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Lowther | Walker’s healthcare fraud investigations defense lawyers represent medical professionals and corporations under investigation for healthcare fraud claims nationwide. Our defense attorneys can represent you in communication with investigators from the DOJ, HHS-OIG, and FBI.
We serve healthcare professionals facing complex medical fraud investigations, including:
Protect your livelihood, your rights, and your reputation. Select Lowther | Walker for aggressive defense representation during healthcare fraud investigations. Call (404) 496-4052 to request a confidential healthcare fraud investigation consultation.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Investigation terminated; no prosecution. DOJ notified our client, the CEO of a major hospital network, that he was the target of a multi-million-dollar healthcare fraud investigation related to “Medicare upcoding” that the FBI and HHS-OIG […]
The FBI and the HHS-OIG investigated our client for Health Care Fraud based on the client’s submitting over $7 million in alleged false claims to Medicare. The Government indicted our client on Conspiracy to commit […]
HHS-OIG investigated our client for Healthcare Fraud and Aggravated Identity Theft based on the client’s allegedly participating in a “telemedicine” kickback scheme that defrauded Medicare of approximately $30 million in reimbursements for not-medically-necessary durable medical […]
A private insurance company discovered that our client, a dentist, fraudulently billed it, various other insurance companies, and federal health care benefit programs for approximately $400,000 of services that our client did not provide. We […]
The Department of Justice’s Criminal Division, Fraud Section charged our client and nine other individuals in a $1.4 Billion health care fraud, wire fraud, and money laundering conspiracy (the largest health care fraud case that […]
Investigation terminated; no prosecution. DOJ notified our client, the CEO of a major hospital network, that he was the target of a multi-million-dollar healthcare fraud investigation related to “Medicare upcoding” that the FBI and HHS-OIG […]
The FBI and the HHS-OIG investigated our client for Health Care Fraud based on the client’s submitting over $7 million in alleged false claims to Medicare. The Government indicted our client on Conspiracy to commit […]
HHS-OIG investigated our client for Healthcare Fraud and Aggravated Identity Theft based on the client’s allegedly participating in a “telemedicine” kickback scheme that defrauded Medicare of approximately $30 million in reimbursements for not-medically-necessary durable medical […]
A private insurance company discovered that our client, a dentist, fraudulently billed it, various other insurance companies, and federal health care benefit programs for approximately $400,000 of services that our client did not provide. We […]
The Department of Justice’s Criminal Division, Fraud Section charged our client and nine other individuals in a $1.4 Billion health care fraud, wire fraud, and money laundering conspiracy (the largest health care fraud case that […]
From the moment you select Lowther | Walker as your healthcare fraud investigation defense lawyer, each action we take will help get you closer to proving your innocence.
Lowther | Walker provides:
Each word in every document submitted to investigators will undergo investigator scrutiny. Lowther | Walker articulates your defense with precision in all communication with the FBI, the DOJ, the FDA, and investigators at the OCI.
Your entire team may be subject to requests for documents from agencies such as the OIG, FDA and DOJ. We’re your healthcare law compliance experts, helping you and your staff avoid missteps in responding to investigators.
Uncovering flaws in your internal processes can help your organization stay ahead of investigators. Lowther | Walker completes comprehensive internal audits, reviewing your systems, identifying shortfalls, and pinpointing areas of potential legal exposure.
You face FDA and DOJ investigators with a large budget and considerable investigatory resources at their disposal. We implement custom-tailored strategies built specifically for your organization and the potential fraud charges you face. We put the full breadth of our expertise and experience behind your defense, identifying weak areas of the prosecution’s strategy and ruthlessly attacking their case as your legal advocates.
Receiving a formal demand for records is often the first concrete indicator of an investigation. This may come in the form of a Grand Jury Subpoena, an administrative subpoena from the Department of Health and Human Services (HHS), or a Civil Investigative Demand (CID) from the Department of Justice (DOJ). These demands typically request extensive patient files, financial records, emails, and billing data.
While routine audits are a standard part of doing business in healthcare, an investigation often triggers intense scrutiny. If you are suddenly subjected to aggressive UPIC (Unified Program Integrity Contractor), ZPIC, or RAC audits demanding documentation, or if the auditors seem hyper-focused on specific billing codes (like upcoding or unbundling)—it is a strong signal that federal authorities are looking closely at your practice.
Federal agents prefer to gather evidence covertly before confronting the primary target. You may discover that investigators from the FBI or HHS-OIG have been contacting your current or former employees, business partners, or even your patients. Agents often show up unannounced at their homes outside of business hours to ask questions about your billing practices, medical necessity, or office protocols.
If your reimbursements from federal healthcare programs are suddenly frozen or suspended without a clear administrative explanation, it is a red flag. The government frequently uses payment suspensions to stop the flow of funds while they actively investigate suspected fraud, such as phantom billing, providing unnecessary services, or kickback schemes.
The most severe and undeniable sign of an active criminal investigation is federal agents arriving at your clinic, office, or home to execute a search warrant. During a raid, agents will seize computers, servers, phones, and physical patient records. If this happens, you are likely the direct target of a high-stakes federal probe.
Stop Talking to Investigators: Never attempt to explain your way out of an investigation. Do not answer questions from federal agents without an attorney present. We immediately stand between you and the DOJ/OIG, routing all inquiries through our office to prevent you or your staff from making self-incriminating statements.
Protect and Preserve Your Records: Do not alter, delete, or destroy any patient files, billing logs, or emails. Doing so can lead to separate, highly severe charges for obstruction of justice.
