Health Care Fraud Defense Attorneys at Johnson Pope
Defending Health Care Providers in Fraud Allegations, Audits, and Investigations
Health care fraud cases often center on whether a medical provider or their staff knowingly defrauded a benefit program. Allegations may include submitting false claims for services, billing for products never provided, or performing unnecessary medical services. While federal statutes criminalize health care fraud, investigations often involve both federal and state agencies working together.
Common Health Care Fraud Allegations Include:
- Submitting claims for services or products not rendered
- Performing unnecessary medical procedures or tests
- Upcoding or misrepresenting services provided
- Billing for non-covered services as covered
- Receiving kickbacks for patient referrals
Even an unintentional billing error or documentation issue can escalate into a criminal investigation when patterns or large sums are involved. Health care providers doing business with insurers — including Medicare or Medicaid — are especially vulnerable to both audits and regulatory scrutiny.
Defense for Audits Before They Become Criminal Cases
We know that not every health care fraud matter begins with criminal charges. Many start with an audit, either from a private insurer or a government agency. Our attorneys work closely with providers to:
- Review and respond to audit requests
- Analyze billing and documentation practices for compliance
- Address overpayment demands and negotiate resolutions
- Prevent audits from escalating into formal investigations
By engaging our team at the audit stage, you can often limit risk, correct potential compliance issues, and avoid criminal exposure.
The Importance of Immediate Legal Counsel
If you receive an audit letter, subpoena, or notice of investigation, it is critical to act quickly. Having experienced legal counsel from the outset allows you to protect your rights, craft a tailored response, and manage communications with investigators or auditors.
Potential Penalties for Health Care Fraud
If an audit or investigation leads to an indictment and conviction, penalties under federal sentencing guidelines can be severe. Factors influencing sentencing include:
- The total loss amount tied to alleged fraudulent claims
- The scope and nature of the conduct
- Whether the conduct is considered especially egregious
Possible consequences include substantial fines, restitution orders, exclusion from federal health care programs, loss of professional licenses, and prison sentences.
How Johnson Pope Can Help
At Johnson Pope, we provide strategic representation for health care providers at every stage — from responding to audits and investigations to defending against criminal charges in court. Our attorneys understand the complex regulations governing the industry and work to protect your reputation, career, and livelihood.
If you are facing health care fraud allegations, an audit, or a criminal investigation, contact Johnson Pope immediately to discuss your defense strategy.