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Healthcare Fraud Defense · DOJ · HHS-OIG · FBI · State AG

Healthcare Fraud
Defense Attorneys

Immediate response counsel for search warrants, target letters, and grand jury subpoenas.

DOJ recovered $6.8 billion in False Claims Act matters in FY2025, with $5.7 billion from healthcare. Most of those investigations ran for months before the target was notified. By the time the subpoena, target letter, or federal agent arrives, the government has already built the record.

Health Law Alliance was founded by a former federal prosecutor who later served as Chief Compliance Officer at UnitedHealth Group. We defend healthcare professionals and companies under federal investigation, before indictment, after indictment, and through trial.

5,000+
Federal & State Matters Handled
2,500+
Healthcare Clients Defended
100+
Combined Years at DOJ, DEA & HHS-OIG
24/7
Emergency Response, Subpoena to Trial
Federal Defense Hotline · Direct Line
(800) 345 - 4125
Speak with a former federal prosecutor. Privileged conversation. Available 24/7.
Former officials from the agencies investigating your matter
U.S. Department of Justice
DOJ
FBI
FBI
HHS OIG
HHS-OIG
DEA
DEA
OptumRx
OptumRx
McKesson
McKesson
NAMFCU
NAMFCU
U.S. Treasury
Treasury
The Stakes
A federal healthcare fraud matter is three cases at once

Civil exposure. Criminal exposure. Administrative exposure. The same conduct produces parallel proceedings that must be defended as one strategic posture.

  • Prison time and personal exposure
  • FCA penalties and treble damages
  • License loss and program exclusion
Case files binders
Case files
01
Prison time and personal exposure

Healthcare fraud under 18 USC § 1347 carries up to 10 years per count. Combined with related charges (false statements, wire fraud, money laundering, AKS), potential sentences stack into decades. Personal liability for officers, owners, and clinicians is the rule, not the exception.

Criminal Exposure
02
FCA penalties and treble damages

False Claims Act per-claim penalties run up to $28,619 per claim, and treble damages apply on top. A 100-claim case can produce $2.8M+ in penalties before damages. Settlements typically reach 1.5x to 3x the alleged false billings.

Financial Exposure
03
License loss and program exclusion

Conviction triggers automatic Medicare and Medicaid exclusion for 5+ years, often longer. State board action runs in parallel. Even without a conviction, administrative exclusion can follow a settlement, often accompanied by a Corporate Integrity Agreement as the negotiated alternative. Exclusion ends most healthcare careers.

Administrative Exposure
Why Federal Healthcare Fraud Defense Is Different
Four structural features make federal healthcare matters fundamentally distinct from regulatory or contract disputes

A defense team that does not know how DOJ builds these cases is litigating against a moving target. A team that has prosecuted them knows where the leverage actually sits.

Factor 01
Parallel civil and criminal posture.
DOJ runs civil FCA and criminal healthcare fraud investigations in parallel. A statement made in the civil case can become the foundation of the criminal case. Defense strategy must address both tracks from day one or risk locking in a position that hurts the harder-to-defend track.
Factor 02
Multi-agency coordination is the norm.
A single matter often involves DOJ Civil, DOJ Criminal, the U.S. Attorney's Office, HHS-OIG, FBI, DEA, the state Medicaid Fraud Control Unit, and the state board of pharmacy or medical board. Each has its own evidentiary standards, timelines, and resolution mechanisms. Defending one track without coordinating the others creates unfixable leaks.
Factor 03
Whistleblower (qui tam) leverage.
In FCA matters, the relator (whistleblower) controls the record before the government makes a charging decision. Most qui tam complaints sit under seal for one to three years while the government investigates. The defense never sees the complaint until it unseals. The seal period is the highest-leverage window for resolution.
Factor 04
Self-disclosure is binary and time-limited.
OIG's self-disclosure protocol and DOJ's corporate disclosure framework can convert a six-year prosecution into a six-month settlement. The same protocols are catastrophic for organizations that disclose before scoping the conduct. The decision to disclose is irreversible. The judgment of when, what, and how to disclose is the entire engagement.
"Federal investigations move on the government's clock. The defendants who get the best outcomes are the ones who move first."
Protect Your Pharmacy Now →
The HLA Federal Defense Process
A four-stage protocol built by the people who prosecuted these cases

Our bench includes a former federal prosecutor (Anthony Mahajan, founding partner) and senior healthcare-company counsel. We know how DOJ builds these cases because we built them. This is how we take them apart.

