Practice Area
Healthcare fraud enforcement has become one of the highest priorities in federal practice — and one of the most complex. Civil False Claims Act cases, qui tam relator suits, criminal indictments under the Anti-Kickback Statute, HHS-OIG and CMS investigations, and parallel state Medicaid Fraud Control Unit matters frequently overlap on a single set of facts. The firm represents providers, executives, and companies across that full landscape.
Healthcare fraud cases turn on detail — coding rules, billing conventions, medical necessity, fair market value, the structure of referral relationships. The firm brings the legal experience of a long career at the U.S. Attorney’s Office together with the discipline to learn each client’s clinical and operational realities thoroughly.
Healthcare cases often surface through a CID, a contractor audit, an HHS-OIG subpoena, or notice of a sealed qui tam complaint. The earliest decisions — about preservation, internal review, billing freeze-frames, and communication with relators — frequently shape resolution.
A privileged internal review of the relevant billing, coding, and referral arrangements can identify real exposure, separate that from non-issues, and lay the foundation for credible remediation and defense.
Productive engagement with line AUSAs, OIG agents, and contractor reviewers — presenting the clinical, operational, and legal context they often lack — can change the trajectory of a case before formal charges or complaints arrive.
Where matters must resolve, the firm negotiates declinations, civil FCA settlements, corporate integrity agreements, deferred-prosecution and non-prosecution agreements, and (where necessary) plea or trial dispositions — with full attention to collateral consequences such as exclusion.
The firm is most useful early. Some signals to call:
Federal experience supervising and prosecuting complex healthcare fraud cases — and now defending them — provides a working understanding of what the government looks for and where defenses are real.
Healthcare fraud cases turn on details only specialists usually see. The firm puts in the work to learn them.
Most healthcare cases require coordinating with civil, regulatory, compliance, and licensing counsel. The firm leads that coordination rather than working around it.
Frequently Asked
The False Claims Act (31 U.S.C. §§ 3729-3733) imposes civil liability on anyone who knowingly submits false claims to the federal government. In healthcare, that often means Medicare or Medicaid claims. Qui tam provisions let private ‘relators’ sue on the government’s behalf and share in recoveries, which has driven much of the modern enforcement landscape.
A qui tam case is a False Claims Act lawsuit filed under seal by a private relator (often a former employee). The government investigates while the case remains sealed — typically for many months — and then decides whether to intervene. The defendant frequently does not know the case exists until the government’s investigation is well underway.
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) is a criminal statute prohibiting the knowing exchange of remuneration to induce or reward referrals of items or services payable by a federal healthcare program. Violations can trigger criminal charges, civil False Claims Act liability, and exclusion.
Yes. Exclusion under 42 U.S.C. § 1320a-7 is one of the most serious collateral consequences of healthcare fraud matters. Avoiding or shaping the scope of exclusion is often a central goal of resolution. The firm addresses exclusion exposure from the first conversation.
Confidential consultations with Michelle Fernald. Serving Austin, San Antonio, Dallas, Houston, El Paso, and federal courts nationally.
Schedule a Consultation →