Lowther | Walker’s Philadelphia healthcare fraud defense attorneys defend medical providers, including physicians, group practices, pharmacies, labs, DME suppliers, behavioral-health programs, and hospital administrators.
Our healthcare fraud defense services span all potential federal medical fraud cases:
Our firm handles investigations and prosecutions by the FBI, Philadelphia, HHS-OIG Philadelphia, DEA Philadelphia Diversion, IRS-CI, and HSI. Our team has proven experience at the federal courts defending cases involving Medicare/Medicaid fraud, telehealth schemes, opioid-prescribing patterns, AKS/Stark exposure, billing-code inflation, and EHR-metadata irregularities.
Immediate defense guide is critical. Contact Lowther | Walker for a confidential federal-healthcare-fraud consultation via (404) 496-4052.
Philadelphia Hours: 24/7
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Philadelphia federal investigations rely on multi-agency task-force tools: UPIC data pulls, MAC audits, EHR audit-trail extraction, subpoenaed billing files, undercover encounters, pharmacy-dispense analytics, referral-pattern mapping, and digital-forensic imaging of servers and cloud accounts. Once the FBI, HHS-OIG, DEA, IRS-CI, or HSI classifies you as “target,” the process accelerates through subpoenas, agent interviews, and grand-jury review.
Eastern District of Pennsylvania cases often center on:
Medicare/Medicaid billing fraud
Opioid-prescribing / DEA diversion
Telemedicine schemes
Kickback-driven referrals (labs, imaging, pharmacies)
False Claims Act whistleblower allegations
IRS-CI practice-finance irregularities
Federal procedure differs sharply from Pennsylvania state rules. The highest-risk points occur early in the investigation. For example, when an agent contacts your medical office, HHS-OIG conducts a knock-and-talk with your team, or you receive federal communications in the form of a grand jury subpoena or EHR production demands. One unguarded statement can shift a healthcare matter from inquiry to indictment.
Knowledge of AUSA Philadelphia negotiation patterns and charging preferences
Familiarity with Eastern District of Pennsylvania sentencing tendencies in healthcare-fraud and opioid-related matters
Command of U.S. Sentencing Guidelines loss-amount calculations and mitigation strategies
Understanding of task-force forensic methods: EHR metadata, prescribing heat-maps, claims-data algorithms
Ability to challenge search warrants, wiretaps, metadata pulls, DEA audits, and financial records subpoenas
Guidance on target letters, OIG interviews, HSI visits, and grand-jury demands
We serve Philadelphia healthcare practice owners and providers by representing them at the James A Byrne federal courthouse, at 601 Market St, Philadelphia, PA.
Lowther Walker brings deep federal-level experience to Medicaid fraud matters arising in Philadelphia and across the Eastern District of Pennsylvania. Our attorneys have handled investigations involving HHS-OIG, CMS, the Pennsylvania Office of Attorney General, Medicaid Fraud Control Section, and U.S. Attorney’s Offices pursuing alleged overbilling, kickbacks, improper eligibility determinations, and service-level manipulation. Because we know how federal agents build Medicaid fraud cases with data-analytics pulls, claims-pattern reviews, and informant statements. We intervene early, push back on flawed assumptions, and position providers for the best possible outcome.
Lowther Walker defends Philadelphia providers against federal and local contractor-driven audits, including ZPIC, UPIC audits, RAC audits, Medicare/Medicaid integrity reviews, and commercial-payer SIU inquiries. Our team’s federal background allows us to distinguish routine audit errors from red flags that may trigger HHS-OIG or DOJ escalation. We manage record production, challenge extrapolated damages, correct unsupported findings, and negotiate audit closures before they evolve into civil or criminal exposure.
Philadelphia healthcare entities rely on us because we understand both the audit mechanics and the federal enforcement playbook behind them.
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From complex healthcare fraud to multi-defendant healthcare case conspiracies, we excel in cases involving large scale allegations, complex discovery, technical evidence, and expert analysis. Our team has successfully defended clients in historic healthcare fraud cases throughout the U.S., including helping our client win largest healthcare fraud case the DOJ has ever prosecuted.
