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Federal Healthcare Fraud

Facing charges of federal healthcare fraud is a daunting and life-altering experience. The implications of such charges can be severe, affecting not only your professional career but also your personal life and reputation. Before you consider speaking with investigators or agreeing to any deals, it’s crucial that you consult with a federal healthcare fraud attorney from Chris Lewis & Associates, P.C.

Federal healthcare fraud encompasses a wide range of illegal activities. These crimes are taken very seriously by the government and are vigorously prosecuted. Conviction can lead to hefty fines, restitution payments, and significant time in federal prison. Moreover, professionals convicted of healthcare fraud often face the revocation of their professional licenses, effectively ending careers in the healthcare industry.

If you’re under investigation or have been charged with federal healthcare fraud, it’s imperative to seek legal guidance immediately. At Chris Lewis & Associates, P.C., our experienced team understands the intricacies of federal healthcare law and is committed to defending your rights and your future. We believe that everyone deserves a strong defense, especially when facing charges that can have such profound impacts on your life.Don’t navigate this challenging time alone. Contact a federal healthcare fraud lawyer at Chris Lewis & Associates, P.C. today. We’ll work tirelessly to provide you with the best possible defense and strive to protect your freedom, reputation, and future.

What is Healthcare Fraud?

Healthcare fraud involves knowingly and willfully executing, or attempting to execute, a scheme to defraud any healthcare benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any money or property owned by, or under the custody or control of, any healthcare benefit program. This can include billing for services not rendered, performing unnecessary services for the purpose of billing, kickbacks, and more.

What is federal healthcare fraud?

Federal healthcare fraud involves the intentional deception or misrepresentation of information that results in unauthorized benefits. This can include billing for services not rendered, upcoding services to receive higher reimbursements, performing unnecessary procedures to bill more services, or illegally prescribing medications. Due to the federal government’s significant investment in healthcare programs like Medicare and Medicaid, they aggressively pursue individuals and entities suspected of fraud, often leading to severe penalties for those convicted.

Elements of Federal Healthcare Fraud Crimes

To secure a conviction for federal healthcare fraud, the prosecution must convincingly prove each element of the alleged crime beyond a reasonable doubt. Although the specific elements can vary based on the precise nature of the fraud, they generally encompass:

  • Intent: The defendant knowingly engaged in deceptive practices.
  • Knowledge: The defendant was aware that their actions were fraudulent.
  • Action: The defendant executed or attempted to execute a scheme to defraud a federal healthcare program or obtain money or property under the custody of such a program through fraudulent means.

For instance, in a case of billing fraud, prosecutors must demonstrate that the defendant intentionally submitted false claims to a federal healthcare program with the knowledge that the claims were untrue and with the objective of unlawly gaining reimbursement.

Penalties for Federal Healthcare Fraud

The consequences of being convicted for federal healthcare fraud are severe and wide-ranging. Convicted individuals can face substantial prison time, with sentences varying depending on the magnitude of the fraud and the specific statutes violated. Fines can reach up to twice the gross loss or gain associated with the fraud, making the financial repercussions significant.

Moreover, individuals found guilty of healthcare fraud may be subject to restitution payments to compensate victims for their losses. In certain egregious cases, there’s also the potential for additional penalties, such as exclusion from participation in federal healthcare programs, which can effectively end a healthcare provider’s career.

In addition to criminal penalties, those involved in healthcare fraud may face civil lawsuits, including actions under the False Claims Act, where whistleblowers can sue fraudsters on behalf of the government and share in any recovered funds.

Differences Between Federal and State Criminal Law in the Context of Healthcare Fraud

Healthcare fraud can be prosecuted under both federal and state laws, but there are significant differences in how these cases are handled. This section explores the distinctions between federal and state criminal law as they pertain to healthcare fraud.


One of the primary differences lies in jurisdiction. Federal healthcare fraud involves offenses against federal healthcare programs like Medicare, Medicaid, and Tricare. These crimes often have a broader impact, affecting multiple states or the entire nation. Examples include billing for services not rendered, kickbacks, and false claims.

State healthcare fraud, meanwhile, is focused on crimes that violate state-level healthcare regulations or affect state-funded healthcare programs. These might include similar acts of fraud but on a scale that impacts state budgets and resources directly.


Investigations into healthcare fraud at the federal level are typically conducted by agencies such as the Department of Health and Human Services’ Office of Inspector General (HHS-OIG), the Federal Bureau of Investigation (FBI), or the Drug Enforcement Administration (DEA). These agencies have vast resources and expertise in unraveling complex schemes that may span across states.

