Federal Healthcare Fraud Lawyer

Federal Healthcare Fraud Enforcement

Healthcare fraud enforcement is a major focus for the U.S. Department of Justice. For example, in December of 2024, the DOJ released reports stating that they had achieved more than $3.4 billion in recoveries from healthcare fraud cases during fiscal year 2023. The Department also obtained civil settlements and judgments under the False Claims Act that surpassed $1.8 billion. The Department of Justice started 802 criminal healthcare fraud investigations while bringing charges in 346 cases with 530 defendants.

Potential Consequences of a Federal Conviction

Federal sentencing guidelines consider the total financial loss, the number of victims, and whether the defendant was a leader or organizer of the scheme. Civil penalties may also be imposed under the False Claims Act, where each false claim can result in thousands of dollars in fines, even without a criminal conviction. The penalties for federal healthcare fraud are steep and life-altering. A conviction can lead to:

• Fines reaching hundreds of thousands or even millions of dollars
• Restitution payments to the government or affected parties, such as private insurance companies
• Prison sentences of up to 10 years per offense or more if patient harm is involved
• Mandatory exclusion from participation in Medicare and Medicaid programs
• Loss or suspension of professional licenses, including medical licenses
• Damage to reputation and business relationships that may be irreversible

Defense Strategies in Federal Healthcare Fraud Cases

At SBBL Law, we understand that no two healthcare fraud cases are alike. We take a customized approach to defense, which may include strategies such as:

• Lack of Intent: Arguing that billing errors were mistakes and not part of a scheme to defraud. For example, a provider who mistakenly selected the wrong billing code or whose staff did not fully understand a particular coding rule may not be criminally liable.
• Good Faith Reliance: Demonstrating that the accused relied on the guidance of billing professionals, accountants, or legal counsel.
• Challenging the Evidence: Scrutinizing the accuracy, authenticity, and interpretation of billing records, emails, and financial data. We evaluate whether the prosecution’s narrative is supported by credible data.
• Procedural Defenses: Filing motions to suppress unlawfully obtained evidence or dismiss charges based on insufficient evidence.
• Standard of Care Testimony: Calling upon expert witnesses to show that the defendant’s conduct aligned with industry norms and that coding practices were reasonable.
• Constitutional Violations: Arguing that the defendant’s rights were violated during investigation, search, or interrogation. This can include filing motions to suppress search warrants or statements made by the defendant.
• Negotiated Resolution: In some cases, a strategic plea bargain may minimize exposure to incarceration or reduce fines. These deals may also allow professionals to preserve their licenses or avoid program exclusion. Providing information to the government that is useful in the prosecution of others or in recovering funds can also help improve the outcome for the defendant.

We will assess the specifics of your case to determine which defenses apply and begin building your case immediately.