The Eleventh Circuit has issued the highly anticipated decision we discussed in our June 2026 article concerning the constitutionality of the False Claims Act’s whistleblower provisions.

And, at least for now, the False Claims Act’s qui tam system survives.

On September 1, 2026, the U.S. Court of Appeals for the Eleventh Circuit vacated the district court’s dismissal in United States ex rel. Zafirov v. Florida Medical Associates, LLC, No. 24-13581.

The Eleventh Circuit rejected the district court’s conclusion that False Claims Act relators—private whistleblowers who prosecute FCA cases in the name of the United States—are “Officers of the United States” who must be appointed in accordance with Article II of the Constitution.

But the decision does not necessarily end the constitutional challenge to the False Claims Act.

Instead, the Eleventh Circuit sent the case back to the district court to consider two additional constitutional arguments that were never decided below: whether the qui tam provisions violate the Constitution’s Take Care Clause or Vesting Clause.

For companies, physicians, health care providers, government contractors, and individuals facing False Claims Act investigations or litigation, the September 1 decision is important.

The most significant constitutional challenge to the FCA’s qui tam mechanism has been rejected by the Eleventh Circuit—but other constitutional arguments remain alive.

What Happened in Zafirov?

As we discussed in our earlier article, Zafirov arose from allegations of Medicare fraud.

Dr. Clarissa Zafirov brought a False Claims Act lawsuit against her employer and related health care entities. She alleged that the defendants knowingly submitted false diagnosis codes to Medicare in order to receive payments to which they were not entitled.

The United States declined to intervene initially, meaning that Dr. Zafirov proceeded with the litigation as a private FCA relator.

Years into the litigation, the defendants attacked something much larger than the underlying fraud allegations:

They challenged the constitutionality of the False Claims Act’s qui tam system itself.

The defendants argued that permitting a private citizen to exercise federal enforcement authority in the name of the United States violates Article II of the Constitution.

The district court agreed with one of those arguments.

The District Court’s Landmark 2024 Decision

In 2024, U.S. District Judge Kathryn Kimball Mizelle concluded that the FCA’s qui tam provisions violated the Constitution’s Appointments Clause.

The constitutional problem, according to the district court, arose from the enormous authority exercised by a False Claims Act relator.

A relator can bring litigation in the name of the United States, select defendants, pursue discovery, litigate motions, and potentially prosecute a massive federal fraud case even after the Department of Justice declines to intervene.

The district court concluded that a relator exercising that authority qualified as an “Officer of the United States.”

That presented a constitutional problem.

Article II provides a specific mechanism for appointing federal officers. A False Claims Act relator is not appointed by the President, a court, or the head of a federal department.

Instead, the relator effectively assumes the position by filing a qui tam lawsuit.

The district court therefore concluded that the arrangement violated the Appointments Clause and dismissed Zafirov’s case.

The decision immediately attracted national attention because, if its reasoning ultimately prevailed, it could threaten one of the federal government’s most powerful fraud-enforcement mechanisms.

The Eleventh Circuit Disagrees: FCA Relators Are Not Federal Officers

On September 1, 2026, the Eleventh Circuit rejected the district court’s Appointments Clause analysis.

The appellate court focused on a fundamental requirement for determining whether someone qualifies as an “Officer of the United States.”

Under Supreme Court precedent, officer status requires more than the exercise of significant federal authority. The person must also occupy a “continuing position established by law.”

The Eleventh Circuit concluded that an FCA relator does not.

A relator’s role is tied to a particular lawsuit. The position is temporary and personal to the relator. The relator does not receive a continuing government salary or other continuing compensation, and the relator’s duties are not transferred to a successor who occupies an ongoing governmental office.

In short, the Eleventh Circuit rejected the concept that the False Claims Act creates a permanent governmental “office of relator.”

Because relators do not occupy a continuing governmental position, the court held that they are not “Officers of the United States” for purposes of the Appointments Clause.

Accordingly:

The False Claims Act’s qui tam provisions do not violate the Appointments Clause.

The Eleventh Circuit vacated the dismissal of Zafirov’s case.

The Eleventh Circuit Now Joins Other Federal Appeals Courts

The decision is also significant because the Eleventh Circuit joined the other federal appellate courts that have considered similar Appointments Clause challenges to False Claims Act relators.

The Fifth, Sixth, Ninth, and Tenth Circuits have previously rejected constitutional challenges based on the theory that FCA relators are improperly appointed federal officers.

The September 1 decision therefore does not create a circuit split on the Appointments Clause question.

Instead, the Eleventh Circuit has now aligned itself with the other circuits that have addressed that issue.

For False Claims Act defendants in Georgia, Florida, and Alabama, which comprise the Eleventh Circuit, the decision is particularly important.

At the appellate level, an argument that the ordinary FCA relator violates the Appointments Clause because the relator has not been constitutionally appointed now faces binding Eleventh Circuit precedent.

But Zafirov Is Not Over

This may be the most important part of the September 1 ruling.

The Eleventh Circuit did not resolve every constitutional challenge to the False Claims Act’s qui tam provisions.

The defendants originally raised three separate Article II arguments:

1. Appointments Clause — the relator allegedly acts as an unconstitutionally appointed federal officer;
2. Take Care Clause — allowing a private relator to prosecute federal claims allegedly interferes with the President’s constitutional obligation to “take Care that the Laws be faithfully executed”; and
3. Vesting Clause — permitting a private citizen to exercise federal enforcement authority allegedly conflicts with Article II’s vesting of executive power in the President.

The district court found an Appointments Clause violation and therefore did not reach the other two arguments.

The Eleventh Circuit reversed the Appointments Clause holding.

But instead of deciding the remaining constitutional questions itself, the appellate court remanded the case to the district court to consider the Take Care Clause and Vesting Clause challenges.

That means the constitutional litigation continues.

The Next Battle: Who Controls a Declined False Claims Act Case?

The unresolved issues go to the heart of the unusual structure of the False Claims Act.

The federal government unquestionably possesses authority to investigate and prosecute fraud against itself.

The more difficult constitutional question is what happens when the government declines to intervene and allows a private citizen to prosecute the government’s claim.

Under the False Claims Act, the government retains substantial statutory rights even after declining intervention.

But the private relator can nevertheless conduct extensive litigation in the name of the United States.

