Practice Areas
Healthcare & Medicare Fraud Defense
Healthcare fraud investigations target physicians, clinics, pharmacies, and other providers over billing, coding, and referral practices. They are driven by data analytics and whistleblowers, and they carry criminal, civil, and administrative exposure at once.
How healthcare fraud cases arise
These matters often begin with billing-data audits, a whistleblower complaint under the False Claims Act, or referrals from program integrity contractors. Allegations commonly involve claims to Medicare, Medicaid, or private insurers.
- Billing for services not rendered or upcoding
- Medically unnecessary services or tests
- Kickbacks and self-referral (Anti-Kickback Statute, Stark Law)
- Prescription and controlled-substance allegations
Criminal, civil, and administrative exposure
A single set of facts can produce a criminal investigation, a civil False Claims Act case, and administrative action such as payment suspension or exclusion. Coordinating the defense across these tracks protects both liberty and the ability to keep practicing.
Defending providers
The defense focuses on the genuine complexity of billing rules, the medical necessity reflected in the records, the absence of intent to defraud, and the reliance providers place on billing staff and established practice. Forensic and clinical consultants are often essential.
Prior results and recognitions do not guarantee a similar outcome. Every case is different and must be evaluated on its own facts.
Answers
Frequently asked questions
General information about healthcare & medicare fraud. It is not legal advice. Every case turns on its own facts.
What is the difference between a billing error and fraud?
What is a qui tam or whistleblower case?
Can I keep practicing during an investigation?
Facing a federal investigation or serious charges?
Speak directly with George G. Mgdesyan about your situation. Consultations are confidential, and the sooner you call, the more can often be done.