HealthCare Fraud Lawyers

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Brian Kuester
Attorney Brian Kuester
HealthCare Fraud Defense Team Lead
Former US Attorney
Former District Attorney
Ellen Comley
Attorney Ellen Comley
HealthCare Fraud Defense Team Lead
Senior Counsel
Roger Bach
Roger Bach
HealthCare Fraud Defense Team Consultant
Former Special Agent (OIG)

The Criminal Defense Firm is a national healthcare fraud defense law firm serving all of the United States. As a physician, pharmacist, or owner of a company in the healthcare industry, you know that federal audits and investigations need to be taken seriously. If you are experiencing an audit or investigation, you also know how immensely disrupting they can be for your business. Our healthcare fraud lawyers provide experienced representation that aims to bring investigations to an end and having any charges against our clients dismissed.

Our attorneys represent clients in complex fraud and compliance cases across the country. Representing clients in all types of federal criminal law matters, they have particular experience in the healthcare and pharmaceutical industries. He has successfully represented clients in cases involving the Office of Inspector General of the Department of Health and Human Services (OIG), the Department of Defense (DOD), the Department of Justice (DOJ), the Department of Labor (DOL), the Drug Enforcement Administration (DEA), and the Federal Bureau of Investigation (FBI).

HealthCare Fraud Explained

health care fraud lawyerFederal and state agencies across the board are cracking down on healthcare fraud. Broadly speaking, this involves making false statements or engaging in illegal practices for financial gain. While this may make it sound like those who commit healthcare fraud are serious criminals, the reality is that physicians and other healthcare industry professionals often find themselves facing fraud charges when they have no idea what has gone wrong. Common healthcare fraud allegations include:

  • Billing fraud
  • Medicaid and Medicare fraud
  • Anti-kickback violations
  • False Claims Act violations

Many companies and private practices face charges due to the actions of individual employees. In other cases, physicians, pharmacists, and business owners themselves may be accused of criminal misconduct. Regardless of the situation you are facing, our healthcare fraud attorneys can help obtain the best possible outcome in light of the facts at hand.

Defending Against HealthCare Fraud

defending fraud charges - health care defense lawyerPhysicians and healthcare entrepreneurs nationwide hire our healthcare fraud lawyers to defend them against state and federal investigations. Our team led by our experienced healthcare criminal lawyers and former federal prosecutors has advised hundreds of clients on complex matters with resounding success.

The following is just a small sampling of our recent case results in matters involving health fraud and other alleged violations:

  • Represented clients in OIG investigation for alleged Medicare and Tricare fraud.
    Result: Case Dismissed.
  • Represented clients in OIG Investigation for alleged violations of Stark Law and False Claims Act based on a qui tam against client.
    Result: Government Declined to Intervene, Case Dismissed.
  • Represented client in OIG Investigation alleging Medicare Fraud, Billing Fraud, and False Claims Act violations.
    Result: No Civil or Criminal Liability.
  • Represented client in defense against audit by the U.S. Department of Labor.
    Result: Resolved as No Audit.
  • Represented clients in DEA investigations to revoke pharmacy licenses.
    Result: No Charges, Licenses Retained.
  • Represented hospital client in defense of federal dispute over alleged marketing and patent infringement.
    Result: Case Dismissed.

Representative Clients

Our team of healthcare criminal attorneys represents physicians, practices, and companies of all sizes in a wide range of medical and pharmaceutical fields. Our client list includes:

  • A DNA testing laboratory
  • A national surgery center
  • Chiropractors and physical therapy groups
  • Healthcare providers across the United States
  • Large-scale anesthesia groups
  • National compound pharmacies
  • National pharmacies
  • National operating device companies
  • National toxicology laboratories
  • Physicians across the United States
  • Physician-owned distributorships

Defending Against HealthCare Fraud Audits

health care audit - health care criminal lawyerIn many cases, a healthcare provider’s introduction to the federal government’s fraud enforcement regime will be in the form of an “audit” conducted by a private contractor authorized by the Centers for Medicare and Medicaid Services (CMS). While there are several of these contractors authorized by CMS, most audits involve entities known as either Recovery Audit Contractors (RACs) or Zone Program Integrity Contractors (ZPICs).

RACs and ZPICs have broad authority to audit providers that bill for reimbursements through Medicare. They can choose the providers they investigate; and, since they operate under a “fee-for-service” model, they are incentivized to find as many fraudulent Medicare billings as possible.

If your business or practice is being targeted in a RAC or ZPIC audit, it is important that you seek legal representation. There are ways to defend against unfavorable audit determinations, and providers who are dealing with RACs and ZPICs need skilled healthcare fraud attorneys who can challenge their auditor’s methods and refute their allegations. Our healthcare fraud lawyers represent providers nationwide in RAC and ZPIC audits and we have experience in federal Tricare audits as well. Learn more:

Defending Against HealthCare Fraud Investigations

investigations - health care fraud defense lawyerAnother way that providers can face financial liability (and potentially other penalties) is through a federal fraud investigation. CMS and numerous other federal agencies routinely pursue investigations against providers in all sectors of the healthcare industry, from physician-owned entities and telemedicine providers to medical facilities and durable medical equipment (DME) manufacturers. If you are being targeted in a federal investigation, you need legal representation. You do not want the investigation to lead to civil or criminal charges, and the best way to avoid prosecution is to hire a healthcare fraud law firm that can prove your defense before formal civil or criminal proceedings begin.