That raises a broader separation-of-powers question:

Does the Executive Branch retain sufficient control over litigation brought in the name of the United States when a private relator is actually prosecuting the case?

The district court will now have an opportunity to address that issue through the defendants’ remaining Take Care Clause and Vesting Clause arguments.

What Does the Decision Mean for False Claims Act Defendants?

For defendants, the immediate consequence is straightforward:

Qui tam False Claims Act litigation remains alive in the Eleventh Circuit.

Companies and individuals cannot currently obtain dismissal merely by arguing that an FCA relator is an improperly appointed “Officer of the United States.”

But defendants should not interpret Zafirov as eliminating every constitutional defense to qui tam litigation.

The Eleventh Circuit expressly remanded the case for consideration of the remaining Article II challenges.

Those issues may be particularly important in declined cases, where the Department of Justice has chosen not to intervene and the private relator is conducting the litigation.

The constitutional argument has therefore become narrower—but it has not disappeared.

Why Zafirov Matters So Much in Health Care Fraud Cases

The False Claims Act is especially significant in the health care industry.

FCA investigations and lawsuits frequently arise from allegations involving:

• Medicare billing;
• Medicaid billing;
• allegedly false diagnosis codes;
• medically unnecessary services;
• laboratory testing;
• genetic testing;
• durable medical equipment;
• improper physician referrals;
• Anti-Kickback Statute allegations;
• Stark Law issues;
• pharmaceutical arrangements;
• hospice and home health services;
• upcoding;
• false certifications; and
• allegedly improper reimbursement claims.

A whistleblower—often a current or former employee, physician, billing professional, executive, or business partner—can file a sealed qui tam complaint alleging that a health care provider caused false claims to be submitted to the government.

The Department of Justice then investigates and determines whether to intervene.

If DOJ declines, the relator may still be permitted to proceed.

Zafirov matters precisely because it challenges the constitutional legitimacy of that last scenario.

A Declined FCA Case Does Not Mean the Case Is Over

Health care providers sometimes misunderstand what it means when DOJ declines to intervene in a qui tam case.

Declination can certainly be an important development.

But it does not necessarily mean the lawsuit disappears.

The private relator may continue litigating the case on behalf of the United States.

And because False Claims Act liability can include treble damages and statutory penalties for individual violations, the financial exposure can become enormous.

That makes early defense strategy critical.

False Claims Act Cases Can Also Create Criminal Exposure

Companies and individuals facing FCA allegations should also recognize another important issue:

A civil False Claims Act investigation can overlap with a federal criminal investigation.

Allegations involving false Medicare claims, kickbacks, fabricated medical records, false certifications, medically unnecessary procedures, or fraudulent billing can potentially attract scrutiny from criminal investigators and prosecutors.

That may include agencies such as:

DOJ, FBI, HHS-OIG, DEA, or other federal investigative agencies.

For physicians and other licensed health care professionals, additional consequences can include licensing proceedings, Medicare or Medicaid exclusion, credentialing issues, hospital-privilege problems, and potential DEA consequences.

The civil and criminal strategies therefore should not be developed in isolation.

What Should You Do If You Receive an FCA Subpoena or Learn About a Qui Tam Investigation?

Do not assume that receiving a subpoena means the government has already decided that fraud occurred.

But do not treat it as a routine records request either.

An FCA investigation can involve years of billing data, medical records, emails, text messages, internal compliance materials, employee communications, financial records, and other evidence.

Early counsel can help determine:

What is the government actually investigating?

Is the investigation civil, criminal, or parallel?

Which billing practices or transactions are under scrutiny?

Who are the potential individual targets?

Is there a sealed qui tam complaint behind the investigation?

What evidence exists that contradicts the government’s theory?

Are the alleged false claims actually the product of reasonable medical judgment, coding disagreements, regulatory ambiguity, or mistake rather than knowing fraud?

Those distinctions can be critical under the False Claims Act.

Zafirov Preserves Qui Tam—for Now

The September 1, 2026 decision represents an important victory for the continued operation of the False Claims Act’s qui tam framework.

But it is not necessarily the final word on its constitutionality.

The Eleventh Circuit held that FCA relators are not “Officers of the United States” because they do not occupy continuing positions established by law. That defeats the Appointments Clause theory accepted by the district court.

But the court sent the case back for consideration of the defendants’ Take Care Clause and Vesting Clause challenges.

So the constitutional question has changed.

It has not disappeared.

For businesses, physicians, health care providers, executives, and other individuals facing False Claims Act allegations in Georgia and throughout the Eleventh Circuit, Zafirov is a decision worth watching closely.

Facing a False Claims Act Investigation? The Civil Case May Be Only Part of the Risk.

False Claims Act cases can expose companies and individuals to enormous financial liability.

For physicians, health care executives, and other professionals, the consequences can extend further—to criminal investigations, professional licenses, Medicare and Medicaid participation, DEA registration, credentialing, and professional reputation.

At Conaway & Strickler, P.C., we represent individuals and businesses facing complex federal investigations, health care fraud allegations, False Claims Act matters, and parallel civil and criminal proceedings.

If you have received a Civil Investigative Demand, federal subpoena, grand jury subpoena, search warrant, DOJ inquiry, HHS-OIG inquiry, or notice of a False Claims Act investigation, the time to evaluate the government’s allegations and potential exposure is before critical decisions are made.

Contact Conaway & Strickler, P.C. to discuss your False Claims Act or federal health care fraud matter.

Frequently Asked Questions About the Zafirov False Claims Act Decision

What did the Eleventh Circuit decide in Zafirov?

On September 1, 2026, the Eleventh Circuit held that False Claims Act relators are not “Officers of the United States” because they do not occupy a continuing position established by law. The court therefore held that the FCA’s qui tam provisions do not violate the Constitution’s Appointments Clause.

Did the Eleventh Circuit rule that the entire False Claims Act is constitutional?

No. The court resolved the Appointments Clause issue presented on appeal but remanded the case for the district court to consider the defendants’ remaining Take Care Clause and Vesting Clause arguments.

Was the False Claims Act struck down?

No. The Eleventh Circuit vacated the district court’s dismissal. Qui tam False Claims Act actions continue to be available in the Eleventh Circuit.

Does Zafirov apply in Georgia?

Yes. Decisions of the U.S. Court of Appeals for the Eleventh Circuit govern federal courts within Georgia, Florida, and Alabama.

