs and billing for brand-name drugs
• Prescription drug diversion
• Operating “pill mills” that dispense large quantities of opioids
• Accepting kickbacks from pharmaceutical companies
• Off-label marketing of medical devices and drugs

DME (Durable Medical Equipment) Fraud Defense Attorneys

DME companies are charged for billing Medicare for wheelchairs, braces, or supplies never ordered or medically necessary. DME cases Often uses aggressive telemarketing and forged physician signatures. If your Company has been investigated by OIG Strike Force teams or indicted by DOJ, call our DME federal healthcare fraud defense lawyers.

Billing Medicare/Medicaid for Medically Unnecessary Services – Federal Healthcare Fraud Defense Lawyers

At Watson & Associates, LLC, we defend providers accused of billing Medicare or Medicaid for medically unnecessary services.

DOJ and OIG often frame these allegations as federal healthcare fraud and False Claims Act violations.

Our federal healthcare fraud defense lawyers focus on challenging the government’s definition of “medical necessity” and “reasonable and necessary” care.

Whether your case involves hospice, home health, DME, laboratories, hospital billing, or pain management, we build a tailored defense strategy.

We build a dedicated team that helps you respond to OIG and DOJ subpoenas, civil investigative demands, and grand jury proceedings.

When whistleblowers allege unnecessary tests, admissions, or procedures, we attack credibility and motive while reinforcing your compliance efforts.

We work with coding experts and medical professionals to counter the government’s experts and narrow the scope of the case.

For organizations already facing federal criminal healthcare fraud charges, we negotiate with prosecutors while preparing a trial-

If you are accused of billing Medicare or Medicaid for medically unnecessary services, contact our federal healthcare fraud defense team today.

False Cost Reports (Hospitals & Home Health) False Claims Act Defense Attorneys 

Hospitals, hospices, or agencies inflate cost reports to obtain higher reimbursements. FCA cases for False Cost reports include misallocating overhead, inflating wages, or mischaracterizing expenses. If your company has been charged with federal False Cost reporting healthcare fraud, call our False Cost Report federal healthcare fraud defense attorneys. 

Need to speak with a former federal prosecutor now? Call (866) 601‑5518, our emergency lines are available 24/7.

Key Federal Healthcare Fraud Statutes

Understanding the federal statutes used to prosecute healthcare fraud is essential to building an effective defense. Our federal healthcare fraud attorneys have extensive experience defending cases under these key statutes:

18 U.S.C. § 1347 – Healthcare Fraud

This is the primary federal statute used to prosecute healthcare fraud. It makes it a federal crime to knowingly and willfully execute, or attempt to execute, a scheme to:

1. Defraud any healthcare benefit program, or
2. Obtain money or property from a healthcare benefit program through false or fraudulent pretenses, representations, or promises

Penalties: Up to 10 years in federal prison, or up to 20 years if the violation results in serious bodily injury. If the violation results in death, the defendant can be imprisoned for any term of years or for life.

The False Claims Act (31 U.S.C. § 3729-3733)

The False Claims Act is the government’s primary civil remedy for healthcare fraud. It imposes liability on any person or entity that:

• Knowingly presents a false or fraudulent claim for payment
• Knowingly makes or uses a false record or statement material to a false claim
• Conspires to commit a violation of the FCA

Penalties: Treble damages (three times the amount of the fraudulent claims) plus civil penalties of $13,946 to $27,894 per false claim (as of 2024).

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b)

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving remuneration to induce referrals for services or items payable by federal healthcare programs.

Penalties: Up to 10 years in federal prison, fines up to $100,000 per violation, and mandatory exclusion from participation in federal healthcare programs.

The Stark Law (42 U.S.C. § 1395nn)

While the Stark Law is primarily a civil statute, violations can support criminal prosecutions when combined with other federal charges. The Stark Law prohibits physician self-referrals for certain designated health services payable by Medicare or Medicaid.

Penalties: Civil penalties, repayment of claims, and potential exclusion from federal healthcare programs.

18 U.S.C. § 1349 – Federal Conspiracy to Commit Healthcare Fraud 

Many federal healthcare fraud cases are brought against medical providers and others as a conspiracy. The government essentially claims that multiple people have contributed something to the overall success of a fraud scheme.

For example, if a marketer unlawfully incentivizes a doctor to send referrals to a pharmacy (“kickbacks”), then all three individuals may be charged by way of a conspiracy: the marketer for bribing, the doctor for accepting the bribe, and the pharmacy for billing claims that were based on a kickback.

Aggravated Identity Theft (18 U.S.C. § 1028A)

Aggravated identity theft is a good illustration of why it is important to be represented by trusted, experienced federal healthcare fraud attorneys. Recently, the Justice Department started to add aggravated identity theft to healthcare fraud indictments. Each count contains a mandatory two-year imprisonment. That means, probation is not an option.

Need to speak with a former federal prosecutor now? Call (866) 601‑5518 for a confidential strategy session, available 24/7.