Healthcare Fraud

Healthcare Fraud Criminal Defense

• Our attorneys include former government trial attorneys, former law clerks to federal judges, law professors, and dual-credentialed CPAs with deep experience in white-collar defense. Nearly one-third of our attorneys serve as law professors at tier-one law schools.
• Our white-collar attorneys have been recognized nationally and internationally, including being named to U.S. News and World Report’s Best Lawyers in America list, Super Lawyers, and recognized by Chambers & Partners as among the leading attorneys in the United States, including for fraud representations.
• Freeman’s attorneys have extensive white-collar litigation experience in complex, sophisticated federal matters. We maintain an in-house board-certified MD, providing a unique, cross-functional team to navigate healthcare fraud investigations and prosecutions.

Freeman is a go-to white-collar boutique for companies, executives, and healthcare professionals facing sensitive healthcare fraud investigations, prosecutions, and related litigation. Our white-collar defense attorneys offer big-firm talent in a collaborative environment; think-tank intellect; and exacting analytical precision. Unique among law firms, we maintain an in-house board-certified MD, certified by the American Board of Neurology and the American Board of Psychiatry, who collaborates with our highly credentialed legal counsel to navigate healthcare fraud investigations and prosecutions.

Well-versed in healthcare fraud defense, our attorneys are trial-ready and battle tested; we’re ready when you are. And in the context of healthcare fraud investigations, the right move at the right time can mean the difference between the right outcome and the wrong one. Navigating the process requires an organized, strategic response, often on multiple fronts, framing the discourse and issues. Many of our most successful representations never see the light of day. But when trial is necessary, we defend our clients zealously and strategically. Our strategic approach and attention to detail underscore the reason why Freeman is the firm that clients seek out when the stakes are high and the issues are complex.

Our attorneys have experience representing clients in healthcare fraud matters involving various issues, including:

• False billing
• Medical necessity
• Kickbacks
• Miscoding
• Upcoding
• Unbundling

Our legal team defends clients in federal healthcare fraud investigations and prosecutions involving allegations of improper billing Codes; billing medically unnecessary services; billing for services not provided; and for billing for services performed by an improperly supervised or unqualified employee

We have represented clients involved in healthcare fraud matters, defending against alleged violations of the Federal False Claims Act, Anti-Kickback Statute, Physician Self-Referral Law (Stark Law), Criminal Health Care Fraud, and other healthcare laws.

The federal healthcare fraud laws are set out in several statutes, including a number of prominent healthcare laws that are frequently involved in our representations:

The Federal Civil False Claims Act (FCA)

The False Claims Act imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government.

The Anti-Kickback Statute

The Anti-Kickback Statute, set out at 42 U.S.C. Section 1320a-7b(b), makes it a crime to knowingly and willfully offer, pay, solicit, or receive any remuneration directly or indirectly to induce or reward patient referrals or the generation of business involving any item or service reimbursable by a Federal health care program

The Physician Self-Referral Law

The Physician Self-Referral Law, also known as the Stark Law, is set out at 42 U.S.C. section 1395nn, and prohibits a physician from referring patients to receive “designated health services” payable by Medicare or Medicaid to an entity with which the physician or a member of the physician’s immediate family has a financial relationship, unless an exception applies.

The Stark law specifically prohibits:

• Physician referrals for certain designated health services (DHS) payable by Medicare to an entity in which the physician has a financial relationship, unless an exception applies.
• An entity from presenting claims to Medicare for such referred services.

The Criminal Health Care Fraud Statute

The Criminal Health Care Fraud Statute, 18 U.S.C. section 1347, prohibits knowingly and willfully executing, or attempting to execute, a scheme or lie in connection with the delivery of, or payment for, health care benefits, items, or services to either:

• Defraud any health care benefit program
• Obtain (by means of false or fraudulent pretenses, representations, or promises) any of the money or property owned by, or under the control of, any health care benefit program

The Civil Monetary Penalties Law

The CMPL, 42 U.S.C. Section 1320a-7a, authorizes Office of Inspector General to seek CMPs and sometimes exclusion for a variety of health care fraud violations.

Experience Against the Government

Our attorneys have experience navigating, and defending against, a range of government agencies, including the:

• Department of Justice (DOJ)
• The Federal Bureau of Investigation (FBI)
• Office of Inspector General
• Medicare Fraud Strike Force
• Medicaid Fraud Control Unit, Attorney General
• State Agencies

Freeman’s white-collar attorneys also assist corporate and individual clients with responses to government inquiries, including Department of Justice investigations, federal agency investigations, and investigations carried out by state Attorneys General.

Corporations and Executives

Government scrutiny into alleged healthcare fraud can have high-stakes implications for those involved. Our white-collar defense practice represents clients facing threatened enforcement, as well as clients in civil fraud litigation and administrative proceedings. We represent companies, senior executives, public officials, and other individuals in healthcare fraud investigations and prosecutions.

High Stakes

Healthcare fraud investigations and prosecutions can represent an existential threat. And a white-collar investigation can be a life-altering event. Whether the investigation results in an indictment or not, it can be expensive, protracted, and stressful. Our firm is accustomed to handling complex, sensitive matters; we were designed for bet-the-company proceedings. Often such a threat is no more pronounced than in the context of alleged healthcare fraud violations.

Aggressive

Courtrooms are human institutions. And when parochial interests threaten the principles of justice, clients need articulate, forceful advocacy. Clients need advocates with courage and the fortitude to push through the most difficult challenges.

Strategic Representation

White-collar healthcare fraud investigations test savvy and strategic thinking, necessitating tactical navigation of complex factors. We work collaboratively, developing a strategic plan of attack. Recognizing that indictments in many white-collar matters can be almost as devastating as convictions, we proactively investigate the facts, develop viable defenses, and engage the government in an effort to stop prosecutions short of an indictments.

White-collar matters often involve simultaneous and parallel criminal, regulatory and civil proceedings. Freeman can navigate the complexities and collateral consequences of multiple proceedings. And when it comes to the court of public opinion, we employ ethical and strategic tactics to manage publicity.

Proactive

Our attorneys at Freeman employ a proactive approach to defend and strategically position our clients. Our attorneys often initiate interaction with federal and local prosecutors, regulatory agencies, congressional investigators, and the media. The stigma of criminal accusations can impact anyone, especially professionals. Where appropriate, we seek early and rapid intervention, counteracting the impact of an investigation before it becomes public.

Judgment

Our attorneys exercise sound judgment and discretion. Ultimately, our credibility is our most important attribute. We build upon it through discerning judgment and considered analysis.

Connected

Our lawyers are connected, as former government trial attorneys, former federal court law clerks, law professors at top-tier law schools, and leaders in positions of influence in public organizations. We use our firsthand knowledge of government agencies and their investigative protocols to navigate our clients through the morass, leveraging our government experience and contacts.

Experience that Counts

We have experience representing clients against a broad range of allegations and investigations.

Our white-collar defense attorneys have experience in complex and sensitive matters, including tax evasion, healthcare fraud, government contract fraud, government investigations, enforcement actions, and internal investigations. Our attorneys have experience defending allegations of public corruption, the Anti-Kickback Statute, mail and wire fraud, money laundering, government program fraud, and other matters. Particularly unique among law firms, we maintain an in-house board-certified MD, certified by the American Board of Neurology and the American Board of Psychiatry, who collaborates with our highly credentialed legal counsel to navigate healthcare fraud investigations and prosecutions