Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
Healthcare Fraud Takedowns: How Practices Get Swept In
The DOJ's coordinated healthcare fraud takedowns rely on data analytics that flag referring and ordering physicians alongside sche…
Independent Review Organizations: What They Actually Do
Independent review organizations audit claims under a Corporate Integrity Agreement, distinct from health plan appeal reviewers. W…
Individual Liability for Executives Under the FCA
The False Claims Act reaches individual executives, not just companies. What compliance officers need to know about personal expos…
Government Intervention: What the Decision Signals
What DOJ's decision to intervene or decline under 31 U.S.C. § 3730 signals for a qui tam case's value, and why declination does no…
Implied Certification After Escobar
How the Supreme Court's Escobar decision held that implied certification can support liability at least where two conditions are s…
Healthcare Fraud Sentencing: How Loss Is Calculated
How federal courts calculate actual versus intended loss under Section 2B1.1, and why the billed-amount presumption is often the k…
Grand Jury Testimony: Preparing a Provider Witness
How DOJ classifies grand jury witnesses as target, subject, or witness, and what a physician should know before testifying.
Going to Trial in a False Claims Act Case
How FCA trial rates, jury standards, and treble-damages exposure shape the decision to settle or fight a False Claims Act case.
Free EHR and Technology Donations: Kickback Limits
The Stark Law and Anti-Kickback Statute let hospitals donate EHR technology to referring physicians, but only inside strict, easil…