  • Subpoena triage & preservation
  • Internal investigation
  • Government engagement
  • Resolution and trial readiness
Federal courtroom
Federal courtroom
01
Subpoena triage & preservation

Within 24 hours: place a litigation hold on every responsive document, identify the universe of records, evaluate parallel exposure (civil + criminal + administrative), and confirm whether any witnesses have already been contacted by the government.

02
Internal investigation

We reconstruct the conduct independently, identify the legal theory the government is most likely to pursue, scope the actual exposure, and prepare the defense narrative. The internal investigation is privileged. The product becomes the foundation of every subsequent move.

03
Government engagement

Direct presentation to the prosecutor, factual rebuttal of the theory, advocacy for declination or non-prosecution agreement. Most federal healthcare fraud matters never reach trial because pre-charge advocacy resolves them. The presentation is the engagement.

04
Resolution and trial readiness

Settlement, deferred prosecution agreement, non-prosecution agreement, or trial preparation. We have taken matters to trial and we have closed them at the indictment stage. The posture stays adaptive until the resolution is signed.

Common Investigation Triggers
The six patterns that put a healthcare practice on the federal radar

If any of these describe your situation, the investigation may already be open. The first signal you receive is rarely the first signal that exists.

01
Audit referral to MFCU or DOJ.
A PBM, RAC, UPIC, or ZPIC audit finding referred to the state Medicaid Fraud Control Unit or to the U.S. Attorney's Office. The audit became the predicate for an enforcement matter.
02
Whistleblower (qui tam) complaint filed under seal.
A current or former employee, business partner, or competitor filed an FCA complaint. The seal period runs one to three years before the practice ever sees the complaint. Government interviews and document subpoenas are the first signs.
03
Anonymous tip to HHS-OIG, FBI, or state AG.
The HHS-OIG hotline, the FBI tip line, and state attorney general healthcare fraud units all process anonymous tips. A single tip can open a months-long investigation before any contact is made with the target.
04
Industry-wide takedown sweep.
DOJ's annual healthcare fraud takedowns sweep dozens to hundreds of providers in coordinated charging across multiple federal districts. A practice can be swept in by association, geography, or referring-prescriber relationships.
05
Disgruntled patient or family complaint.
A complaint filed with the state medical board or pharmacy board can escalate to a federal investigation when the conduct alleged crosses into Medicare or Medicaid billing. State board matters that look small often have federal back-ends.
06
Parallel civil-criminal escalation.
A civil investigative demand (CID) or FCA matter that has been running quietly for months suddenly produces a target letter or grand jury subpoena. The civil track was the predicate for the criminal review.
Recent Federal Defense Outcomes
Representative Case Results

Outcomes are summarized for confidentiality. Client names, precise geography, and identifying facts are redacted.

Federal courtroom Indictment Dismissed
Federal Healthcare Fraud Indictment Against NJ Physician Collapses.

Solo physician faced a multi-count federal indictment for alleged healthcare fraud. Health Law Alliance filed responsive motions, built the procedural record, and challenged the government's theory; the indictment collapsed before trial and the matter was dismissed.

Northeast · Solo physician · 2025
US Capitol DOJ Declination
DOJ Declines Criminal Prosecution of Alleged $6M Fraud.

Healthcare company faced alleged $6M healthcare fraud allegations across multiple federal districts. After Health Law Alliance's pre-charge presentation to prosecutors and factual rebuttal of the government's theory, DOJ declined criminal prosecution.

National scope · Healthcare company · 2024
Federal courtroom FCA Dismissed
False Claims Act Lawsuit Against Oncology Practice Dismissed.

Oncology dispensing practice faced a False Claims Act lawsuit alleging multi-million dollar billing fraud. Health Law Alliance attorney Anthony Mahajan secured dismissal at the pleading stage on grounds that the relator failed to plead the alleged fraud with the particularity required.

Mid-Atlantic · Oncology dispensing practice · 2024

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.

The Firm
We Used to Work for Them.
Now We Fight for You.
Client Reviews
What Clients Say
  1. 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.
Healthcare Fraud Defense FAQ
Frequently Asked Questions

Seven questions that come up on almost every first call. The answers below are general; specific situations require privileged consultation.