What is a False Claims Act qui tam lawsuit?

A qui tam action allows a private person known as a “relator” to bring specified False Claims Act claims in the name of the United States. The government has an opportunity to investigate and decide whether to intervene in the litigation.

What happens when DOJ declines to intervene in a False Claims Act case?

Declination does not necessarily end the case. Subject to the FCA’s statutory framework, the relator may continue pursuing the action even though the federal government has declined to take over primary responsibility for litigating it.

Can a False Claims Act investigation become a criminal case?

Potentially. Conduct underlying FCA allegations may also be investigated under federal criminal statutes depending upon the facts. This is particularly important in health care fraud cases involving allegations of intentional false billing, kickbacks, fabricated records, or other allegedly fraudulent conduct.

What should a physician do after receiving an FCA subpoena?

Contact Conaway & Strickler, PC. We are experienced with federal investigations and we work with you before providing substantive explanations concerning the allegations. We determine whether the matter is civil, criminal, or parallel and evaluate potential professional consequences in addition to the FCA exposure.

Is the constitutional challenge to FCA whistleblower lawsuits over?

Not necessarily. Although the Eleventh Circuit rejected the Appointments Clause challenge in Zafirov, it remanded for consideration of the defendants’ separate Take Care Clause and Vesting Clause arguments.

A physician facing criminal allegations may find themselves dealing with two separate proceedings:

The criminal case AND a Georgia Composite Medical Board matter.

Those proceedings operate under different rules, serve different purposes, and can create very different consequences.

For a Georgia physician, successfully defending the criminal case is critically important—but protecting the medical license may require a coordinated strategy from the beginning.

Does an Arrest Automatically Cause a Georgia Doctor to Lose Their Medical License?

No.

An arrest is an allegation. It is not a conviction and does not establish that the physician committed the alleged offense.

A physician should therefore not assume that being arrested automatically results in suspension or revocation of a Georgia medical license.

But the analysis does not end there.

The Georgia Composite Medical Board has broad regulatory authority over physicians, and criminal allegations can potentially lead to Board scrutiny or investigation depending upon the circumstances.

The Board identifies criminal violations among matters that can warrant formal investigation.

The important distinction is:

An arrest does not automatically equal license discipline—but a criminal case can create a separate licensing problem.

Can the Georgia Medical Board Investigate a Doctor Before the Criminal Case Is Over?

Potentially, yes.

A Medical Board proceeding does not necessarily have to follow the same timeline as the criminal prosecution.

That creates a difficult strategic situation.

The physician may simultaneously have Conaway & Strickler, PC assist with:

prosecutors, agents and investigators and also the the licensing matter requiring interaction with the Georgia Composite Medical Board.

Those proceedings should be coordinated carefully.

Be Careful About Explaining the Arrest to the Medical Board

Physicians are trained to document, explain, and solve problems. After an arrest, that instinct can sometimes create additional risk.

A doctor may want to immediately write a detailed explanation establishing why the allegations are wrong.

That explanation could become important.

But when a criminal investigation or prosecution remains pending, counsel should consider how substantive statements concerning the allegations could affect the criminal case.

The physician may have constitutional protections in the criminal proceeding that do not translate neatly into a professional licensing investigation.

A statement intended to save the medical license should not inadvertently damage the criminal defense.

This is one of the strongest reasons for retaining counsel early on.

What Can the Georgia Medical Board Do?

The consequences of a Board proceeding depend upon the facts, applicable law, and procedural posture.

Potential professional consequences can include conditions or restrictions on practice, probation, suspension, surrender, revocation, and other disciplinary or remedial action authorized by Georgia law.

Not every complaint or investigation results in public discipline.

But once a matter develops into formal public disciplinary action, the consequences may extend beyond the Georgia license itself.

Public discipline can potentially affect credentialing, employment, hospital privileges, other state licenses, malpractice coverage, and future professional opportunities.

Can the Medical Board Act While Criminal Charges Are Still Pending?

The existence of an unresolved criminal case does not necessarily mean that licensing issues must remain frozen until the prosecution ends.

The Georgia Composite Medical Board’s published orders demonstrate that interim restrictions can arise while criminal charges remain pending.

That does not mean that every physician who is arrested will have their license suspended.

The nature of the allegations matters enormously.

A criminal allegation involving medical practice, patient safety, controlled substances, fraud, dishonesty, impairment, or other conduct directly connected to professional responsibilities may present different licensing issues from an unrelated allegation.

The individual facts matter.

What Types of Criminal Charges Can Create Medical-License Problems?

There is no single category of criminal charge that automatically determines the outcome of a Georgia licensing matter.

But allegations that can raise significant professional concerns include:

• health care fraud;
• Medicare or Medicaid fraud;
• unlawful prescribing;
• controlled-substance diversion;
• prescription fraud;
• theft or embezzlement;
• false statements and fraud offenses;
• patient abuse or neglect;
• sexual offenses;
• criminal allegations involving patients;
• offenses allegedly committed through the medical practice; and
• substance-related allegations that raise questions concerning professional practice or patient safety.

The connection between the alleged conduct and the practice of medicine may be particularly important.

What About a DUI Arrest?

A DUI arrest should not automatically be equated with loss of a medical license.

But depending upon the circumstances, a DUI or other substance-related case can raise issues extending beyond the traffic or criminal proceeding.

For example, facts suggesting impairment in connection with patient care or a broader professional-practice issue could create different concerns from an isolated allegation unrelated to medical practice.

The individual circumstances should be evaluated rather than assuming that every DUI produces the same licensing result.

What If the Criminal Charges Are Dismissed?

A dismissal is obviously significant to the criminal case, but physicians should not automatically assume that every licensing issue disappears solely because prosecutors dismiss the charge.

The criminal justice system and professional licensing system apply different procedures and standards.

Conversely, an arrest or allegation should not be treated as proof of professional misconduct merely because it occurred.

Counsel should determine whether a licensing investigation exists and, if so, what steps are necessary to bring it to a favorable conclusion after the criminal matter is resolved.

A Plea Agreement Must Be Reviewed for Medical-License Consequences

This is one of the most important considerations for a physician charged with a crime.

Imagine that the prosecutor offers:

No jail. Reduced charge. Probation. Case closed.

For some clients, that might sound like an excellent resolution.

