Healthcare Fraud Defense
Federal and state investigations, False Claims Act defense, and criminal healthcare fraud cases.
EHR Audit Logs in Criminal Healthcare Investigations
An EHR's audit trail records who touched a chart, when, and what they did, the same system data investigators and defense counsel…
Advice of Counsel as a Defense in Healthcare Fraud Prosecutions
Advice of counsel can blunt a healthcare fraud case, but asserting it waives privilege and fails without full disclosure and good-…
Nursing Home Administrator License Investigations
A facility survey deficiency and a state board license complaint are separate proceedings, but one record can open both against an…
False Claims Act Exposure in Remote Patient Monitoring
Remote patient monitoring billing exposure turns on the civil False Claims Act's knowing and materiality standards, not on an ordi…
Remote Patient Monitoring Fraud Enforcement
OIG found $536 million in 2024 Medicare RPM payments and five billing patterns tied to fraud, followed by an RPM-specific False Cl…
New York Investigates More Than 100 Social Adult Day Care Providers
New York ordered prepayment review, payment suspensions, and a continued moratorium for social adult day care providers after a jo…
Hospice Fraud Prosecutions: How Criminal Cases Are Built
DOJ turns hospice fraud into a criminal case with grand jury subpoenas, kickback counts and false certifications, apart from civil…
Healthcare Fraud Investigations of Nursing Home Operators
DOJ's individual accountability policy means a nursing home fraud investigation often reaches the owner personally, not only the f…
False Claims Act Cases Against Skilled Nursing Facilities
Recent DOJ settlements show three recurring False Claims Act theories against skilled nursing facilities: therapy upcoding, worthl…