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Lowther | Walker’s Medicare fraud defense lawyers hold decades of experience representing healthcare professionals nationwide. We protect doctors, nurses, and healthcare clinic owners facing Medicare audits, investigations, and government fraud accusations tied to Medicare billing violations.
Our Medicare fraud experience includes representing healthcare professionals facing the following criminal actions related to Medicare services:
Book your free consultation or call (404) 496-4052 to discuss our Medicare fraud defense services.
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 […]
If you or your healthcare team are under investigation for Medicare fraud, consult a healthcare fraud defense attorney with decades of Medicare defense experience. Healthcare professionals can turn to Lowther | Walker for:
Landmark Medicare fraud case results follow proven experience, as Lowther | Walkers harnesses our history in healthcare fraud cases to help identify flaws at each stage of the prosecutor’s case against you. From healthcare professionals facing a Medicare audit to those launching an appeal and facing a hearing before a judge, Lowther | Walker is adept at navigating complex fraud litigation and unraveling healthcare fraud allegations against our clients.
Your professional reputation and freedom are on the line in Medicare fraud cases. Our Medicare fraud defense attorneys can respond quickly to clients across the United States. We meet with healthcare professional clients countrywide and can schedule a visit to your offices.
Our team has a comprehensive background in the prosecutorial side of government cases against healthcare professionals. Law firm partner attorney Murdoch Walker has experience leading a Department of Justice task force. This experience means Lowther | Walker is one of the country’s top Medicare fraud defense firms for effectively countering government prosecutor strategies.
An innocent-seeming Medicare audit by a UPIC or MAC can quickly turn into a DOJ referral if handled improperly. A specialized defense attorney intervenes early to keep administrative inquiries from crossing the line into federal criminal investigations.
The government can mistake poor record-keeping, misunderstandings of complex coding rules, or billing staff errors for calculated criminal fraud. A skilled lawyer knows how to demonstrate that an honest mistake does not equate to criminal intent.
The threat isn’t just federal prison. You face the immediate suspension of your medical license, the loss of your DEA registration, and permanent exclusion from Medicare and Medicaid programs. Your attorney fights to keep your doors open and your career intact while the investigation unfolds.
When you are up against the combined force of the DOJ, the FBI, and HHS-OIG, you are facing agencies with virtually unlimited time, funding, and personnel. You need a defense team with federal court experience to counter their aggressive tactics and protect your constitutional rights.
If agents show up at your clinic unannounced or you receive a grand jury subpoena, the actions you take in the first 24 hours are critical. A defense attorney acts as an immediate shield between you and federal investigators, ensuring you don’t incriminate yourself or your practice.
Under Title 18 of the United States Code, Section 1347, it is a federal crime to defraud government healthcare programs or obtain money, property owned, or under the control of a healthcare benefit program under false or fraudulent pretenses. Proving these allegations requires criminal intent.
No matter how organized your medical office and how precise your billing practices are, you likely will face a Medicare audit and potentially healthcare fraud charges if you submit many claims through the CMS (Centers for Medicare and Medicaid Services).
The latest data from the HHS-OIG (Health and Human Services Office of the Inspector General shows the government receives $11 for every $1 spent on Medicare fraud investigations. This figure is based on the Spring 2025 Semiannual Report to Congress, which covers the period from October 1, 2024, to March 31, 2025. During this period, the OIG’s efforts resulted in over $16.61 billion in total monetary recoveries through federal Medicare investigations.
This financial analysis underscores how aggressively Medicare and medicaid fraud is pursued by both federal authorities and state Medicaid fraud control units. In the same reporting period, more than 1000 healthcare providers and executives were convicted of federal and state healthcare fraud offenses of Medicare fraud.
What begins as an administrative audit or overpayment review can quickly escalate into a full-scale federal investigation and prosecution.
Any medical professional working in a position through which they receive or handle Medicare funds for patient care may face Medicare fraud charges. This list includes:
Whether you’re facing a Medicare audit or federal government charges, proactively booking a free consultation with a defense attorney can help safeguard your practice and your reputation.
The False Claims Act (FCA) protects the government from being overcharged for medical services or sold substandard services.
Medical providers found guilty under the FCA (31 U.S.C. Sections 3729 – 3733) face fines of up to three times the Medicare program’s loss. False Claims Act violations may also lead to criminal charges. Therefore, medical providers risk their finances and freedom if they don’t hire a qualified Medicare fraud defense lawyer to analyze their charges under the False Claims Act.