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Healthcare fraud cases can quickly image your practice and clinic. We respond immediately to agent contact, subpoenas, target letters, and search warrants, helping limit the impact on your ability to practice medicine and serve patients.
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Lowther | Walker handles only federal healthcare-fraud cases, giving our team a command of federal statutes, regulations, and investigative practices unmatched by most Philadelphia practitioners. When a provider, practice, or healthcare executive needs immediate federal counsel for an investigation involving HHS-OIG, FBI, CMS, or the U.S. Attorney’s Office, our firm steps in from minute one. This proactive, defense-driven approach helps protect your liberty and stabilize your practice.
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Our healthcare fraud attorneys, including lead counsel Joshua Lowther and Murdoch Walker have represented healthcare professionals, including practice owners and doctors throughout Pennsylvania. We have a comprehensive knowledge of local representation for medical providers and a broad regional network to support our healthcare defense practice.
If you’re under investigation or facing healthcare fraud charges in Philadelphia, contact Lowther | Walker’s offices today via (404) 496-4052 to confirm your free consultation. Our team accepts calls 24/7 to provide urgent legal advice to medical providers.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Medicare fraud cases usually begin with data-analytics anomalies detected by CMS, HHS-OIG, or a Unified Program Integrity Contractor (UPIC). Unusual billing patterns, modifier misuse, excessive frequency of services, or telehealth-volume spikes often generate automated flags that get referred to FBI agents or the DOJ’s Healthcare Fraud Unit for review.
Medicaid is jointly funded, but federal prosecutions arise when billing crosses federal funding thresholds or involves the False Claims Act. Pennsylvania Medicaid cases, for example, can be referred from the state MFCU to the U.S. Attorney’s Office when the allegations involve large-scale overbilling, kickback schemes, or multi-state provider networks.
Prosecutors rely on documentation gaps, irregular coding patterns, staff emails, audit histories, prior payer warnings, training records, and statistical analyses. They attempt to show the provider “knew or should have known” claims were false—often relying on patterns rather than a single bad claim.
Federal billing fraud includes upcoding, unbundling, medically unnecessary services, missing documentation, sham telehealth encounters, improper supervision, DME phantom claims, and billing for services not rendered. Prosecutors typically charge these under 18 U.S.C. § 1347 (healthcare fraud), § 1341/1343 (mail/wire fraud), or the False Claims Act.
Penalties may include restitution, millions in civil damages under the False Claims Act, exclusion from Medicare/Medicaid, criminal fines, and imprisonment under 18 U.S.C. § 1347. Providers may also face license discipline and loss of DEA registration if controlled-substance billing or prescribing is involved.
A CID allows the DOJ to demand documents, data, and testimony before filing charges in a civil or criminal healthcare-fraud investigation. A target letter indicates prosecutors believe there is substantial evidence the recipient committed a federal offense. Both require immediate counsel because they often precede search warrants, grand-jury subpoenas, or charging decisions.
Yes, federal prosecutors and agents from agencies such as FBI or IRS-CI may contact employers, compliance departments, or HR offices when seeking employment records, payroll information, or access credentials. Legal counsel can intervene to limit disclosures and protect rights.
Most healthcare-fraud probes involve HHS-OIG, FBI, IRS-CI, CMS contractors (UPIC, ZPIC, RAC), the DEA (when controlled substances are involved), and the DOJ Fraud Section. In Pennsylvania, the Eastern District (Philadelphia) frequently teams HHS-OIG and FBI agents with AUSAs for provider-focused prosecutions.
Do not call investigators yourself and do not produce records without counsel. Contact a federal healthcare-fraud defense attorney immediately. DOJ letters are often part of a coordinated effort involving agents, subpoenas, and data already gathered from CMS, insurers, or co-defendants.
Yes. UPIC, ZPIC, and RAC audits frequently escalate when auditors spot red-flag billing patterns or documentation gaps they believe indicate intent to defraud. These audit findings are routinely passed to HHS-OIG or the DOJ, especially in cases involving high-dollar extrapolations or suspected kickback relationships.