State-level investigations are usually carried out by local law enforcement or state-specific agencies dedicated to combating healthcare fraud. While effective within their jurisdiction, they may lack the broader reach and resources of their federal counterparts.


Charges for healthcare fraud also differ between the federal and state systems. At the federal level, charges could be brought under laws such as the False Claims Act, the Anti-Kickback Statute, or the Federal Health Care Fraud Statute. These laws are designed to protect the integrity of federal healthcare programs.

State charges, conversely, are based on violations of state statutes that govern healthcare practices and insurance fraud. While there can be overlap in the nature of the crimes, the specific charges will reflect the jurisdiction’s particular legal framework.


Penalties for healthcare fraud under federal law can be particularly severe, including significant fines, restitution payments, and lengthy prison sentences. Convicted individuals or entities might also face exclusion from participation in federal healthcare programs, a penalty that can effectively end a healthcare provider’s career.

State penalties vary widely but generally include fines, imprisonment, and possible suspension or revocation of professional licenses. The severity often depends on the amount defrauded and the specific laws violated.


The appeals process in federal healthcare fraud cases moves from the district court to the circuit courts and potentially to the U.S. Supreme Court. Each level reviews the application of federal law and procedural correctness.

State appeals follow a path from trial courts to intermediate appellate courts and finally to the state’s highest court, focusing on interpretations of state law and the fairness of the trial process.

Types of Federal Healthcare Fraud Your Dallas Attorney Handles

In the complex landscape of healthcare, federal healthcare fraud represents a significant legal challenge that necessitates skilled legal defense. If you’re in Dallas and facing such charges, it’s crucial to understand the various types of federal healthcare fraud cases that your attorney can handle. Drawing from comprehensive resources including the FBI, CMS, HHS, and legal databases, here’s an overview of the common types of healthcare fraud cases:

1. Billing for Non-Existent Services

One of the most straightforward forms of healthcare fraud involves billing Medicare, Medicaid, or other health insurance providers for services, tests, or procedures that were never actually performed. This type of fraud not only misappropriates funds but also undermines the integrity of patient records and trust in healthcare providers.

2. Upcoding & Unbundling

These practices involve manipulating coding to inflate billing. Upcoding occurs when a provider bills for a more expensive service than the one actually provided. Unbundling refers to charging separately for procedures that are usually offered at a bundled rate, thereby increasing the overall charge fraudulently.

3. Kickbacks and Referral Fees

The Anti-Kickback Statute (AKS) prohibits the exchange of anything of value in an effort to induce or reward the referral of patients for services or items covered by federal healthcare programs. This includes kickbacks, bribes, and rebates made directly or indirectly, overtly or covertly.

4. Fraud Involving Prescriptions

This encompasses a range of fraudulent activities from forging or altering prescriptions to obtain drugs, to doctors prescribing medications unnecessarily to profit from pharmaceutical companies’ incentives. It also includes the illegal distribution or diversion of prescription drugs.

5. Services Not Rendered or Medically Unnecessary Services

Submitting claims for services that were never provided or not medically necessary is a common form of healthcare fraud. This can include exaggerating a patient’s diagnosis to justify unnecessary tests or procedures, which not only defrauds the healthcare system but also exposes patients to unwarranted medical risks.

6. Misrepresentation of Non-Covered Treatments

Some providers may misrepresent non-covered cosmetic or elective procedures as medically necessary treatments to secure insurance payouts. This manipulation of treatment descriptions undermines the principles of truthful and transparent healthcare provisioning.

7. False Claims Act Violations

The False Claims Act (FCA) is a key tool in combating healthcare fraud. It targets any fraudulent claim for payment from federal healthcare programs. Violations include knowingly presenting a false claim for payment or making or using a false record or statement material to a false or fraudulent claim.

Chris Lewis is well-versed in federal healthcare laws and experienced in defending against these and other types of healthcare fraud, plays a pivotal role in navigating the complexities of your case. From investigating the evidence against you, challenging prosecutorial claims, to negotiating settlements or sentences, they work diligently to protect your rights and achieve the best possible outcome.

Partner With A Federal Healthcare Fraud Defense Attorney in Dallas, Texas

The consequences of a federal healthcare fraud conviction are severe and life-altering. Such crimes are taken seriously by the judicial system, and being found guilty could result in lengthy prison sentences. Beyond incarceration, a conviction could lead to the loss of your professional license, significantly impacting your career and future employment opportunities. Your criminal record will follow you, hindering various aspects of your life, from financial stability to social relationships. Moreover, you may lose specific rights due to your conviction, affecting your ability to fully reintegrate into society.

If you’re looking for a team to help you fight federal healthcare fraud allegations, reach out to Chris Lewis today.


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