A healthcare fraud investigation can upend your career, threaten your professional license, and expose you to federal prison time before charges are even formally filed. Federal agents working alongside the Department of Justice and the Department of Health and Human Services build these cases methodically, often over years, which is why retaining knowledgeable healthcare fraud defense attorneys is imperative the moment you learn you are under scrutiny.
Federal Medicare and Healthcare Fraud Laws
Several federal statutes form the backbone of healthcare fraud prosecutions, and each carries its own elements that the government must prove. The most commonly applied laws include:
- False Claims Act: Imposes civil liability on individuals and entities that knowingly submit false claims to federal healthcare programs.
- Anti-Kickback Statute: Prohibits offering, paying, soliciting, or receiving anything of value to induce referrals for services payable by federal healthcare programs.
- Stark Law: Restricts physician self-referrals for designated health services payable by Medicare and Medicaid.
- Health Insurance Portability and Accountability Act (HIPAA): Establishes the federal healthcare fraud offense at 18 U.S.C. § 1347, criminalizing schemes to defraud any healthcare benefit program.
- Federal Mail and Wire Fraud Statutes: Often used in parallel with healthcare-specific charges when billing communications cross state lines.
Healthcare Fraud Allegations: We Build Defenses Against
Our attorneys defend physicians, pharmacists, nursing home operators, durable medical equipment suppliers, billing companies, and other healthcare professionals facing the full spectrum of fraud accusations. Allegations our Detroit firm regularly handles include the following:
- Medicare and Medicaid billing fraud
- Upcoding and unbundling
- Duplicate billing
- Bills for services not rendered
- Kickback and self-referral schemes
- Prescription fraud
- Telemedicine and telehealth fraud
- Home health and hospice fraud
- Identity theft and patient brokering
- Durable medical equipment (DME) fraud
- Falsified records and documentation
Criminal Penalties for Healthcare Fraud
A criminal conviction under federal healthcare fraud statutes carries severe consequences that extend well into your professional and personal future. Sentences imposed in these cases often include:
- Up to 10 years in federal prison per count
- Up to 20 years per count if the fraud results in serious bodily injury
- Life imprisonment if the fraud results in death
- Fines of up to $250,000 per count for individuals
- Restitution requires the full repayment of fraudulently obtained funds
- Forfeiture of assets traceable to the alleged scheme
- Mandatory supervised release following any prison sentence
Civil and Administrative Penalties
Beyond criminal exposure, healthcare fraud allegations trigger parallel civil and administrative proceedings that carry their own punishing consequences. Penalties imposed through civil and administrative actions may include:
- Civil monetary penalties of up to $28,619 per false claim
- Treble damages under the False Claims Act
- Exclusion from Medicare, Medicaid, and other federal healthcare programs
- Suspension or revocation of professional licenses
- Loss of Drug Enforcement Administration (DEA) prescribing privileges
- Mandatory corporate integrity agreements impose years of compliance oversight
- Reputational damage that affects future employment and contracting opportunities
How Chapman, Dowling & Mallek Represent Healthcare Fraud Allegations
Our firm approaches every healthcare fraud case with the precision these complex matters demand, drawing on decades of federal criminal defense experience and direct knowledge of how prosecutors build their cases. Our representation includes:
- Pre-Indictment Intervention: Engaging with federal prosecutors before charges are filed to argue against indictment or for reduced charges.
- Document and Billing Analysis: Collaborating with forensic accountants and medical billing experts to dismantle the government’s loss calculations.
- Grand Jury Strategy: Protecting your interests when subpoenas, document requests, or testimony demands arrive.
- Parallel Proceedings Coordination: Managing the intersection of criminal, civil, and administrative actions to prevent statements in one forum from damaging your position in another.
- Trial Preparation and Litigation: Building courtroom defenses that challenge the government’s evidence, witness credibility, and theory of the case.
- Sentencing Advocacy: Presenting mitigation arguments that reduce sentencing exposure when a conviction cannot be avoided.
Our attorneys also handle related grand jury investigations that often precede or accompany healthcare fraud indictments, giving clients seamless representation from the earliest signs of an investigation through final resolution.
Healthcare Fraud Allegations Demand Immediate Legal Counsel
Federal investigators do not announce themselves until they are ready. By the time you receive a subpoena, target letter, or visit from federal agents, the case against you has been developing for months or years. Chapman, Dowling & Mallek brings the trial experience, familiarity with federal court, and strategic insight required to push back against the most serious healthcare fraud allegations.
Call us at 346-242-7626 or contact us online to schedule your free consultation with our healthcare fraud defense attorneys in Detroit, who can assess the scope of the investigation, identify weaknesses in the government’s theory, and build a defense aimed at protecting your freedom, your license, and your future.