A physician needs to ask another question:

“What does this plea do to my medical license?”

The exact offense, statutory language, factual basis, plea terminology, and ultimate disposition can potentially affect professional consequences.

The answer should be investigated before the physician enters the plea.

Once a plea has been entered and sentence imposed, attempting to undo an unexpected professional consequence can be considerably more difficult.

Could Medical Board Discipline Affect Hospital Privileges?

Potentially.

A licensing action can create consequences outside the Medical Board proceeding itself.

Hospitals, employers, insurers, and credentialing organizations may have disclosure requirements concerning disciplinary actions.

Certain adverse professional actions may also implicate reporting requirements involving the National Practitioner Data Bank.

This creates a potential domino effect:

Criminal case → licensing proceeding → professional discipline → credentialing or privileges issues.

Avoiding or minimizing that cascade requires thinking several steps ahead. It is important to divulge the arrest and surrounding circumstances on all applications for renewal. Conaway & Strickler, PC can assist with these applications.

What Should a Georgia Doctor Do Immediately After an Arrest?

First, do not assume the criminal case and medical license are separate problems that can be addressed independently.

Before making substantive statements concerning the allegations, the physician should determine what criminal, licensing, employment, credentialing, and reporting obligations may apply.

Physicians should also preserve relevant records and communications and should never alter medical records, create misleading retrospective documentation, destroy evidence, or attempt to influence potential witnesses.

And before accepting any criminal disposition, the physician should understand what that resolution may mean for the medical license.

The Goal Is to Protect Both the Criminal Case and the Medical Career

A physician facing criminal charges has often invested more than a decade in education and training before beginning independent practice.

The consequences of a criminal case therefore cannot be measured solely by the potential sentence.

At Conaway & Strickler, P.C., we understand that representing a physician requires looking beyond the criminal courtroom.

When a Georgia doctor is arrested or placed under investigation, the defense strategy should consider:

the criminal allegations, the Georgia medical license, DEA registration where applicable, hospital privileges, credentialing, federal health care program participation, and the potential long-term impact on the physician’s career.

Georgia Doctor Arrested or Under Investigation? Talk to Counsel Before You Talk to Anyone Else About the Allegations.

If you are a Georgia physician who has been arrested, charged with a crime, contacted by law enforcement, served with a subpoena, or learned that you are under criminal investigation, do not wait until the criminal case is resolved to determine what it means for your medical license.

The decisions made early in the case can affect both proceedings.

Conaway & Strickler, P.C. represents physicians and other professionals facing serious state and federal criminal investigations and prosecutions in Georgia.

If your freedom, medical license, professional reputation, and career are at stake, the defense needs to account for all of them.

Contact Conaway & Strickler, P.C. to discuss the criminal case and the potential consequences for your Georgia medical license before making decisions that may be difficult—or impossible—to reverse.

Frequently Asked Questions About Georgia Medical Licenses and Criminal Charges

Does an arrest automatically cause a Georgia doctor to lose their medical license?

No. An arrest is not a conviction and should not be treated as an automatic license revocation. Criminal allegations can, however, potentially lead to investigation or other action by the Georgia Composite Medical Board depending upon the circumstances.

Can the Georgia Medical Board investigate a physician while criminal charges are pending?

A licensing matter can potentially proceed while a criminal matter remains unresolved. This makes coordination between the criminal-defense and licensing strategies particularly important.

Should I respond to the Medical Board without a lawyer if criminal charges are pending?

A physician should consider obtaining legal advice before making substantive statements about allegations that are also the subject of an active criminal investigation or prosecution. Statements made in one proceeding can potentially have consequences in another.

Can a felony conviction affect a Georgia medical license?

Yes. A felony conviction can have significant professional-licensing consequences. The specific consequences depend upon the offense, facts, applicable Georgia law, and action taken by the Georgia Composite Medical Board.

Will a DUI cause a Georgia physician to lose their medical license?

A DUI arrest does not automatically mean a physician will lose a medical license. The particular circumstances, including whether the allegations implicate professional practice or patient safety, can matter.

What happens if the criminal charges against the doctor are dismissed?

Dismissal of the criminal charge is highly significant but does not necessarily answer every question in a separate licensing proceeding. If a Board investigation has already begun, counsel should determine what remains necessary to resolve it.

Should a physician consider medical-license consequences before accepting a plea?

Absolutely. A proposed plea should be analyzed for licensing and other professional consequences before it is entered. A resolution that appears favorable from a sentencing perspective may have separate consequences for a physician’s career.

A doctor facing criminal allegations may also have to worry about hospital privileges, DEA registration, employment, credentialing, Medicare and Medicaid participation, the National Practitioner Data Bank, malpractice insurance, and professional reputation, among other issues.

And some of those problems can develop before the criminal case is over.

At Conaway & Strickler, P.C., we represent professionals facing serious state and federal criminal investigations and prosecutions. When the client is a physician, criminal defense requires understanding something prosecutors may not be focused on:

The way a criminal case is resolved can affect the physician’s ability to practice medicine for years to come.

An Arrest Is Not a Conviction

Being arrested does not mean a physician is guilty.

Charges can be dismissed. Evidence can be suppressed. Prosecutors can decline prosecution. Charges can be reduced. Cases can end without a traditional conviction.

But physicians are different from many criminal defendants because their careers are regulated by numerous entities outside the criminal justice system.

A criminal matter may potentially implicate the Georgia Composite Medical Board, DEA, hospitals, employers, credentialing organizations, Medicare and Medicaid, HHS-OIG, malpractice insurers, and the National Practitioner Data Bank.

That makes it essential to investigate collateral consequences before resolving the criminal case.

The Plea That Avoids Jail Could Still Damage a Medical Career

For some clients, a plea offer involving probation and no incarceration may appear extremely favorable.

But for a physician, that is not necessarily the end of the analysis.

The exact offense of conviction, factual basis for the plea, and form of disposition can potentially determine whether other professional consequences follow.

One particularly important example involves the National Practitioner Data Bank.

For qualifying health-care-related offenses, federal NPDB rules use a definition of “conviction” that can encompass guilty and nolo contendere pleas as well as certain deferred-adjudication and first-offender arrangements in which judgment has been withheld.

That means:

“You won’t have a traditional conviction on your record” does not necessarily mean “this disposition won’t affect your medical career.”

