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Lowther | Walker are Medicaid fraud defense lawyers with 30 years of experience successfully shielding Medicaid care providers from False Claims Act penalties, OIG scrutiny, and Anti-Kickback violations. We defend doctors, nurses, clinic owners, and other providers facing government healthcare audits, investigations, or fraud accusations tied to Medicaid billing.
Our Medicaid fraud law firm handles the following charges:
Proactively book your free, confidential consultation online or call (404) 496-4052 to discuss our Medicaid fraud defense services.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
The 2025 data from the HHS-OIG shows the Medicaid Fraud Control Units recover $3.46 for every $1 on investigations. Federal government investigators recovered $1.4 billion in settlements and judgments, and 1,151 individuals were convicted of Medicaid fraud.
When investigators suspect you of Medicaid fraud, the consequences are serious. Financial penalties, loss of licensing, and criminal charges are all on the table. Many providers don’t realize how quickly an administrative inquiry can evolve into a criminal investigation.
Whether triggered by an automated claim analysis or a whistleblower report, once your name is flagged, investigators can access volumes of your patient data and billing history. Without skilled legal representation, you risk being overwhelmed by government scrutiny.
Lowther | Walker’s healthcare fraud defense attorneys have guided clients through every phase of the Medicaid investigation process. From solo practitioners to multi-site healthcare organizations, we offer tailored defense strategies backed by real courtroom experience.
Below are some of the most effective defenses against Medicaid fraud allegations.
Under federal law, criminal Medicaid fraud requires the government to prove intent. Prosecutors must show that the provider knowingly and willfully attempted to defraud the healthcare system. In the highly complex world of Medicaid billing, CPT codes, and NCCI edits, mistakes happen frequently. We work to demonstrate that any discrepancies were the result of a misunderstanding of ambiguous regulations or a simple oversight, rather than a calculated scheme. Without proven intent, there is no criminal fraud.
Often, what government investigators label as “fraud” is actually a clerical error made by an employee. Whether it is a keystroke mistake, misinterpreting a physician’s clinical notes, or accidental duplicate billing, Lowther | Walker builds defenses around administrative mistakes and your criminal liability. We demonstrate that the provider did not direct, approve, or intentionally orchestrate the staff inaccuracies.
Modern healthcare facilities rely heavily on Electronic Health Records (EHR) and automated billing software. These intricate systems are prone to glitches, improper default settings, auto-population errors, and coding mapping failures. An anomaly in the software might automatically “upcode” a service or unbundle procedures completely without the physician’s knowledge. Our legal team collaborates with forensic data experts to trace the root of the billing anomalies back to system flaws, proving the software, not the provider, is at fault.
The federal government is bound by strict time limits to bring Medicaid fraud charges. Generally, under federal law, the statute of limitations for healthcare fraud is five years from the date the alleged offense was committed. If prosecutors attempt to build a case on claims submitted outside of this statutory window, our federal attorneys will file pre-trial motions to have those specific charges, or potentially the entire indictment, dismissed outright.
Don’t let a billing mistake cost you your career. If you are facing a Medicaid audit, a DOJ investigation, or formal fraud charges, contact the experienced federal defense attorneys at Lowther | Walker today.
Understanding the stages of a Medicaid fraud case can help your team prepare and respond decisively:
The process often starts with internal data analysis—CMS or MFCUs may flag providers whose billing patterns deviate from local or national norms. Sometimes, a single complaint can trigger a deep-dive investigation.
Once concerns are validated, the matter may be handed off to fraud control units, attorneys general, or the DOJ. At this point, the investigation becomes formal—records are collected, and interviews may begin.
Any communication or cooperation at this stage should be carefully guided by a Medicaid fraud defense attorney.
Investigators will likely demand extensive documentation: patient records, billing logs, staff communications, and contracts. These requests can be overwhelming, especially if they go back years. Lowther | Walker can manage these requests, protect your legal rights, and guard against overreach or misinterpretation.
Government analysts, including medical experts, will conduct a thorough review of the materials you provide. This can take weeks or months and often determines whether the case is closed, escalated, or resolved through negotiation.
Outcomes may include a repayment demand, civil settlement, criminal referral, or a referral to your licensing board. Early intervention by our defense team can shift the direction of the investigation and reduce your legal exposure.
Lowther | Walker provides aggressive defense and representation to physicians, dentists, psychiatrists, and other health professionals and companies facing Medicaid investigations. Turn to our healthcare lawyers for:
Our attorneys have an in-depth understanding of the healthcare system, from billing codes to regulatory compliance. We’ve successfully defended doctors, nurses, dentists, mental health professionals, and clinics across the U.S.
Medicaid fraud cases often begin without warning. That’s why our legal team is available around the clock to help you respond to subpoenas, navigate audits, and avoid critical missteps.
From negotiating settlements to winning at trial, our attorneys have achieved results in complex, high-profile fraud cases. We understand how prosecutors think—and we know how to counter their strategies effectively.
Lowther Walker provides nationwide defense for healthcare professionals facing Medicaid fraud investigations and charges. Our team of former DOJ prosecutors and federal defense attorneys represents doctors, clinics, and other providers against aggressive government scrutiny.
The firm handles a wide array of Medicaid fraud defense claims, including:
Improper Billing Codes: Defending against accusations of upcoding or unbundling services.
Medically Unnecessary Services: Countering claims that patient treatments were not clinically justified.
Phantom Charges: Addressing allegations of billing for services, tests, or equipment never provided.
Record Discrepancies: Handling cases involving inadequate, falsified, or altered patient records.
Kickbacks and Referrals: Defending against Stark Law violations and unlawful financial arrangements.
Administrative Errors: Proving that discrepancies stem from staff mistakes, third-party billers, or software flaws rather than criminal intent.
By intervening early, Lowther Walker aims to downgrade potential criminal liabilities into civil administrative disputes before formal charges are filed.
If you’re under investigation or want to protect your practice from becoming a target, reach out to the Medicaid defense attorneys at Lowther | Walker. Call (404) 496-4052 or schedule a consultation online. We’re ready to defend your career, your practice, and your future.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Investigations may begin due to unusual billing patterns, data mismatches, whistleblower reports, or tips from patients or staff. Often, it’s an automated system—not a person—that flags providers for audit or investigation.
We defend against accusations of:
Our attorneys can also defend client from errors made by staff, third-party billers, or outdated software.
Yes. Medicaid fraud is a serious offense that can result in criminal charges, including felonies punishable by prison time and steep fines. Early legal counsel can help reduce or avoid these charges altogether.
In many cases, findings from a Medicaid fraud investigation are referred to licensing boards. This could lead to disciplinary actions like suspension, probation, or full revocation of your license.
We represent the full spectrum of healthcare providers including individual practitioners, group practices, hospitals, home health agencies, DME suppliers, pharmacies, laboratories, and other healthcare businesses of all sizes.
