Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
Parallel Proceedings: Managing Civil, Criminal, and Administrative Tracks at Once
An audit, a False Claims Act case, and a licensure action can arise from one billing pattern at the same time. Coordinating the th…
OIG Exclusion: Scope, Screening, and Collateral Damage
An OIG exclusion bars billing to federal health programs and forces termination from any employer that receives federal funds, cli…
False Claims Act Damages and Per-Claim Penalties
Treble damages combine with a per-claim civil penalty to turn a modest per-claim error into ruinous total exposure, and claim volu…
FCA Civil Exposure vs Criminal Charges: Keeping Them Apart
A civil FCA demand and a criminal healthcare fraud charge trigger different statutes, standards, and remedies. Physicians need to…
Corporate Integrity Agreements: Terms, Costs, and Negotiation
A Corporate Integrity Agreement binds a provider for five years, with IRO review, self-reporting duties, and stipulated penalties…
Billing Error or Fraud: Where Enforcement Draws the Line
Civil and criminal healthcare fraud statutes apply different knowledge standards. Documentation is what separates a billing error…
Stark Law vs the Anti-Kickback Statute: The Differences That Matter
Stark Law imposes strict liability on physician referrals. The Anti-Kickback Statute requires proof of intent. How the exposure di…
A DOJ Target Letter: What Happens in the First 48 Hours
A DOJ target letter signals substantial evidence, not a guaranteed indictment. What happens in the first 48 hours often matters mo…
The Federal Healthcare Fraud Statute (18 USC 1347) Explained
A physician's guide to 18 USC 1347: the elements, intent standard, penalties on conviction, and the line separating it from civil…