Stark Law violations involve medical providers referring Medicare patients to companies through which they or their family members hold ownership, financial interest, or a compensation agreement.
An example of a Stark Law violation would be a physician receiving compensation from a testing company while referring their patients specifically for tests to the same organization.
Medicare fraud defense law firm Lowther | Walker brings a comprehensive knowledge of Stark Law exceptions. For example, there are exceptions for physicians with shares in a publicly traded company and specific conditions under which healthcare providers can bill for preventative testing services.
The Anti-Kickback Statute prohibits solicitation and payment for designated health services to entities through which the medical professional or a family member has a financial relationship. The referring medical specialist and the service provider can face penalties under the Anti-Kickback Statute and the Stark Law.
Violations of the AKS constitute a felony punishable by a fine of $25,000, 5 years in prison per violation, or both.
You’ve worked tirelessly for your healthcare career. Don’t take any chances with your future.
Lowther | Walker’s healthcare fraud lawyers will harness their in-depth knowledge of billing codes and Medicare policies to bridge the knowledge gap and build a compelling defense of your office’s Medicare work.
Our Medicare fraud defense lawyers will evaluate your billing practices and the case against you and use their knowledge of healthcare fraud law to scrutinize the evidence and identify flaws in the prosecution’s case.
Book your free consultation or call now to discuss our Medicare fraud defense services.
Lowther | Walker is the leading U.S. healthcare fraud defense firm for medical professionals facing Medicare fraud charges. Aggressively defend your professional reputation and call Lowther | Walker today at (404) 496-4052 to book your free, no-obligation Medicare fraud consultation.
No-obligation. Fully confidential.
Call Us Today: (404) 496-4052
A Medicare audit is typically a routine review conducted by Medicare Administrative Contractors (MACs) or Recovery Audit Contractors (RACs) to verify that claims were properly documented and coded. Medicare audits focus on compliance and may result in overpayment demands that you’ll need to repay, but they’re administrative in nature.
A fraud investigation, however, is a criminal or civil inquiry conducted by agencies like the Office of Inspector General (OIG), the FBI, or the Department of Justice. These investigations suggest the government suspects intentional wrongdoing, including submitting false claims, kickbacks, or deliberate upcoding. Fraud investigations can lead to criminal charges, substantial fines, exclusion from Medicare, and even imprisonment. If you’re uncertain which situation you’re facing, contact a healthcare fraud defense attorney immediately, as the stakes and strategies differ dramatically.
Yes, Medicare fraud accusations can jeopardize your medical license, even before you’re convicted of any crime. State medical boards often initiate their own disciplinary proceedings when they learn of fraud allegations, and they operate independently from criminal or civil cases. A conviction for Medicare fraud almost always triggers license suspension or revocation.
However, even accusations alone can prompt board investigations. Additionally, if you’re excluded from participating in federal healthcare programs (placed on the OIG’s List of Excluded Individuals and Entities), many state boards view this as grounds for disciplinary action. An experienced attorney can help coordinate your criminal defense with strategies to protect your license, including working with healthcare licensing attorneys and preparing responses to medical board inquiries that don’t compromise your legal defense.
Yes, you can technically still practice medicine if excluded from Medicare, but your career options become severely limited. Exclusion means you cannot bill Medicare, Medicaid, or any federal healthcare program for your services. Patients covered by these programs cannot use their benefits to pay you, even if they want to pay directly for your services.
Most hospitals, healthcare systems, and group practices won’t employ excluded physicians because they risk losing their own Medicare funding by doing so. You would be restricted to treating only patients with private insurance or those paying entirely out-of-pocket in a private practice setting. For many physicians, exclusion effectively ends their career. The exclusion period typically lasts a minimum of five years, but can be permanent depending on the severity of the fraud. This is why avoiding exclusion or negotiating the terms of any settlement is a critical priority in your defense.
Not necessarily. Medicare fraud requires proof of intent, that you knowingly and willfully submitted false claims. Honest mistakes, coding errors, or misunderstandings of complex Medicare rules generally don’t constitute fraud, though they may result in overpayment demands or civil penalties.
However, the government may try to establish a pattern that suggests intent, such as repeated errors that always favor higher reimbursement, billing for services after being warned about improper coding, or ignoring compliance training. Your defense attorney will work to demonstrate that errors were inadvertent, that you acted in good faith, that you relied on your billing staff or outside billing companies, or that Medicare’s guidelines were ambiguous.