While many federal investigations involve allegations of false and fraudulent Medicare billings, providers can face intense scrutiny for other alleged forms of fraud as well. These include Tricare fraud, Department of Defense (DOD) fraud, and related offenses such as tax evasion and wire fraud.

Defending Against Civil and Criminal HealthCare Fraud Charges

fraud defense - health care defense attorneyIf you did not hire a healthcare fraud defense lawyer for your federal investigation, you may now be facing civil or criminal charges. If you don’t know already, it is critical that you determine whether your case is civil or criminal in nature as soon as possible, and you need to try to negotiate a resolution that avoids the possibility of facing federal incarceration at trial. Our healthcare fraud lawyers have decades of combined experience in civil and criminal healthcare fraud prosecutions; and, with former federal prosecutors on our defense team, we can quickly make contact with the government attorneys involved in your case to determine the status and the penalties that are on the table.

Once we have this information, then we can begin building a comprehensive defense strategy focused on securing the best possible outcome in light of the facts and circumstances at hand. In every case, our goal is to resolve our client’s charges without a conviction or finding of civil liability, and above all to ensure that our clients will be able to keep their businesses and practices up and running.

Skilled Representation for HealthCare Fraud Appeals

appeals - health care fraud attorneyIf you have received an unfavorable audit determination from an RAC or ZPIC, or if you have been convicted or found liable in federal court, this does not necessarily mean that your case is over. You may have grounds to file an appeal; and, if you do, it is important that you take action as soon as possible. There are strict timelines for both contractor audit and federal court appeals, and if you miss the deadline for preserving your rights, you could be stuck with the unjust result of your audit or prosecution.

If you are facing recoupments, denial of payments, prepayment review, or other consequences as a result of a RAC or ZPIC audit, the first stage of appeal involves filing a request for redetermination by a Medicare Audit Contractor (MAC). If the MAC confirms your audit findings, there are four additional levels of appeal, culminating with a filing in federal district court. Our healthcare defense lawyers have experience at all levels of the audit appeal process. We understand the arguments that can succeed at each level, and we pursue aggressive appellate strategies designed to obtain a reversal of our client’s audit determinations as quickly as possible.

Our healthcare defense attorneys also have extensive experience representing clients in civil and criminal healthcare fraud appeals. An appeal is unlike what you experienced at the trial level, and achieving success requires extensive knowledge of federal appellate law and procedure. Whether your case is resolved “on the briefs” or we need to argue a federal Circuit Court of Appeal, you can count on our appellate lawyers to present the strongest possible arguments for having your trial verdict overturned.

The Statutes Federal Authorities Use to Prosecute HealthCare Fraud

While there are numerous federal laws that CMS, the OIG, the FBI, and other agencies use to prosecute cases of suspected healthcare fraud, there are three statutes in particular that federal authorities rely on when taking legal action against healthcare providers. These are The Anti-Kickback Statute, the False Claims Act, and the Stark Law.

1. Anti-Kickback Statute

The Anti-Kickback Statute makes it a federal offense to exchange anything of value in exchange for a business opportunity under Medicare, Tricare, and other federal healthcare benefit programs. While the Anti-Kickback Statute applies to all healthcare providers who bill these programs, it is of particular concern for physicians who run the risk of being targeted for illegal “referrals.” The law’s definition of a “referral” is much broader than most providers realize, and this leads to many providers facing unexpected investigations and prosecutions.

2. False Claims Act

The False Claims Act applies to “false and fraudulent claims” submitted under Medicare and other federal healthcare benefit programs. False Claims Act investigations can lead to both civil and criminal charges, and they can result from direct government inquiries as well as referrals from private citizens (including former employees and competitors) who can receive whistleblower compensation.

3. Stark Law

The Stark Law is another federal statute that applies to physician referrals. Specifically, it prohibits “self-referrals” between physicians and affiliated providers, and it prohibits providers from billing Medicare where all or a portion of the amount billed is for referred services. While the Stark Law originally applied only to relationships between physicians and labs, today federal prosecutors use the law to bring charges against home health agencies, pharmacists, therapists and a wide range of other providers.

Meet Our Healthcare Fraud Defense Team

The Criminal Defense Firm is a team of experienced healthcare fraud defense lawyers, former federal prosecutors, and appellate lawyers who have decades of experience representing providers across the nation.

HealthCare Fraud Attorneys, Former Federal Prosecutors, and Appellate Lawyers

Our healthcare fraud defense team includes experienced federal law attorneys. During your case you may work with:

At The Criminal Defense Firm, we take a team approach that ensures that all clients receive the full benefit of our firm’s decades of experience and deep knowledge of federal healthcare law. We understand the gravity of your situation, and we know that you can afford nothing less than the best our firm has to offer. From your free fraud defense evaluation through the resolution of your case, you can feel confident knowing that the healthcare fraud attorneys of The Criminal Defense Firm are on your side.

Contact the Trusted HealthCare Fraud Defense Lawyers at The Criminal Defense Firm Today

If you or your business is facing allegations of fraud, we encourage you to contact our healthcare criminal lawyers as soon as possible. By the time you find out that you are under investigation, the government may have already taken substantial steps toward building a case for criminal charges.

We offer free, confidential consultations. To speak with a healthcare fraud defense attorney about your investigation, call The Criminal Defense Firm at 866-603-4540 or contact us online today.

Further Information About Healthcare Fraud Defense

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Dallas 214-817-2053
Houston 713-454-7814
Detroit 313-634-0925
Baton Rouge 225-269-8749
New York 332-239-7345
Winter Park 407-890-0460
Miami 786-751-3247
Portland 207-222-7742
Nationwide 866-603-4540