Healthcare Fraud

Understanding Healthcare Fraud

Healthcare fraud is a serious federal and state crime involving the submission of false or misleading claims to healthcare programs for financial gain. Prosecutors aggressively pursue healthcare fraud cases because they view them as a direct threat to the integrity of government healthcare programs, including Medicare, Medicaid, TRICARE, and private insurance plans.

Healthcare fraud can take many forms, including:

Billing for Services Not Provided: Submitting claims for medical procedures, tests, or treatments that were never actually performed.
Upcoding and Unbundling: Billing for more expensive procedures than those actually performed or separating bundled services to increase reimbursement.
Kickbacks and Bribes: Offering or receiving payments, gifts, or other benefits in exchange for patient referrals or the purchase of medical equipment.
False Diagnoses: Deliberately misdiagnosing patients to justify unnecessary treatments or tests.
Prescription Fraud: Issuing prescriptions for controlled substances without a legitimate medical purpose, often in connection with opioid diversion schemes.
Medical Identity Theft: Using a patient’s information without their consent to submit fraudulent claims.
Provider Identity Fraud: Using another provider’s credentials to submit claims or operating under a false name.
False Cost Reporting: Misrepresenting costs or expenses on cost reports submitted to government healthcare programs.

Healthcare fraud can be prosecuted under a wide range of federal laws, including the False Claims Act (FCA), Anti-Kickback Statute (AKS), Stark Law, Healthcare Fraud Statute (18 U.S.C. § 1347), and the Controlled Substances Act. Investigations are typically led by the Department of Justice (DOJ), Department of Health and Human Services – Office of Inspector General (HHS-OIG), Federal Bureau of Investigation (FBI), Drug Enforcement Administration (DEA), and state Medicaid Fraud Control Units (MFCUs).

Healthcare fraud cases require a sophisticated, strategic defense because they often involve complex billing records, medical procedures, and regulatory compliance.

Our Approach to Healthcare Fraud Defense: Strategic, Evidence-Driven, and Proactive

At A Einhorn Law, we understand that healthcare fraud cases are complex and high stakes. Our approach is built on providing a strong, proactive defense that protects your rights and minimizes your exposure.

Comprehensive Case Review: We begin by conducting a detailed review of the allegations, your billing records, patient records, insurance claims, and any other relevant documents. Our goal is to identify weaknesses in the government’s case.
Challenging the Government’s Evidence: We critically analyze the evidence, challenging the government’s ability to prove intent, false statements, or fraudulent conduct. In many cases, billing errors or compliance mistakes can be misinterpreted as fraud.
Access to Medical Experts: Where necessary, we work with healthcare experts, medical billing specialists, and forensic accountants to review your practices and challenge the government’s conclusions.
Strategic Defense Development: Our defense strategy is customized to your case, whether that means demonstrating that the claims were accurate, showing that you acted in good faith, or negotiating for reduced charges.
Protecting Your Professional License: We recognize that healthcare fraud allegations can threaten your medical license and your ability to practice. We work to protect your professional reputation and minimize disciplinary consequences.
Discreet Resolution: Whenever possible, we work to resolve healthcare fraud cases discreetly, minimizing public exposure and reputational harm.

Whether you are a physician, dentist, pharmacist, nurse, medical practice, clinic, or healthcare executive accused of healthcare fraud, we are here to protect your rights and secure the best possible outcome.

Why Choose Us for Healthcare Fraud Defense?

When facing healthcare fraud allegations, choosing the right defense attorney is critical. At A Einhorn Law, we offer a unique combination of experience, skill, and personalized representation. Here’s why clients choose us:

Elite BigLaw Background: Our firm’s experience includes nearly a decade of handling complex, high-stakes healthcare fraud cases at a top-tier BigLaw firm, including False Claims Act and Anti-Kickback Statute cases.
Strategic, Evidence-Driven Defense: We do not take a one-size-fits-all approach. Instead, we conduct a detailed investigation of the facts, challenge the evidence, and develop a customized defense strategy.
Access to Medical and Billing Experts: We work with medical professionals, billing specialists, and forensic accountants to analyze the evidence, identify legitimate claims, and challenge the government’s conclusions.
Protecting Your License and Reputation: We understand that healthcare fraud allegations can damage your name and threaten your ability to practice. Our practice is built on maintaining client privacy and resolving cases with minimal exposure.
Defending Against Related Charges: Healthcare fraud investigations often lead to additional allegations, including wire fraud, conspiracy, money laundering, and controlled substances violations. We are prepared to defend you against any related charges.
Selective, Client-Focused Representation: Our practice is intentionally selective. We take on fewer cases to ensure that each client receives focused, high-caliber representation.

A Einhorn Law is here to defend your rights, protect your reputation, and secure your future — with the experience, strategy, and dedication that complex healthcare fraud cases demand.