At Lowther | Walker, our Chicago Medicaid fraud defense attorneys stand ready to represent health care providers in Illinois under HHS (Health and Human Services)scrutiny. Whether you’re a physician, hospital administrator, clinic owner, or ancillary provider, we defend clients facing audits, investigations, or criminal charges tied to Medicaid billing in Chicago and throughout Illinois.
Our Illinois Medicaid defense practice handles the following federal government allegations and actions:
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Medicaid in Illinois (known as Illinois HealthCare and Family Services – HFS) is subject to both state and federal oversight. The Illinois Attorney General’s Medicaid Fraud Control Unit (MFCU) collaborates with federal prosecutors and inspectors general. Once flagged, a provider’s billing history, patient files, and contracts may be subject to deep scrutiny by investigators.
In Illinois, Medicaid fraud actions may be prosecuted both at the state level (by the MFCU) and at the federal level (via the U.S. Attorney’s Office in the Northern District of Illinois). A misstep in cooperating with investigators, failing to respond appropriately to subpoenas, or mishandling document requests may escalate a case from civil inquiry to criminal charges.
Lowther | Walker’s team has deep experience defending clients across Illinois, including in federal court in Chicago (Northern District of Illinois) and in U.S. District Courts elsewhere in the state.
Understanding the phases of an investigation can help you prepare a stronger defense:
Anomalies in your claims to HFS—such as unusually high utilization, services outside norms, or mismatches between diagnosis and procedure codes—may prompt a preliminary review or referral to Illinois MFCU.
Once referred to MFCU or federal agents, investigators may serve subpoenas, demand records, and initiate interviews with staff and executive leadership. At this point, your responses must be strategic.
You may be required to produce years of billing logs, medical charts, contracts, referral agreements, corporate records, and internal audit memos. Lowther | Walker’s team can manage these demands, assess privilege risks, and protect against overreach.
Government-hired medical experts or forensic accountants will scrutinize your billing patterns, coding practices, and medical necessity. These analyses often inform whether the case proceeds to criminal referral.
Potential outcomes include:
Early counsel with an initial consultation and a vigorous defense of your fraud charges often help limit exposure and redirect the case before it escalates.
We understand how Illinois Medicaid works, including HFS rules, reimbursement structures, and state-federal interplay. Our team has defended physicians, dentists, clinics, pharmacies, home health agencies, diagnostic labs, and more.
Because these cases can materialize without warning, our attorneys stand ready to respond to subpoenas, demands, or government inquiries immediately—protecting your rights from the outset.
Lowther | Walker brings seasoned litigators with federal courtroom experience across Illinois. We have defended major health care fraud matters in the Northern District of Illinois, including in Chicago, and in other federal courts statewide. Our team understands how U.S. Attorneys and federal investigators in Chicago operate.
We are familiar with major hospital systems and providers in the Chicago area, such as the University of Chicago Medical Center, Northwestern Memorial, Rush University Medical Center, John H. Stroger Jr. Hospital (Cook County), Cook County Health, Advocate Health, and Loyola Medicine. We are well versed in the compliance environment, referral patterns, and inter-hospital billing practices unique to Chicago providers. Our local experience helps Chicago providers navigate federal government programs.
In United States v. J.P., et al., the Department of Justice’s Criminal Division, Fraud Section charged our client and nine other individuals in a $1.4 Billion healthcare fraud, wire fraud, and money laundering conspiracy (the largest health care fraud case that DOJ has ever prosecuted) concerning toxicology laboratories using rural and critical-access hospitals in an alleged pass-through billing scheme.
After a six-week trial, during which the DOJ presented forty-two witnesses, including cooperating, alleged co-conspirators, and over 500 exhibits, the jury deliberated for four days before failing to unanimously agree on a verdict, prompting the Court to declare a mistrial.
The DOJ released all of the client’s seized assets at the conclusion of the trial. The Government elected to try the case again with a different expert witness and an additional cooperating, alleged co-conspirator, and after a four-week trial, the jury found our client not guilty on all counts in the indictment.
Our client was under investigation by the HHS-OIG in a $30 million telemedicine kickback scheme. Lowther | Walker’s attorneys convinced the government not to prosecute.
The FBI and the HHS-OIG investigated our client for Health Care Fraud for submitting over $7 million in alleged false claims to Medicare. Our lawyers negotiated probation with no restitution.
A private insurance company accused our client, a dentist, of fraudulently billing approximately $400,000 of services. We settled the case with a $248 reimbursement and no prosecution.
Build your defense with attorneys who have successfully represented healthcare providers in complex Medicaid fraud cases in Chicago.
We understand Illinois billing regulations, compliance requirements, and the nuances that distinguish billing errors from fraudulent conduct. Call Lowther | Walker via (404) 806-7997 and book a free, no-obligation consultation with a Medicaid fraud attorney.
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