Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
FCA Retaliation Claims Under Section 3730(h)
How Section 3730(h) protects employees who report suspected fraud, and what employers must prove to defend the retaliation count o…
FBI Agents at the Door: What Employees Should Know
FBI and HHS-OIG interviews of practice employees are voluntary. What staff should know in advance about false-statement exposure u…
False Claims Act Exposure in Managed Care
Medicare Advantage risk-adjustment settlements now reach chart-review vendors and provider groups, not just the plan that submits…
Clinical, Coding, and Statistical Witnesses in FCA Litigation
Clinical, coding, and statistical witness testimony, not the paper record alone, typically decides whether an FCA claim is false a…
Data Analytics in Federal Healthcare Fraud Cases
How DOJ and CMS use predictive analytics and claims data to target physicians for fraud investigations, and how a statistics-first…
Deferred and Non-Prosecution Agreements in Healthcare
When DOJ offers a healthcare company a deferred or non-prosecution agreement instead of an indictment, and the obligations that co…
COVID-Era Billing Under Retrospective Review
How the Section 1135 telehealth waivers that applied during the COVID-19 Public Health Emergency affect retrospective Medicare bil…
Defending a Declined Qui Tam Case
A declined qui tam case is not over. The relator can litigate alone under the False Claims Act, and the government retains real op…
Compliance Program Effectiveness as a Defense
How DOJ's charging factors and the Sentencing Guidelines' three-point culpability reduction reward a compliance program that actua…