What is the difference between a federal subpoena, a Civil Investigative Demand (CID), and a target letter? +
Each signals a different stage and a different type of investigation. A grand jury subpoena means a federal prosecutor has opened a criminal investigation and is gathering evidence; the recipient may be a witness, a subject, or a target. A CID is a civil investigative tool used in False Claims Act and antitrust matters; the conduct is being evaluated for civil exposure. A target letter is a formal notification from the U.S. Attorney's Office that you are the target of a criminal investigation and that the government is considering bringing charges. The distinctions affect privilege strategy, document production, and whether a Fifth Amendment posture is appropriate. Receiving any of the three should trigger immediate engagement of counsel.
Should I respond to a federal subpoena without counsel? +
No. Subpoena responses are evidentiary acts. Documents produced are admissible against the producing party. Documents withheld create their own exposure if the basis for withholding is wrong. Attempting to scope the production yourself often produces over-disclosure that becomes the foundation of the government's case. Counsel will negotiate the scope, assert applicable privileges, and produce in a manner that complies without prejudicing the defense. The cost of counsel at the subpoena stage is a fraction of the cost at the indictment stage.
What happens after a federal indictment in a healthcare fraud case? +
Indictment triggers arraignment, an initial appearance, and a series of pre-trial motions. The government produces discovery; the defense reviews and files responsive motions (suppression, dismissal on legal grounds, motion to dismiss the indictment for failure to plead with particularity in FCA matters). Most federal healthcare fraud indictments resolve through pre-trial motions, plea negotiations, deferred prosecution agreements, or non-prosecution agreements. Trial is the exception, not the rule. The first months after indictment are when the resolution path is set; the procedural moves taken in that window often determine the outcome.
Is OIG self-disclosure under the protocol ever the right move? +
Sometimes. The OIG self-disclosure protocol can convert a six-year prosecution into a six-month settlement. It can also be catastrophic for an organization that discloses without first scoping the conduct. Each disclosed fact becomes admissible in subsequent enforcement. The decision to disclose, what to disclose, and how to scope the disclosure is the entire engagement. The default recommendation is the same in every case: do not disclose anything until counsel has independently investigated the conduct, confirmed the legal theory, and confirmed the scope. Once the disclosure is made, it cannot be unmade.
Can my regulatory counsel handle a federal investigation? +
Regulatory counsel and white-collar defense counsel solve different problems. Regulatory counsel knows the substantive law (Medicare conditions of participation, Stark, AKS). White-collar counsel knows how DOJ builds and tries criminal cases. The two roles often work in coordination on a federal healthcare fraud matter. Regulatory counsel alone is the right team only when the matter is purely civil and the agency posture is administrative. The moment a CID, a grand jury subpoena, or a target letter appears, white-collar defense counsel should be engaged in addition.
What is a qui tam case and how does it work? +
A qui tam case is a False Claims Act matter filed by a private whistleblower (the "relator") on behalf of the government. The complaint is filed under seal, meaning the defendant is not notified. The government then has 60 days (typically extended to one to three years) to investigate and decide whether to intervene. If the government intervenes, the case proceeds with DOJ as the lead. If the government declines, the relator may proceed independently. Successful qui tam relators receive 15 to 30 percent of the recovery. The seal period is the highest-leverage window for resolution because the defendant has not yet had an opportunity to address the allegations, but the government is making its charging decision.
How long does a federal healthcare fraud investigation typically take? +
Months to years. A typical federal healthcare fraud investigation runs 18 to 36 months from initial inquiry to resolution. Civil FCA matters often run longer, with seal periods of one to three years before the defendant ever sees the complaint. Criminal investigations can resolve faster when the government chooses pre-charge resolution. The investigation timeline is not under the defendant's control, but the response posture is. Engaging counsel early shortens the active-investigation phase by enabling pre-charge advocacy.
Speak with Defense Counsel Today

Get a free, privileged review of your matter before you respond

Before you respond to a subpoena, before you sit for an interview, before you produce a single document, have a privileged conversation with attorneys who prosecuted these cases from inside DOJ. Free, confidential, no retainer.

"We received a target letter from the U.S. Attorney's Office on a Friday. By the following Wednesday, Health Law Alliance had reviewed our matter, identified the prosecutor's likely theory, and walked us through what to do in the first 30 days. The case resolved without indictment six months later. We do not know what would have happened with regulatory counsel alone, but we are not curious to find out." - General counsel, healthcare company (anonymized client, 2024)
Under federal investigation? Every day matters.