Pre-indictment is the highest-leverage window in any federal matter.
A grand jury subpoena, a target letter, an FBI or HHS-OIG agent at the door, or a DOJ Fraud Section opening letter all put the matter on a federal criminal track. 18 USC § 1347 carries up to 10 years per count, 20 years if the offense results in serious bodily injury, and life if it results in death.
The Anti-Kickback Statute (42 USC § 1320a-7b) carries up to 10 years per count and is regularly charged alongside § 1347 and § 371 conspiracy. The U.S. Sentencing Guidelines turn loss-amount math into prison-term math. The pre-indictment window is when defense counsel has the most leverage: factual rebuttal of the government's theory, attorney proffer practice, and grand jury management can produce declination, narrowed indictments, a Deferred Prosecution Agreement, or non-prosecution agreements.
Once the indictment files, the public record fixes the posture. Health Law Alliance defends federal criminal healthcare fraud matters with a former federal prosecutor and senior healthcare executive bench - including a multi-count NJ physician indictment that collapsed before trial and a $6M alleged fraud that DOJ declined after pre-charge advocacy.
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Statutory maximums under 18 USC § 1347 run up to 10 years per count, 20 years if the offense results in serious bodily injury, and life if it results in death. The U.S. Sentencing Guidelines turn loss-amount math into prison-term math. Conviction or guilty plea triggers permanent collateral consequences: HHS-OIG exclusion, license loss, professional bar to re-entry. The defense posture has to address all three from the first contact with the government forward.
18 USC § 1347 carries up to 10 years per count for healthcare fraud, 20 years if the offense results in serious bodily injury, and life if it results in death. 18 USC § 1349 makes attempt and conspiracy punishable to the same extent as the substantive offense. The Anti-Kickback Statute (42 USC § 1320a-7b) carries up to 10 years per count and is regularly charged alongside § 1347. Federal healthcare fraud indictments routinely include 10 to 30 counts, which compounds the statutory maximum exposure.
USSG § 2B1.1 sentencing tables turn the alleged loss amount into the offense level, which then drives the advisory guideline range. The loss amount calculation in healthcare fraud cases is contested in nearly every matter: actual loss, intended loss, "billed amount" versus "paid amount" versus "should-have-been-paid amount." Enhancements for abuse of trust, role in the offense, and use of sophisticated means stack on top. A $1M alleged loss can produce a 41-to-51-month guideline range; a $10M alleged loss can produce 87-to-108 months. Loss-amount advocacy is often the single most consequential sentencing issue.
A felony conviction for healthcare fraud triggers mandatory HHS-OIG exclusion under 42 USC § 1320a-7(a) for a minimum of five years. Exclusion ends federal healthcare program participation and, for most provider businesses, ends the business. State medical boards, pharmacy boards, and DEA all open parallel proceedings on conviction or even on indictment. License loss and DEA registration loss are common collateral outcomes. A misdemeanor plea in some matters can avoid mandatory exclusion under § 1320a-7(b), but the path requires careful charge-bargaining and a privileged read on the facts.
Federal criminal healthcare fraud sits at the intersection of complex healthcare regulation, federal grand jury practice, and federal sentencing. Defense counsel that does not know the regulatory framework misreads the materiality and intent issues. Defense counsel that does not know federal criminal practice misreads the procedural posture. Both ends matter from the first contact with the government forward.
Our bench includes a former Assistant U.S. Attorney with DOJ Director's Award recognition and senior healthcare-company counsel. We have produced DOJ declinations on $6M alleged fraud after pre-charge presentation, defeated multi-count federal indictments through pre-trial motion practice, and produced sentencing reductions through USSG loss-amount advocacy. This is the protocol.