Initiate a Shadow Investigation: Our team conducts a confidential, parallel forensic audit of your patient billing data. This allows us to identify your exact scope of exposure and secure favorable evidence before the government can secure it against you.
Do not wait for an indictment to start building your defense. The moment you suspect an investigation is underway, you need attorneys who speak the language of healthcare law to challenge the government’s assumptions and protect your livelihood.
A healthcare fraud investigation involves multiple federal and state entities and follows a structured legal process to uncover and prosecute fraudulent activities.
The primary federal agencies involved include the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and the Centers for Medicare & Medicaid Services (CMS). State-level investigations are often handled by state attorneys general, state Medicaid fraud control units, and law enforcement agencies.
The investigation typically begins with the detection of suspicious activity. This can come from audits, whistleblower complaints (Qui tam lawsuits under the False Claims Act), insurance claims data, or routine compliance checks.
Once a potential violation is identified, investigators gather documentary evidence, such as billing records, patient files, prescriptions, and financial statements. They may also conduct interviews with employees, patients, and witnesses to corroborate evidence. The investigation often includes data analytics, which detect patterns of overbilling, unbundling of services, or submission of claims for services never rendered.
When sufficient evidence exists, investigators may use subpoenas, search warrants, and administrative demands to collect additional information. Throughout this phase, the law requires adherence to constitutional protections, ensuring that evidence is legally obtained.
Our team has proven experience proactively defending healthcare providers during this initial contact stage. Our attorneys can guide your response to:
Schedule a free consultation with Lowther | Walker for an urgent response.
If you’re under investigation for healthcare fraud involving FDA-regulated drugs and medical devices, you will have contact with investigators at the OCI. Meanwhile, the FBI and the DOJ’s healthcare fraud unit primarily investigate billing fraud and other healthcare-related financial fraud crimes. When under a healthcare fraud investigation, you will face investigators from one or more of these four federal agencies.
The OCI (Office of Criminal Investigations) is the investigative arm of the FDA. The OCI regularly charges and prosecutes physicians and healthcare organizations, and its regulatory scope and budget have grown considerably in recent years.
Lowther | Walker’s healthcare investigation defense lawyers have proven experience communicating with the OCI during fraud investigations. We respond vigorously to prosecutorial positions and help healthcare providers maintain their innocence throughout OCI, FBI, and DOJ investigations.
If you are a medical provider, pharmacist, medical equipment supplier, or have any other role within the medical industry and have been notified of legal proceedings, contact Lowther | Walker immediately.
Whether you’re beginning a healthcare audit or you’re the known target of an ongoing healthcare fraud investigation, our seasoned defense lawyers can help reduce your exposure to criminal and civil charges.
Lowther | Walker are tried, tested, and proven healthcare fraud investigation defense lawyers. Our expertise spans the fraud investigation stages, from healthcare audits to sentencing appeals. Our track record of fraud defense includes decades of forthright advocacy for healthcare professionals and corporations.
Our team’s prodigious healthcare defense background includes successful defense in the largest health fraud case the DOJ has ever prosecuted. Within the case (United States v. J.P., et al.), our client and nine others were charged with healthcare fraud, wire fraud, and money laundering. After a six-week trial including over 500 exhibits, the court declared a mistrial. When the government brought the case to the courts a second time, our client was declared not guilty on all counts.
The sooner you act, the better your attorney can protect you. Contact Lowther | Walker online or call (404) 496-4052 for an urgent response to your federal healthcare fraud case.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
The OIG and CMS use a tool called the Comparative Billing Report (CBR), which benchmarks a provider’s E&M code distribution against peers in the same specialty and geographic region. A red flag emerges when a physician consistently bills 99214 or 99215 (high-complexity visits) at rates far exceeding peers — e.g., billing 99215 80% of the time when the national average for a family physician is around 15%.
Unbundling means billing individual CPT component codes separately when a comprehensive bundled code should apply under the CMS Correct Coding Initiative (CCI). The CCI maintains roughly 200,000 column 1/column 2 edit pairs; when two codes are mutually exclusive, or one is integral to the other, only the column 1 code is billable. A classic example is billing every intraoperative component of a total knee replacement separately instead of using the single comprehensive code.
Investigators look for doctors who order large volumes of expensive items, like back braces, for patients they have only spoken to briefly on the phone and have never met in person.
Investigators use tools like GPS tracking, login times on electronic health apps, and even social media to prove that a caregiver was at a different location when they claimed to be at the patient’s home.
It crosses the line into fraud if the surgeon’s profit from the company is directly tied to the number of implants they use, as this creates a financial incentive to perform unnecessary surgeries.
You are not required to answer questions without an attorney present, and while you cannot obstruct a valid search warrant, you generally have the right to request time to review any administrative subpoenas with legal counsel before voluntarily turning over privileged medical records.
Investigators frequently interview staff and patients directly to compare their accounts against your billed services; while you can inform employees that they have the right to their own legal counsel, instructing them not to speak to investigators can lead to severe secondary charges of witness tampering or obstruction of justice.
Yes, under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) has the authority to suspend all payments based on “credible allegations of fraud,” which can effectively starve a practice of cash flow long before any formal guilt or innocence is determined in court.
Administrative audits typically begin with standard letters requesting medical records from contractors (like MACs or UPICs), whereas the involvement of the Department of Justice (DOJ), the FBI, or the HHS Office of Inspector General (OIG) issuing grand jury subpoenas or executing search warrants strongly indicates a high-stakes criminal probe.
