At Lowther | Walker, we provide aggressive Chicago Medicare fraud defense strategies built on decades of federal trial experience and a deep understanding of how Medicare fraud cases are prosecuted in Illinois.
Facing Medicare fraud charges in Chicago is not just about financial penalties. It can jeopardize your license, reputation, and freedom. Civil fines may reach millions of dollars, while criminal convictions can carry long prison sentences.
If your practice has been contacted by federal agents, don’t wait. Schedule a free consultation with a Medicare fraud defense attorney to review your legal options.
24/7 Office Hours in Chicago.
Over the years, we have defended clients across the city against a wide range of allegations, including:
Even small mistakes in documentation or billing can be treated as fraud by federal investigators. That’s why it’s critical to have defense counsel with hands-on knowledge of both healthcare compliance and federal court litigation.
The Chicago metro area is home to some of the nation’s largest medical centers, research hospitals, and private practices. With this concentration of healthcare activity, the Department of Justice, the FBI, and HHS-OIG keep a close watch on Medicare billing across Cook County and surrounding areas. Cases are often filed in the Northern District of Illinois federal court, where prosecutors aggressively pursue both civil and criminal actions.
Federal prosecutors may use one of the following methods to indicate you’re under suspicion of healthcare fraud:
These formal notices usually indicate they have already spent months gathering information. Early legal intervention is often the best way to resolve the matter before formal charges are filed.
Several statutes form the backbone of government prosecutions:
Federal prosecutors often rely on the False Claims Act when they believe a provider billed Medicare improperly. Penalties can include treble damages and additional civil fines. Many cases begin with whistleblower complaints in Chicago’s competitive healthcare market.
The Stark Law restricts referrals to entities in which physicians have a financial stake. These cases are common in urban centers like Chicago, where doctors often work with specialty practices and diagnostic facilities. Certain exceptions apply, and an experienced attorney can evaluate whether your practice qualifies.
Under the Anti-Kickback Statute, exchanging anything of value for patient referrals tied to Medicare can result in felony charges. Even business relationships that appear routine may be scrutinized. Violations carry fines, prison terms, or both.
Our team approaches every case with the understanding that what’s at stake goes far beyond financial loss. We examine billing patterns, coding practices, and patient records to demonstrate legitimate medical judgment and expose flaws in the government’s claims. By anticipating prosecutorial tactics, we push back effectively and, in many cases, resolve matters without trial.
Although we represent healthcare providers nationwide, our firm is well-versed in defending cases brought in Chicago. From audits affecting suburban clinics to indictments filed in the Everett M. Dirksen U.S. Courthouse downtown, we understand how these cases move through the federal system in Illinois.
Examples of Our Medicare Fraud Defense Results
Our Medicare fraud defense attorneys will begin our investigation into your case by examining billing records, speaking to any witnesses, and consulting with medical coding and healthcare compliance experts to provide testimony on your behalf.
Lowther | Walker offers a comprehensive Medicare fraud defense process, including the following elements:
Our attorneys meticulously challenge the prosecution’s evidence. We analyze every document, record, and statement presented, looking for inconsistencies, procedural errors, or gaps in the government’s case. This includes closely examining Medicare claims data, Explanation of Benefits (EOB) statements, patient medical records, and witness testimony for signs of bias, inaccuracy, or improper interpretation.
When necessary, we consult independent medical billing specialists, healthcare compliance experts, or forensic accountants to dispute the prosecution’s findings and provide alternative explanations that support your defense.
Our legal team understands that Medicare regulations and billing codes are extraordinarily complex, and honest mistakes can be mischaracterized as fraud. To counter these allegations, we often build a defense around the absence of criminal intent.
Lowther | Walker’s attorneys work to present evidence that any Medicare billing discrepancies, upcoding issues, or documentation errors were due to inadvertent mistakes, misinterpretation of CPT or ICD coding guidelines, reliance on incorrect billing software or third-party medical billing services, or confusion regarding Medicare’s Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs), not deliberate wrongdoing.
Demonstrating a lack of intent can be pivotal in weakening the prosecution’s case and may result in civil rather than criminal penalties.
When the circumstances call for it, Lowther | Walker’s attorneys negotiate favorable plea agreements. If the Medicare fraud evidence is substantial and a trial poses significant risks, we help clients evaluate their options and may recommend negotiating a plea to reduced charges with minimized penalties. Our team carefully considers each client’s goals, legal exposure, and personal circumstances to secure outcomes that serve their best interests while limiting long-term consequences such as exclusion from Medicare and Medicaid programs.
The firm’s experience in Medicare fraud cases includes intervening on our clients’ behalf during audits, inquiries from MFCU teams, Grand Jury proceedings, Controlled Substances Act diversion cases, and False Claims Act investigations.
Our legal team has a broad background serving all healthcare professionals, including dentists, psychologists, DME suppliers and telemedicine providers.
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.
When federal agents target you or your medical practice, every decision matters. Lowther | Walker offers decisive, immediate representation to protect your livelihood and your reputation in the Chicago healthcare community.
Call Lowther| Walker via (404) 806-7997 and book a free, no-obligation consultation with a healthcare fraud attorney.
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. These 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), FBI, or Department of Justice. These investigations suggest the government suspects intentional wrongdoing—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. 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.
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. This is critical. 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 it first. Do not destroy, alter, or hide any documents, as this constitutes obstruction of justice and will make your situation far worse.