Documentation showing you sought compliance guidance, corrected errors when discovered, or participated in training can strongly support a lack-of-intent defense. Even if criminal fraud charges aren’t warranted, you may still face civil False Claims Act liability, which has a lower burden of proof and doesn’t require criminal intent.
Wait for your attorney. While your instinct may be to explain yourself or cooperate to show you have nothing to hide, anything you say to investigators can and will be used against you. Medicare fraud investigators are skilled at obtaining statements that seem innocent but can be twisted to suggest guilt.
Do not speak with OIG agents, FBI investigators, or other federal officials without legal representation present. Politely decline to answer questions and state that you’d like to consult with your attorney first. Do not allow investigators to search your office or access records without a warrant or subpoena, and even then, have your attorney review the document first. Similarly, do not destroy, alter, or hide any documents, as this constitutes obstruction of justice and will make your situation far worse.
Your attorney can communicate with investigators on your behalf, negotiate the terms of any interviews, and ensure your rights are protected throughout the process. In some cases, your attorney may advise limited cooperation as part of a strategic defense, but this decision should only be made with legal counsel.
The False Claims Act is a federal law that imposes civil liability on individuals and entities that knowingly submit false or fraudulent claims for payment to the government, including Medicare. Under this law, you can be held liable for submitting claims for services not rendered, upcoding, billing for medically unnecessary services, or any other false statement to obtain Medicare payment.
The FCA allows for treble damages (three times the amount of false claims) plus penalties of thousands of dollars per false claim submitted. The law also has a “whistleblower” provision that allows private individuals, often employees or former employees, to file qui tam lawsuits on behalf of the government and share in any recovery. Even without criminal intent, you can face substantial civil liability under the FCA if the government proves you acted with “deliberate ignorance” or “reckless disregard” of the truth. Many Medicare fraud cases are pursued civilly under the FCA rather than criminally because the burden of proof is lower.
Medicare fraud criminal penalties are severe and can include lengthy prison sentences, substantial fines, and restitution. Under federal law, healthcare fraud can result in up to 10 years in prison for each count. If the fraud results in serious bodily injury to a patient, the sentence can increase to 20 years. If a patient dies as a result of the fraud, you could face life imprisonment.
Financial penalties are equally devastating. Criminal fines can reach $250,000 per count for individuals, and you’ll likely be ordered to pay restitution to Medicare for all fraudulently obtained funds. You’ll also face mandatory exclusion from all federal healthcare programs, effectively ending your ability to treat Medicare and Medicaid patients.
Additionally, a felony conviction results in loss of your DEA license to prescribe controlled substances and will almost certainly lead to state medical board action against your license. These consequences underscore why experienced legal representation is essential from the moment you learn of an investigation.
Upcoding occurs when a healthcare provider bills Medicare for a more complex, expensive service than was actually performed. For example, billing for a comprehensive office visit (higher-level E&M code) when only a brief consultation occurred, or coding a simple procedure as a complex one to receive higher reimbursement.
Upcoding is considered fraud when done knowingly and intentionally to increase payment. However, the line between honest coding errors and fraudulent upcoding can be blurry.
The government looks for patterns, such as a provider whose distribution of high-level codes is statistically abnormal compared to peers, consistent billing of the highest-level codes regardless of patient complexity, or documentation that doesn’t support the billed codes. If you’re accused of upcoding, your defense may focus on demonstrating good faith coding practices, reliance on billing staff or coding software, compliance with your understanding of coding guidelines, or the complexity of Medicare’s coding rules. Medical necessity documentation is crucial in defending against upcoding allegations.
Yes, you can potentially be held liable for your billing staff’s actions under the legal doctrine of “respondeat superior” (employer liability) and because providers must ultimately sign off on or be responsible for claims submitted under their National Provider Identifier (NPI). As the treating physician, you’re expected to ensure proper oversight and compliance in your practice.
However, reliance on billing staff can also be part of your defense if you can demonstrate that you implemented reasonable compliance measures, provided proper training and supervision, had no knowledge of improper billing, and acted in good faith. If an employee engaged in fraudulent billing without your knowledge or contrary to your policies, this may support a lack-of-intent defense.
Willful blindness or deliberate ignorance of obvious red flags won’t protect you. You must demonstrate that you maintained adequate compliance systems and oversight. This is why having documented compliance policies, regular audits, and staff training is so important. It provides evidence of good faith efforts to prevent fraud.