The professional consequences should be analyzed before the plea is entered.

DEA Registration Can Become a Separate Problem

Criminal cases involving controlled substances create another level of risk for physicians.

Physicians who prescribe controlled substances generally depend upon DEA registration in addition to their state authority.

Federal law gives DEA authority to pursue suspension or revocation of registration on specified grounds, including certain felony controlled-substance convictions and loss of state authority to handle controlled substances. If you receive an Order to Show Cause and Immediate Suspension of Registration, it is imperative to seek legal counsel immediately.

This can be particularly important in cases involving allegations of:

unlawful prescribing, diversion, prescription fraud, controlled substances, pill mills, Schedule II medications, or improper distribution.

For physicians whose specialties depend heavily upon prescribing authority, a DEA problem can make continued practice extremely difficult even if the criminal sentence itself is relatively limited.

Medicare and Medicaid Exclusion Can Be Devastating

Certain criminal convictions can result in exclusion from federal health care programs.

HHS-OIG has mandatory exclusion authority for specified offenses, including certain Medicare and Medicaid fraud offenses, felony health care fraud offenses, patient abuse or neglect offenses, and felony controlled-substance offenses.

Several categories carry a minimum five-year exclusion period.

Other criminal offenses may create grounds for permissive exclusion.

The consequences can extend far beyond a physician’s ability to submit a Medicare claim personally. Federal exclusion rules can prohibit federal health care program payment for services furnished, ordered, or prescribed by an excluded physician.

For physicians whose practices depend on federal health care program reimbursement, exclusion can threaten the economic viability of the practice.

Hospital Privileges and Credentialing May Also Be Affected

Hospitals, medical groups, insurers, and credentialing organizations maintain their own rules concerning criminal matters.

The actual language matters.

There is a significant difference between a policy requiring disclosure of:

an arrest; criminal charges; an indictment; a conviction; or disciplinary action against a medical license.

A physician should not assume either that disclosure is required or that nothing needs to be disclosed.

Conaway & Strickler, PC can assist in reviewing the applicable hospital bylaws, employment agreements, medical-staff policies, credentialing applications, and insurance agreements.

The National Practitioner Data Bank Can Follow a Physician for Years

Certain licensing actions, clinical-privilege actions, exclusions, and health-care-related criminal convictions can be reported to the National Practitioner Data Bank.

An arrest alone is not the same thing as an NPDB criminal-conviction report.

But what happens after the arrest may create a reportable event.

That distinction makes the structure of the ultimate criminal disposition particularly important.

Federal Physician Investigations Often Begin Before an Arrest

Many federal investigations involving physicians begin quietly.

The first indication may be:

• an FBI or DEA interview request;
• an HHS-OIG inquiry;
• a grand jury subpoena;
• a search warrant;
• seizure of electronic devices;
• interviews of employees;
• requests for medical or billing records; or
• a federal target letter.

A physician does not need to wait for an indictment to retain criminal defense counsel.

The pre-indictment period may provide important opportunities to investigate the allegations, preserve favorable evidence, communicate with prosecutors, and identify professional consequences before the case reaches a critical stage.

Physicians Need a Criminal Defense Strategy Designed for Physicians

Medical school. Residency. Fellowship. Board certification. Hospital privileges. DEA registration. A medical practice. Patients.

A physician may have spent decades building a career before a criminal investigation begins.

The defense strategy therefore cannot be limited to:

“How do we keep you out of jail?”

It should also ask:

Can we prevent charges from being filed?

Can the charge be dismissed or defeated?

Is it possible for negotiaion on the wording of the offense or factual basis to reduce collateral consequences?

Could the resolution affect DEA registration?

Could it result in federal health care program exclusion?

Is there an NPDB consequence?

Could it affect hospital privileges or credentialing?

And, critically:

What does it mean for the physician’s Georgia medical license?

That last issue deserves its own analysis. See our related article: Can a Georgia Doctor Lose Their Medical License if Arrested

Georgia Physician Under Investigation? Protect Your Career Before Making Irreversible Decisions.

If you are a physician who has been arrested, indicted, subpoenaed, contacted by federal agents, served with a search warrant, or informed that you are under investigation, obtaining counsel early can matter.

At Conaway & Strickler, P.C., we represent professionals in serious state and federal criminal matters and understand that physicians have professional consequences at stake beyond the criminal courtroom.

Before speaking to your employer or an investigator, or answering a subpoena, it is very important to understand both the criminal and collateral consequences.

Contact Conaway & Strickler, P.C. to discuss your case and the steps that may be available to protect your freedom, your reputation, and your medical career.

The Numbers

The 2026 Takedown did not match last year’s record numbers.  But, 455 defendants, including 90 doctors and other licensed medical professionals were charged.  The coordinated enforcement involved a “whole of government” approach which included:

• Actions by the Centers for Medicare and Medicaid Services (CMS) to suspend 1,079 providers and revoke billing privileges for 1,403 providers.
• 48 Civil Monetary Payment settlements amounting to over $73 million, over 1,400 provider exclusions, and 25 actions by the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”) under the Civil Monetary Penalties Law seeking more than $10 billion in payments to the Medicare Trust Fund from payments that CMS caught and suspended before the funds were paid to the fraudulent providers.
• Civil charges against 13 defendants for $14.8 million in health care fraud schemes, as well as civil settlements with 31 defendants totaling $23 million.
• 928 administrative cases by the Drug Enforcement Administration (DEA) seeking the revocation of authority to handle and/or prescribe controlled substances since October 1, 2025.

Increased “Whole of Government” approach

The government has always used multiple agencies in its efforts to combat fraud.  But the DOJ has now stated they are using “cutting-edge use of data analytics to target the worst actors”, including employing advanced data analytics through its Data Fusion Center. The DOJ is now working to ensure coordination with asset seizure, civil remedies, administrative actions, and payment-policy changes.  As a result, a single health care fraud investigation may now include parallel criminal, civil, administrative, exclusion, payment-suspension, and licensing consequences.  Conaway & Strickler, PC routinely handles licensing and regulatory issues as well as fighting False Claims Act issues at the civil and criminal level.  

Creation of the National Fraud Enforcement Division (“NFED”) 

NFED may be the clearest sign of this whole of government approach.  According to the April, 2026 DOJ memorandum, the NFED’s mission is to “zealously investigate and prosecute” fraud involving taxpayer dollars.  The 2026 Takedown appears to be NFED’s first major public health care fraud press release.

