Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
Healthcare Fraud Charges Against Pharmacists and Pharmacy Owners
How a PBM audit file and wholesaler records become a pharmacy fraud case, and who can be charged when a billing pattern draws a re…
Hospice Fraud Investigations: Eligibility and Certification Theories
How DOJ builds hospice fraud cases: certification theories, marketer and medical director payments, level-of-care billing, and the…
Employing an Excluded Individual: Repayment and Self-Disclosure
A screening hit on OIG's exclusion list starts a clock. Here is how to remove the person, scope the exposure, and choose between r…
EKRA Explained: Kickback Rules for Labs and Treatment Centers
EKRA reaches commercial insurance, not just federal programs, and its exceptions differ sharply from the Anti-Kickback Statute's f…
DME Fraud Charges: How Supplier Cases Are Built
Nominee ownership, enrollment misstatements, and billing after a refusal can turn a DME supplier audit into a criminal referral to…
CID Oral Testimony: Preparing for a DOJ Examination
A civil investigative demand can compel sworn oral testimony, with set rules on who attends, transcript review, and the privilege…
The FCA Knowledge Standard After SuperValu
The Supreme Court's SuperValu decision ties False Claims Act scienter to what a defendant subjectively knew, not a reasonable read…
Presenting a Defense to DOJ Before the Intervention Decision
What defense counsel submits to DOJ and agency counsel before a qui tam intervention decision, and why the work matters either way…
Voluntary License Surrender While Under Investigation
Boards generally treat a surrender entered mid-investigation as discipline, not resignation, and it stays reportable to national d…