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Lowther Walker’s medical billing fraud defense lawyers are nationally recognized for defending billing fraud claims and protecting healthcare providers reimbursed under federal programs such as Medicare, Tricare, and Medicaid. With 30 years of courtroom experience handling Medicare and Medicaid billing cases, our billing fraud attorneys protect medical providers, including physicians, pharmacists, and hospital operators, during CMS, HHS, and OIG billing audits and investigations.
Our federal defense experience spans all forms of medical billing defense, including:
If you’re facing a medical billing fraud investigation and federal charges, depend on Lowther | Walker’s healthcare fraud defense lawyers to protect your rights.
Call (877) 208-7146 for your free and confidential billing fraud analysis or schedule your consultation.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Proactive fraud case analysis can help safeguard your medical reputation against billing fraud allegations and charges. If you’ve recently been subject to a healthcare audit or the FBI has informed you that you’re a target of a fraud investigation, bring in Lowther | Walker as soon as possible for your defense.
Our experienced billing fraud defense lawyers have taken on federal government investigators in large-scale investigations and successfully defended medical professionals across the U.S.
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 […]
Our experience defending charges under the False Claims Act, the Anti-Kickback Statute, and the Stark Law places Lowther | Walker at the forefront of billing fraud defense law in the United States.
From supporting doctors and healthcare business owners during healthcare audits to working with those appealing criminal healthcare fraud convictions, we’ve successfully helped clients at each phase of the federal criminal process.
With our comprehensive team of healthcare fraud defense lawyers, you can rely on Lowther | Walker for a swift response to government action in your case. The moment you contact us about your medical billing fraud concern, we’ll respond immediately, answering your questions through our considerable experience winning healthcare fraud defense cases in federal courts.
Lowther | Walker has landmark experience defending medical providers facing billing fraud charges, including:
Billing for medically unnecessary services violates the False Claims Act. CMS-1500 requires medical providers to certify that services and procedures submitted were medically necessary for the patient. Our billing fraud defense team regularly works with practitioners accused of overbilling and billing for unnecessary diagnostic procedures, surgical procedures, and medications, such as opioids.
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and the Stark Law prohibit medical providers from receiving kickbacks, remuneration, or monetary value in products for referring patients to federal health programs. In securing a conviction under the Anti-Kickback Statute, prosecutors must prove intent to induce referrals.
Your healthcare practice may face a fraudulent billing charge for charging a government program for a service not provided, according to your documentation. You or your administrator may mistakenly bill for the wrong Medicare code. This false billing issue often occurs in diagnostics when providers mistake similar tests for one another – for example, billing for a 3D scan instead of a 2D scan at an ultrasound clinic.
Duplicate billing occurs when a healthcare provider bills or attempts to bill Medicare, Medicaid, or another Federal program for the same service/treatment. Duplicate billing charges filed by the DOJ can also stem from two providers delivering the same service/treatment to the same patient on the same date.
Upcoding charges may result from billing Medicare or another federal payer for a more expensive service than the one provided. For example, healthcare providers can face upcoding charges for falsely billing specialist time as part of a procedure or misstating the role of equipment used in a care service and billing for more complex treatment.
When federal investigators initiate a case against you for Medicare or Medicaid billing fraud, your professional reputation and decades of work are at stake. Our firm is dedicated to protecting your healthcare business and reputation, harnessing our 30 years of defending healthcare providers.
Call Lowther | Walker at (404) 496-4052 to speak with an experienced healthcare fraud defense lawyer.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
Receipt of the target letter is a clear indicator that an investigation into your healthcare practice has already begun. Don’t wait any longer to contact a health care fraud defense attorney to evaluate your charges. Lowther | Walker can contact the authorities on your behalf and build a strong defense against the charges against you.
The defenses specific to your case require a comprehensive analysis of all documentation from a qualified healthcare fraud defense lawyer. However, common defenses in billing fraud cases include safe harbor protections, lack of evidence, and lack of intent.
Each government program has unique billing rules and regulations, and there are differences in the types of charges resulting from medical billing fraud cases. Another difference is which agency is investigating billing fraud. For example, the DOD investigates Tricare billing fraud cases while the DOJ and FBI investigate Medicaid and Medicare billing fraud. Your case may also involve Medicaid Fraud Control Units and Medicare auditors. Your healthcare fraud attorney can help identify the federal and state authorities involved and intervene to help prevent criminal cases from proceeding.
Healthcare providers convicted of billing fraud may face fines, exclusion from federal healthcare programs, and imprisonment, depending on the extent of the fraud and the resulting damages to patients and the federal government. For example, providers convicted of fraudulent insurance claims under the False Claims Act may face up to five years in prison and fines of up to $250,000.
The difference between medical billing fraud and abuse lies in intent. Fraud involves knowingly submitting false insurance claims to receive unauthorized payments. Abuse refers to improper billing practices that lead to unnecessary costs, but may not be intentional. Both can result in legal consequences, but fraud carries more severe penalties, such as criminal charges and fines.
In 2024, to report medical billing fraud, you can contact the Office of the Inspector General (OIG) via their website or hotline (1-800-HHS-TIPS), report to Medicare at 1-800-MEDICARE, or submit a tip to the FBI at 1-800-CALL-FBI. Reporting procedures are generally the same across the U.S.
In cases where you have substantial information on fraud, you might work with an attorney and consider filing a lawsuit under the False Claims Act, which allows whistleblowers to report fraud and potentially receive a portion of the recovered funds.
The earliest indicators often include unexpected requests for patient records (specifically for a large volume of charts or specific procedure codes), unannounced site visits from auditors or agents, and reports from staff or patients that they have been interviewed by investigators. More formal signs include receiving a “Target Letter” from the Department of Justice, a subpoena for documents, or a sudden administrative suspension of Medicare/Medicaid payments.
The process generally moves through four stages: Detection (data analytics identify statistical outliers in billing); Preliminary Inquiry (auditors review records to verify the data); Formal Investigation (issuance of subpoenas, execution of search warrants, and witness interviews to gather evidence of intent); and Resolution (which may involve a negotiated civil settlement, repayment demands, or criminal indictment and trial)
Yes, under certain regulations (such as the “credible allegation of fraud” standard in Medicaid), investigators can suspend payments immediately to protect program funds. This “payment hold” or suspension can last indefinitely while the investigation proceeds, often causing significant financial strain on the practice before any formal charges are even filed.
Investigators rely heavily on data mining to spot “outliers” compared to peer averages. Common triggers include upcoding, unbundling, excessive use of the same billing modifier (like Modifier 25), or a sudden spike in billing volume for a specific, high-reimbursement procedure.
Call upon decades of experience in healthcare fraud defense. From healthcare audit defense to OIG investigations, Lowther | Walker’s healthcare defense team is recognized nationwide for our service and results in complex matters.
Call Lowther | Walker’s experienced healthcare audit defense lawyers for proactive audit preparation, legal representation during audits, and strategic defense against allegations of billing irregularities.
Lowther | Walker is the country’s leading Medicare fraud defense law firm, with proven experience in challenging cases involving upcoding, phantom billing, and providing unsolicited supplies. Our team travels the country to provide legal services for healthcare providers and can offer direct access to a seasoned Medicare fraud defense lawyer for a free consultation.