TRENDS: Healthcare Fraud in Allografts

Allografts and skin grafts cases have risen significantly from an emerging issue to front-line enforcement target.

The allograft cases are important to note because they clearly show what a healthcare investigation looks like in 2026.  The DOJ uses their data driven investigatory prowess to detect high reimbursement, aggressive marketing, alleged kickbacks, vulnerable patients, questionable medical necessity, and patient harm. In the press release for 2026, the DOJ charged 11 defendants in schemes involving allografts, and the press release described Medicare payments for allografts rising sharply before CMS adjusted payment rates.  

DOJ’s theory here is like the cancer genetic cases.  Both the allograft and CGx cases show a high payment for the claim which is an area that created an opportunity for fraud, according to the DOJ.  The 2026 Takedown shows how data analysis has moved to the forefront of their investigations. They comb through all the claims, match it with financial tracing and draw conclusions from there.

Thoughts for Health Care Companies

The 2026 Takedown reinforces that health care fraud enforcement is here to stay. As discussed above, the government investigations are becoming more coordinated, targeted and more focused on the numbers. 

It is important therefore to respond accordingly and be sure all documentation necessary is on hand before any type of inquiry occurs.  

Conaway & Strickler, PC has a deep understanding of these kinds of cases.  Sometimes, prompt disclosure and cooperation is the route to take and sometimes combatting the allegations is the route to take. We continue to monitor enforcement actions to remain aware of all of the newest developments.  Contact us for more information or for assistance.

Although it is not required, having an attorney assist you in physician license defense usually helps you achieve a better outcome than if you were on your own.

WHAT CAN AN ATTORNEY DO TO ASSIST?

If you have had an arrest for any crime, it is important to consult with an attorney to understand your duties to inform the Georgia Composite Medical Board. You may need to immediately self report if the arrest involved substance abuse or moral turpitude issues. How and when you communicate with the Board is crucial to your future success in maintaining your license.

In addition, when it comes time to renewal, you must answer the question about any interactions with law enforcement with a YES and attach a narrative. Again, having an attorney assist you with any and all communications with the Composite Board will help your ultimate success in maintaining your license as a physician.

WHAT IF MY LICENSE IS UNDER INVESTIGATION?

If you have been notified by the Georgia Composite Medical Board that you are under investigation, you should immediately contact an experienced health care physician license defense lawyer. We can assist you in all communications with the Board so that you don’t make any statements or submit any documents that could inadvertently hurt you. You will also need to contact your malpractice insurance carrier right away and be sure to document everything involved in what is alleged in the allegations.

WHAT IF I AM ASKED TO SURRENDER MY DEA REGISTRATION?

Has your clinic been subject to a search warrant? At the time of the execution of the search warrant, did one of the agents ask you to voluntarily surrender your DEA registration? You need to consult an attorney immediately not only because a search warrant was executed on your clinic, but, also because there are long term effects of surrendering your DEA registration. Submitting a DEA Form 104 (“Voluntary Surrender of Controlled Substances Registration”) without legal advice is not a good idea. Voluntary surrenders are also typically reported to the National Practitioner Data Bank (NPBD).

WHAT IS THE NPBD?

The National Practitioner Data Bank was created by Congress in 1986 in order to prevent practitioners with histories of misconduct or incompetence from moving state to state without disclosure. Hospitals, state boards, malpractice insurers, and federal agencies are now legally required to report certain actions. There is an online guidebook that provides details on what specific actions are reported. Most importantly, any and all adverse restrictions or surrenders of privileges and adverse state licensing actions are reported.

Contact us immediately so that we can answer all of your questions and so that we can assist you in properly defend ing your physician license defense.

Conaway & Strickler, PC has over 3 decades of experience assisting nurses whose professional licenses are threatened by allegations of misconduct. If you receive a notification from the Board about an issue with your license, contact us immediately. We are here to help.

Here are a few situations that Conaway & Strickler, PC has experience in when handling issues before the Georgia Board of Nursing, many of which involve issues of moral turpitude.

*If you have been arrested for a DUI, it is very important to notify the Georgia Board of Nursing immediately. It is always a good idea to have an attorney notify them for you. This is because the Board will respond with additional questions that include requesting a narrative of the DUI incident. You will also have to tell the Board when you renew your license, which is every two years. On the renewal application, it will say, “Were you charged with a crime?” and you’ll have to list your DUI charge there. Also, the DUI arrest can ultimately turn in to a private consent order requiring you to do drug/alcohol treatment and counseling, among other things.
*If you have been accused of diverting medications by your employer, you need to let the Board know. Like a DUI, this is something that needs to be addressed immediately as a way to mitigate issues with the board in addition to potential imminent criminal charges.
*If you have been accused of falsifying patient records, or billing issues with an employer or Medicare/Medicaid, you need to let the Board know immediately.
*If you have been accused of inappropriate sexual relationships with patients or sexually harassing colleagues, you need to let the Board know immediately.
*If you you have been accused of neglect or abuse of a patient, this can be seen as an issue of moral turpitude and also may require you to contact the Board immediately.

Here is a list of additional issues that requires mandated reporting:

*Practicing nursing as a registered nurse, an advanced practice registered nurse, or a licensed practical nurse, without a valid, current license;
*Practicing nursing as a registered nurse, an advanced practice registered nurse, or a licensed practical nurse under cover of any diploma, license, or record illegally or fraudulently obtained, signed, or issued;
*Practicing nursing as a registered nurse, an advanced practice registered nurse, or a licensed practical nurse during the time the applicable license is suspended, revoked, surrendered, or lapsed (administratively revoked) for failure to renew;
*Using any words, abbreviations, figures, letters, title, sign, card, or device implying that such person is a registered nurse, an advanced practice registered nurse, or a licensed practical nurse unless such person is duly licensed or recognized by the Georgia Board of Nursing to practice as such under the provisions of Nurse Practice Act;
*Fraudulently furnishing a license to practice nursing as a registered nurse, an advanced practice registered nurse, or a licensed practical nurse;
*Knowingly aiding or abetting any person in violating the Nurse Practice Act;
*Conviction of any felony, crime involving moral turpitude, or crime violating a federal or state law relating to controlled substances or dangerous drugs in the courts of this state, any other state, territory, or country, or in the courts of the United States, including, but not limited to, a plea of nolo contendere entered to the charge; or
*Currently or previously displaying an inability to practice nursing as a registered nurse, an advanced practice registered nurse, a licensed undergraduate nurse, or a licensed practical nurse with reasonable skill and safety due to use of alcohol, drugs, narcotics, or chemicals.

