Practice Areas

Health Care Fraud and Offenses

Health care fraud cases are complex, document-heavy, and often driven by aggressive federal investigations. These matters frequently involve parallel criminal, civil, and administrative exposure, with serious financial and liberty consequences.

We represent health care providers, companies, executives, and professionals facing investigations and prosecutions involving alleged kickbacks, false claims, billing, coding, and reimbursement violations.

Our Litigation Work Includes

Health Care Fraud — 18 U.S.C. § 1347

Allegations of schemes involving false or fraudulent claims submitted to Medicare, Medicaid, or private insurers.

False Statements Relating to Health Care Matters — 18 U.S.C. § 1035

Claims involving allegedly false documentation or statements connected to health care benefits or services.

False Claims Act (Civil Exposure) — 31 U.S.C. §§ 3729–3733

Civil liability for allegedly submitting or causing false claims to the government, often involving treble damages and penalties.

Anti-Kickback Statute — 42 U.S.C. § 1320a-7b(b)

Allegations involving improper payments, referrals, or financial relationships.

Conspiracy Charges — 18 U.S.C. § 371

Frequently added to expand exposure and sentencing risk.

Money Laundering and Forfeiture — 18 U.S.C. §§ 1956, 1957

Used to increase leverage and financial penalties in complex cases.

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RICO Charges in Health Care Fraud Cases — 18 U.S.C. §§ 1961–1964

Prosecutors may allege a health care scheme as a criminal ‘enterprise,’ dramatically increasing exposure through conspiracy liability, extended time frames, forfeiture of assets, and significantly higher sentencing risk, even where individual conduct is limited or indirect.

Potential Penalties

Health care fraud allegations carry severe criminal, civil, and professional consequences. Penalties often extend far beyond prison exposure and can impact a provider’s ability to practice and operate a business.

Criminal penalties - Imprisonment

Sentencing in RICO & Health Care Fraud Cases – 18 U.S.C. §§ 1962, 1963; 18 U.S.C. § 1347; U.S.S.G. §§ 2E1.1, 2B1.1

RICO and health care fraud convictions can sharply increase sentencing exposure through loss calculations, aggregation of conduct across the alleged enterprise, role enhancements, and forfeiture, often resulting in guideline ranges far above what any single transaction or act would suggest.

Criminal penalties - Fines and Forfeiture

Fines

Criminal fines under 18 U.S.C. § 3571, including substantial per-count penalties

Forfeiture

Seizure of assets alleged to be traceable to the offense (18 U.S.C. §§ 981, 982)

Civil and Administrative penalties may include:

False Claims Act liability
Treble damages and per-claim penalties (31 U.S.C. §§ 3729–3733)
Civil monetary penalties
Additional fines under federal health care statutes and regulations
Exclusion from federal health care programs
Mandatory or discretionary exclusion from Medicare and Medicaid (42 U.S.C. § 1320a-7)
License and professional consequences
Disciplinary action, suspension, or loss of professional licenses

Why Penalties Escalate Quickly

Multiple counts are often charged for a single course of conduct

Loss and billing amounts can drive sentencing exposure upward

Conspiracy and money laundering charges increase leverage and risk

Understanding the full scope of potential penalties is critical. Early defense strategy can significantly affect charging decisions, sentencing exposure, and long-term professional consequences.

How We Approach These Cases

We analyze billing data, medical records, and financial evidence in detail
We challenge overbroad theories of intent and aggregation
We focus on individualized conduct, not assumptions based on volume or coding errors
We address criminal, civil, and regulatory exposure together, not in isolation
We prepare cases with trial and sentencing consequences in mind from the outset
Health care fraud cases move fast and escalate quickly. Early strategy, careful investigation, and disciplined advocacy are critical to protecting both freedom and professional livelihood.

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