From the first contact with the government - target letter, grand jury subpoena, agent interview request, search warrant, or U.S. Attorney's Office invitation to meet: evaluate the realistic exposure under § 1347, § 1349, and the AKS; assert privilege over privileged material; manage subpoena response without producing more than is required; and prepare the attorney proffer to the line prosecutor and supervisor. The pre-indictment window is when DOJ still has the discretion to decline, defer, or charge a narrower matter. Our $6M alleged fraud declination came out of this phase.
If the indictment files: file Rule 12 motions on the responsive pleading deadline. Motions to dismiss for failure to state an offense, motions to suppress evidence obtained through tainted searches, motions for a Bill of Particulars on vague healthcare fraud allegations, and severance motions in multi-defendant indictments are the standard early defense moves. Each motion narrows the case and shifts plea leverage. Our NJ physician indictment dismissal came out of this phase.
When the case has to be tried: federal trial preparation runs on a compressed Speedy Trial Act schedule. Discovery review, expert designation (statistical sampling, healthcare economics, medical necessity), Daubert motion practice on government experts, and Brady/Giglio enforcement run in parallel with witness preparation. Our trial bench has tried federal healthcare fraud cases through verdict and knows what the jury hears, what the judge will charge on, and what the appellate record needs to look like.
If conviction or plea: USSG loss-amount advocacy starts at the pre-sentence investigation report (PSR) phase. We work with the U.S. Probation Officer on the PSR, file written objections, prepare the sentencing memorandum with USSG § 3553(a) variance arguments, and present at the sentencing hearing. Loss-amount reductions translate directly into shorter sentences. Post-conviction motions, supervised release modifications, and HHS-OIG exclusion negotiations follow in matters where the conviction stands.
Most federal criminal healthcare fraud matters surface through one of the following channels. The trigger shapes the procedural posture, the realistic timeline, and the pre-indictment leverage available from the very first day.
Outcomes are summarized for confidentiality. Client names, precise geography, and identifying facts are redacted.
Indictment Dismissed
Solo physician faced a multi-count federal indictment that included healthcare fraud counts under 18 USC § 1347 and conspiracy counts under § 1349. Health Law Alliance filed responsive motions, built the procedural record on the materiality and intent issues, and challenged the government's theory through pre-trial motion practice; the indictment collapsed before trial. Federal indictments do not collapse on their own. Pre-trial motion practice on multi-count healthcare fraud indictments is where the procedural record is built that produces dismissal or favorable plea posture.
DOJ Declination
Healthcare company faced alleged $6M healthcare fraud allegations across multiple federal districts after a parallel agency referral. After Health Law Alliance's pre-charge presentation to prosecutors, attorney proffer of the factual rebuttal, and written submission to the line AUSA and supervisor, DOJ declined criminal prosecution. Pre-charge advocacy is the highest-leverage window in any federal criminal healthcare fraud defense. Once the indictment files, the public record fixes the posture; before it files, the prosecutor still has the discretion to decline.
Healthcare provider faced a parallel civil FCA matter and a criminal track in the same district. Through coordinated representation across both tracks, Health Law Alliance produced a civil settlement that resolved the matter and a separate written submission to the criminal AUSA that produced a declination on the criminal side. The civil-to-criminal escalation risk in healthcare fraud matters is real, and a unified defense across both tracks is often the most efficient way to avoid criminal exposure while resolving the civil exposure on commercially reasonable terms.
Attorney advertising. Prior results do not guarantee a similar outcome. Case summaries are generalized for confidentiality and are not a substitute for legal advice on your specific matter.
Anthony's background as a former federal prosecutor and executive for major healthcare companies provided a level of expertise and insight that made all the difference. His deep understanding of healthcare law, particularly in litigation and compliance matters, helped navigate complex legal issues with ease.
Seven questions that come up on almost every first call. The answers below are general; specific situations require privileged consultation.
Before the grand jury returns the indictment, before the public record fixes the posture, before the discovery file fills with material that limits later moves, have a privileged conversation with attorneys who have produced DOJ declinations on $6M alleged fraud and dismissed multi-count federal indictments before trial. Free, confidential, no retainer.