Contact us should you have any questions on how to deal with the Georgia Board of Nursing.

Over the past three decades, Conaway & Strickler, PC has represented physicians, nurses, dentists, CPAs, chiropractors, financial advisors, educators, lawyers, and many others. The list of licenses for the state of Georgia shows how many professionals rely on licensure for their livelihood. We provide strong defenses to protect your professional license and preserve your reputation and career longevity.

It is important to contact Conaway & Strickler, PC very early on so that we can make strategic steps to protect your livelihood. For example, a physician who is facing allegations of misconduct may face suspension, probation or revocation. It is important to have experienced legal counsel to effectively navigate these uncertain waters.

Here is a list of the top 10 of the Most Common Disciplinary Actions Against Healthcare Professionals published recently by GCMB. It helps explain some common pitfalls and responsibilities outlined by
the GCMB.

If you are facing any issues with your professional license, we are here to help.

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.

In “Operation Gold Rush,” prosecutors in the Eastern District of New York indicted 11 defendants, including two pharmacists, members of a transnational criminal organization based in Russia and Eastern Europe. These individuals allegedly orchestrated a massive Medicare fraud and money-laundering scheme that billed over $10.6 billion to federal health programs—making it the largest case by loss amount ever charged by the DOJ. The group used foreign straw owners to acquire dozens of U.S.-based DME suppliers, then submitted fraudulent claims for equipment such as urinary catheters and glucose monitors that never delivered, exploiting stolen identities and confidential patient data. To date, 19 defendants have been charged in the case, including multiple arrests abroad (Estonia) and at U.S. entry points.

COVID-19 Testing Kickbacks

COVID-19 testing kickback schemes typically involve health care providers or marketers billing Medicare for over-the-counter or lab-based COVID-19 tests that were unnecessary, never provided, or obtained through illicit referrals. These cases often rely on the same core tactics as DME fraud: using stolen or misused patient information, paying illegal kickbacks for referrals, and submitting inflated or false claims to federal programs. In both types of fraud, the perpetrators exploit gaps in oversight during high-demand periods—such as the pandemic or public health emergencies—to rapidly bill large amounts to Medicare, often with little or no patient interaction or verification.

These 2025 takedown includes criminal indictments and civil settlement agreements targeting this type of COVID-19 fraud. An indictment out of Illinois charged multiple individuals, including a physician, for their roles in a kickback scheme. According to the indictment, the defendants caused laboratories in Illinois and Texas to submit fraudulent claims to the HRSA COVID-19 Uninsured Program, ultimately receiving over $293 million in payments. The physician involved allegedly misused patient information—including data from a former hospital employer—to falsely claim that uninsured individuals had submitted samples for COVID-19 testing. In reality, many of the patients had not submitted samples at all. Defendants submitted claims through Texas labs they owned, despite those labs being non-operational. The proceeds were then laundered through various financial accounts to disguise the funds’ origin. Charges include wire fraud, conspiracy to commit money laundering, HIPAA violations, and conspiracy to defraud the United States. Authorities have seized a Rolls Royce Phantom and more than $104 million in assets linked to the fraud.

The charges being brought by the federal government in these cases carry significant criminal penalties and collateral consequences, especially for licensed medical professionals. At Conaway & Strickler, we are highly experienced in defending against these types of claims. Contact us to schedule a consultation and discuss your case.

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.
• Civil charges and settlements: In addition to criminal charges being levied, law enforcement has also sought civil penalties from other providers and medical professionals. This includes civil charges against 20 defendants for $14.2 million in alleged fraud, as well as civil settlements with 106 defendants totaling $34.3 million.
• Transnational criminal networks: A major component—Operation Gold Rush—alleges a global ring used foreign straw owners to submit $10.6 billion in false claims for durable medical equipment. Though CMS blocked all but ~$41 million in Medicare payouts, insurers received about $900  Individuals abroad and co-conspirators in the U.S. used encrypted messaging and assumed identities to facilitate the purchase of medical supply companies and subsequent fraud by exploiting the stolen identities of over one million Americans spanning all 50 states and using their confidential medical information to submit the fraudulent claims.
• Telemarketing/genetic testing schemes: One $703 million scheme involved deceptive telemarketing, AI-generated “consent” calls, and stolen Medicare IDs—all to bill labs and DME suppliers
• Wound-care fraud on vulnerable patients: Roughly $1.1 billion in fraudulent Medicare submissions for amniotic allografts were applied to terminally‑ill or hospice patients, without medical need or oversight
• Opioid prescription diversion: 74 defendants, including 44 medical professionals, are accused of diverting over 15 million pills (e.g., oxycodone, hydrocodone), feeding the illegal drug trade
• Genetic testing & telemedicine: At least 49 defendants were tied to over $1.17 billion in telemedicine/genetic testing fraud, a key enforcement focus of the Takedown.

These are just some of the schemes and methods alleged as health care fraud. Additional cases totaling approximately $1.84 billion involved medically unnecessary tests and treatments, kickbacks, and stolen controlled substances. DOJ’s Health Care Fraud Unit, along with FBI, HHS‑OIG, DEA, CMS, and state AGs, led this nationwide operation. The Government was able to leverage cloud computing, artificial intelligence, and advanced analytics to identify emerging health care fraud schemes. Specifically, a new Data Fusion Center used AI to spot suspicious billing patterns

Professionals in the medical industry could face disruptions based on these trends. Individuals could be criminally indicted despite a lack of financial gain for any peripheral involvement in these schemes. With over 205 providers with billing privileges already suspended or revoked, firms must evaluate billing practices and ensure compliance before audits or criminal actions escalate. Medical professionals and individuals in the industry should be proactive in address any potential problems. Assessing practices through comprehensive billing audits, tightening consent documentation and patient qualification protocols, and reviewing prescribing practices are key to ensuring compliance.

