Medicare Fraud

Trends in Healthcare Fraud Enforcement

Published on: July 9, 2025 | By Conaway & Strickler, P.C.

The DOJ boasted their record-breaking 2025 healthcare fraud take down in a recent press release that we discussed more generally in another blog post. This post focuses on some of the specific actions taken by the government and highlights the trends across enforcement.

DME Fraud

Durable Medical Equipment (DME) fraud remains a cornerstone of federal enforcement as seen in the recent takedown. An indictment in the Western District of New York charges a medical doctor with billing roughly $29.6 million for fictious DME and $5.6 million for audio-only telehealth visits, which were brief or never occurred. That doctor produced and maintained false and fictitious medical records and fraudulently certified orders for braces without regard to medical necessity. The doctor now faces federal criminal charges of conspiracy to commit health care fraud, health care fraud, and false statements relating to health care matters.

Largest U.S. Health Care Fraud Takedown: 324 Charged, $14.6 B Alleged Loss

Published on: July 1, 2025 | By Conaway & Strickler, P.C.

On June 30, 2025, the Department of Justice announced its largest-ever National Health Care Fraud Takedown, unveiling criminal charges against 324 individuals, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals across 50 federal districts and 12 state attorney general offices. The alleged schemes involved over $14.6 billion in intended losses—a record more than double the previous $6 billion takedown

The DOJ’s Health Care Fraud Unit coordinated the investigation with the help of strike forces across the nation. Key aspects of the historical take down include the following:

Enormous monetary scale: Again, the federal government alleges $14.6 billion in intended losses in total across the criminal cases. Law enforcement has already seized $245 million in cash, luxury vehicles, cryptocurrency, and assets from alleged fraudsters. The Centers for Medicare and Medicaid Services (CMS) also proactively prevented $4 billion in fraudulent payments, suspended billing privileges of 205 providers.

Legal Considerations for Healthcare Billing

Published on: April 25, 2025 | By Conaway & Strickler, P.C.

Billing to the United States government presents a unique set of legal requirements for healthcare professionals. Physicians who participate in federal healthcare programs like Medicare and Medicaid are subject to strict billing regulations. Even inadvertent errors can lead to severe legal consequences, including criminal charges. Understanding these laws and the potential risk of noncompliance is crucial for healthcare providers.

When the federal government is paying for items or services rendered to Medicare or Medicaid beneficiaries, federal fraud and abuse laws apply. Healthcare professionals influence what services patients receive and are responsible for the documentation of those services. That documentation is the basis for bills sent to insurers, and ultimately, the Government’s payment of a beneficiary’s medical claims.

If a physician knew or should have known that the submitted claim was false, the attempt to collect unearned money constitutes a violation. Federal fraud and abuse laws include the following:

Nursing License Defense FAQs

Published on: October 25, 2024 | By Conaway & Strickler, P.C.

As a nurse, your license is one of your most valuable assets. Yet, complaints or accusations against you could jeopardize your ability to practice. At Conaway & Strickler, P.C., we understand the gravity of these situations and are here to help. Attorney Meg Strickler is experienced license defense attorney who has handled these issues for years. Below are some questions and answers that will help you navigate any issues you might having with the Nursing Board.

Question: What types of issues come before the State of Georgia Nursing Board?

Answer: Below are some common issues the Board handles. Many of these issues may overlap, as most of this conduct also constitutes a crime.

What are the current DOJ priorities?

Published on: April 1, 2022 | By Conaway & Strickler, P.C.

Attorney General Merrick Garland made recent comments about what he considered to be the Department of Justice’s top priorities for 2022. Since taking office in March 2021, Garland has tried to combat crime in a tumultuous time. He has been criticized for his handling of January 6 investigation and has stated it’s the most urgent probe in history.

With all of this going on, the US Attorney’s office increased its prosecutions of individuals of white collar crimes in the year 2021. White collar charges like fraud, theft, corruption, bribery, environmental crime, tax fraud, health care fraud, procurement fraud, money laundering, PPP loan fraud, etc will continue to get more attention from the Department of Justice.

What does this mean? It means that investigations of any sort need to be taken seriously and that you should contact a lawyer immediately if any wrongdoing is alleged.

Whistleblower / Qui Tam cases in Health Care

Published on: September 11, 2021 | By Conaway & Strickler, P.C.

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Health Care Qui Tam cases

What does Qui Tam mean?

Qui tam is short for the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which roughly translates to “he who brings an action for the king as well as for himself.”