Griffin Durham Tanner & Clarkson have garnered a distinguished reputation for adeptly guiding clients through the intricate landscape of healthcare fraud investigations. This area of fraud is a focal point of enforcement for federal and state authorities, with a significant number of individuals annually finding themselves under scrutiny by investigators. The firm’s deep expertise in this complex field allows them to navigate the challenges posed by such high-priority cases, ensuring clients receive the most effective defense possible.
Founded by decorated former federal prosecutors, Griffin Durham Tanner & Clarkson has unique insight into how the government investigates and prosecutes.
Our attorneys have led fraud investigations in some of the largest and most complex cases across the country and have served as:
- United States Attorneys
- Criminal Chief
- Criminal Health Care Fraud Coordinators
- Civil Health Care Fraud Coordinator
- Affirmative Civil Enforcement Coordinator
- Instructors of healthcare fraud for DOJ attorneys
If you are suspected, accused, or indicted on charges of healthcare fraud, you need the knowledge and experience our criminal defense team provides.
One of our healthcare fraud lawyers is standing by to answer any questions you might have. Call our firm at (404) 891-9150 now.
How Griffin Durham Tanner & Clarkson Can Help
While the federal and state governments have enormous resources, our healthcare fraud defense attorneys have intricate knowledge of how they operate.
We have worked with every agency that investigates these types of fraud claims. We have also established relationships with retired federal agents, including the FBI and Office of Inspector General, U.S. Department of Health and Human Services (HHS-OIG), whom we can bring on board to assist our defense team.
We are well-prepared to defend against audits, investigations, grand jury proceedings, state Medicaid Fraud Control Unit (MFCU) teams, False Claims Act (FCA) investigations, Controlled Substances Act diversion investigations, misbranding investigations, and the entire range of fraud or kickback charges.
From the moment you become our client, our healthcare fraud defense attorneys will be proactive. We will undertake our investigation — examining data, speaking to witnesses, and seeking the advice of experts who may give testimony on your behalf at trial.
We may be able to identify weaknesses in the government’s case upfront and be able to discourage prosecution, cast doubt on your intentional participation in a crime, or at least reduce the exposure you or your company may face.
Our expertise in healthcare fraud
Our healthcare fraud defense attorneys bring a wealth of experience and specialized knowledge to the table. Beyond understanding how government agencies investigate and prosecute fraud, we possess a deep grasp of the intricate regulations that govern healthcare providers, including billing practices, compliance with the False Claims Act, and the nuances of Medicare and Medicaid requirements. This expertise enables us to spot potential vulnerabilities in both the government’s case and our clients’ operations that others might overlook.
We are adept at handling a broad range of healthcare fraud issues, from coding errors to complex schemes involving kickbacks and fraudulent billing practices. Our team is skilled in dissecting medical records, reimbursement data, and financial documentation to uncover inconsistencies, errors, or misinterpretations that could be critical in defending against charges.
Our wins speak for themselves
Recent wins include:
- Obtained dismissal of felony health care fraud. Case closed.
- Obtained “declinations” for over a dozen “targets” of health care fraud investigations involving the Department of Justice, Medicaid Fraud Control Unit, and various U.S. Attorney’s Offices.
- Obtained probation-only sentences in health care fraud criminal cases with substantial sentencing exposure.
One client said, “Tom navigated the complexities of my case with confidence and skill. His experience and strategic advice secured a big win for me and my family.”
What is healthcare fraud?
Healthcare fraud encompasses a broad spectrum of fraudulent activities within the medical field, often related to improper billing practices or illicit relationships between parties involved in healthcare services. It commonly includes activities like submitting false claims for services not rendered, overbilling for services provided, or misrepresenting the nature of treatments to secure higher reimbursements.
Investigations into healthcare fraud typically focus on allegations of defrauding government programs such as Medicare, Medicaid, and Tricare, as well as private insurance companies and workers’ compensation systems.
- Medical professionals
- Executives
- Marketers
- Hospital employees
- Laboratories
- Testing services
- Rehabilitation or nursing facilities
- Outpatient surgical centers
- Drug stores
- Pharmaceutical companies
Since billions of dollars are lost in health fraud crimes annually, those convicted of perpetrating them can be sentenced to decades behind bars, restitution, fines, and loss of state licenses.
Have you been accused of one of the following types of healthcare fraud?
