Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
Statistical Sampling in FCA Cases: Where Courts Draw Limits
Courts let sampling size FCA damages routinely, but proving liability by extrapolation turns on representativeness and sample meth…
The 60-Day Overpayment Rule: Identification, Quantification, and Repayment
CMS's 2025 rule replaced reasonable diligence with the False Claims Act's knowing standard for when a Medicare overpayment is iden…
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
In Escobar, the Supreme Court called the False Claims Act's materiality standard demanding and rejected the claim that it is too f…
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…