Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
Consent Orders in License Cases: What You Give Up and What You Keep
A consent order can end a licensing board case without a hearing, but it carries reporting and payor consequences that outlast the…
How a Licensing Board Complaint Becomes an Investigation
How a state board of pharmacy or medical board complaint moves from intake through an investigator interview to dismissal, informa…
The Materiality Defense After Escobar
The Supreme Court's Escobar decision made materiality a rigorous, fact-intensive defense in False Claims Act cases against healthc…
How a Qui Tam Lawsuit Unfolds: From Sealed Complaint to Intervention
A qui tam lawsuit under the False Claims Act moves through a sealed investigation before a physician or practice ever learns a cas…
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…