A broad spectrum of misconduct is categorized as healthcare fraud. Our accomplished attorneys will customize strategies to protect you from any of the following charges:
- Billing for services not provided or goods never delivered
- Billing for services deemed “medically unnecessary.”
- Unlicensed or excluded services where those submitting claims did not follow appropriate enrollment procedures
- “Upcoding” of claims, i.e., inflating the level of service provided to obtain higher reimbursement
- Misrepresenting diagnoses or procedures to maximize payments
- “Unbundling” procedures, i.e., artificially separating procedures that are normally performed and billed as one kind of treatment
- Submitting duplicate claims
- Altering medical records or reports (changing dates, services, patient names)
- Soliciting or receiving kickbacks for goods or services (e.g., receiving referrals, drugs, or money)
If you have been accused of any of these, you face serious consequences. We can help.
Your Opponents Are Formidable
Healthcare fraud investigations are typically spearheaded by sophisticated and well-funded units within the Department of Justice (DOJ) and other federal agencies. While these investigations can be initiated at the local level, they are often handled by the U.S. Attorney’s office in each district, where a designated healthcare fraud coordinator is responsible for overseeing both criminal and civil cases related to healthcare fraud.
These offices often include specialized prosecutors and dedicated teams who focus exclusively on fraud prosecutions, bringing significant expertise and resources to bear in complex healthcare fraud cases. With access to advanced investigative tools, these teams are well-equipped to pursue fraud charges against individuals and organizations within the healthcare industry.
At the DOJ, there are also prosecutors assigned to the Criminal Division, headquartered out of Washington D.C., assigned to various DOJ’s Health Care Fraud Strike Force.
As described by the DOJ, the Strike Force uses advanced data analysis techniques combined with traditional investigative techniques to determine “hot spots”—cities with high levels of billing fraud.
DOJ has Strike Force operations in Miami, FL; Los Angeles, CA; Detroit, MI; Houston, TX; Brooklyn, NY; the Gulf Coast; Tampa, FL; Orlando, FL; Chicago, IL; Newark, NJ; and Philadelphia, PA; Dallas, TX; the Appalachian Region (Tennessee, Alabama, Ohio, Kentucky, Virginia, and West Virginia); and Washington, DC (National Rapid Response Strike Force).
Top-level government agencies:
- Federal Bureau of Investigation (FBI)
- Medicaid Fraud Control Unit (MFCU)
- Department of Justice Health Care Fraud Strike Force
- U.S. DEA (Drug Enforcement Administration)
- U.S. Department of Health and Human Services Inspector General (HHS-OIG)
This is no project for amateurs. It requires one of our capable, professional, highly-trained healthcare fraud attorneys.
Civil and criminal charges: the threat is real
Healthcare fraud carries significant consequences, both criminal and civil, making it a particularly dangerous legal issue for anyone involved in the healthcare industry. From a criminal perspective, healthcare fraud involves engaging in illegal activities that violate specific laws and regulations. Criminal courts will punish individuals or organizations found guilty of such activities, often resulting in severe penalties such as imprisonment, hefty fines, and long-lasting damage to professional reputations.
On the civil side, healthcare fraud can lead to substantial financial liabilities. Civil courts aim to provide justice by awarding financial compensation to victims who have been harmed by fraudulent practices. If a healthcare organization is found guilty of fraud, it may not only face criminal prosecution but also be subject to civil lawsuits.
Victims of fraud can pursue compensation through these lawsuits, which can result in significant financial settlements or damages if the case is not resolved through negotiation or settlement.
For those charged with healthcare fraud, the potential for both criminal charges and civil liability creates a daunting challenge. The complex web of laws and regulations governing the healthcare sector can make navigating these charges especially difficult.
With the stakes so high, it is crucial to work with an experienced healthcare fraud attorney who can help mitigate the potential consequences and provide a strategic defense aimed at achieving the best possible outcome for your case.
Contact Our Healthcare Fraud Lawyer Today
Griffin Durham Tanner & Clarkson handles healthcare fraud investigations nationwide. We will work tirelessly to protect your finances, freedom, and reputation from the prosecution’s onslaught.
Reach out to one of our healthcare fraud lawyers to discuss options on your case and to determine the best path to receiving the full coverage you are entitled to. Call (404) 891-9150 now.