Given the unprecedented scope of this takedown, anyone involved in Medicare/Medicaid billing—especially in telemedicine, genetic testing, wound care, DME supply, opioid prescribing—should evaluate their practices now. Protecting your license, assets, and reputation hinges on early legal counsel, transparent operations, and robust documentation. Upon any contact from law enforcement, individuals should secure legal counsel immediately. The presumption of innocence matters, and charges are allegations—not convictions. Early intervention and strong representation can shift outcomes. Medical providers should document everything diligently. Medical necessity, patient consent, referrals, and codes must be in writing and defensible.

Even if charges carry potential fines or incarceration, negotiated resolutions mitigating those consequences are viable. At Conaway & Strickler, we are highly experienced in federal health care fraud cases. Contact us to discuss your situation confidentially—we’re here to protect your rights and your future.

• Wire fraud
• Mail fraud
• Bank fraud
• Tax fraud (tax evasion or false statements)
• Healthcare fraud/FCA
• Medicare/Medicaid fraud
• PPP loan or COVID relief fraud
• Securities fraud
• Mortgage fraud
• Immigration or visa fraud
• Government contract fraud
• Identity theft or benefits fraud
• Trafficking in Counterfeit Goods or Services
• Anti kickbacks
• AML

The FBI gives this list of frauds and the DOJ publishes some of their cases here.

Fraud investigations can begin in a number of ways. In many cases, they are triggered by:

• A whistleblower or former employee
• A suspicious activity report
• A suspicious activity report (SAR) from a bank or financial institution
• Data flagged by automated fraud detection software
• A referral from another federal agency (e.g., IRS, SBA, USPS, HHS)
• A civil audit or regulatory review that uncovers irregularities
• Investigative journalism or public tips
• Problems in real estate transactions.  (FINCEN’s new rule extends Anti-Money Laundering (AML) and Countering the Financing of Terrorism (CFT) obligations to investment advisers involved in these transactions)

Once red flags are detected, the matter is referred to a federal investigative agency. These can include:

• Federal Bureau of Investigation (FBI)
• Internal Revenue Service – Criminal Investigation (IRS-CI)
• Office of Inspector General (OIG)
• Postal Inspection Service (USPIS)
• Securities and Exchange Commission (SEC)
• Health and Human Services (HHS)
• Small Business Administration (SBA)

If you have been contacted by federal agents FOR ANY REASON, contact a federal criminal defense attorney immediately.  Do not speak period.  If you have received a grand jury subpoena, contact a federal criminal defense attorney immediately.  If you have received a target letter, contact a federal criminal defense attorney immediately.  If you are being audited by the IRS, SBA, HHS or another agency, contact a federal criminal defense attorney immediately. It never hurts in this  last instance to have sage advice before the investigation goes any further.

At Conaway & Strickler, PC, we are here to help. Contact us to discuss your options.

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:

• False Claims Act (31 U.S.C. §§ 3729-3733)
• Anti-Kickback Statute (42 U.S.C. §§ 1320a-7b(b))
• Physician Self-Referral (Stark Law).
• Exclusion Statute (42 U.S.C. § 1320a-7).
• Civil Monetary Penalties Law (42 U.S.C. § 1320a-7a).

These laws aim to prevent improper billing practices and financial incentives that could compromise patient care. These laws further grant powerful enforcement tools to federal agencies to penalize violations, ranging from civil fines to criminal charges.

The government can audit claims and investigate providers when there is a reason to suspect fraud. Unusual billing patterns or reports from others, including staff, competitors, and patients, may raise suspicion of fraud and abuse. If you’re a doctor who bills government healthcare programs, compliance with these rules and procedures is critical, as violations can lead to severe legal consequences.

One of the most critical aspects of government payer compliance is coding and billing insurers accurately for services rendered. Physicians may inadvertently engage in practices that violate federal billing regulations. Common billing violations include:

• Upcoding: Billing for more expensive services than those actually provided.
• Unbundling: Separately billing services that are typically bundled together.​
• Unnecessary Services: Providing services that are not medically necessary to increase reimbursement.​
• Kickbacks: Receiving or offering remuneration for patient referrals.
• Billing for services that an improperly supervised or unqualified employee performed.

In addition to maintaining compliance with billing regulations, these laws set forth requirements for maintaining accurate patient records, protecting patient privacy, and more.

Given the complexity and severity of potential penalties, healthcare professionals who find themselves under federal scrutiny for billing practices should seek the counsel of a federal criminal defense attorney as soon as possible. Physicians must be vigilant in adhering to federal billing regulations to avoid severe legal consequences. Understanding the legal framework and implementing proactive measures can safeguard against inadvertent violations and protect your practice’s integrity. Contact us to schedule a consultation.

Experienced federal criminal defense attorneys like those at Conaway & Strickler, PC may suggest early on about the possibility of entering into a “deferred prosecution agreement” which is essentially a contract with the Department of Justice. DPAs are frequently used in cases involving corporate fraud, bribery, and antitrust violations.  These pretrial agreements may involve an admission of wrongdoing, the payment of fines, and the implementation of compliance measures.  Charges may be dropped if the defendant complies with the requirements of the agreement.  Generally, the Assistant United States Attorney will file the criminal complaint and the DPA with the court, so it is of public record. This will be accompanied by a formal request to the court that any prosecution be delayed according to the terms of the DPA, allowing the defendant to fulfill its agreed-upon actions.  This is very similar to conditional discharge / pre trial diversion agreements found at the state level.

An example of a DPA would be one that was entered in to by the DOJ and Teva Pharmaceuticals USA, Inc in August 2023 in response to the company’s involvement in a price fixing conspiracy involving several pharmaceuticals.   As seen in this example, terms can include paying a fine, waiving certain rights, agreeing to a factual basis for the charges, and an agreement to cooperate and compliance monitoring and of course, agreeing to what will happen if there is a breach of the agreement.

The central benefit to entering in to a DPA is that the individual or business entity is not convicted of any crime. It offers an opportunity to have the federal criminal charges dismissed or dropped once the accused completes all the required conditions.

Here is an another example of a DPA entered in to with the NDGA and Avanir Pharmaceuticals.  This pharmaceutical manufacturer based in Aliso Viejo, California, was charged for paying kickbacks to a physician to induce prescriptions of its drug Nuedexta.   Of note in that case – the Northern District of Ohio indicted four individuals, including former Avanir employees and one of the top prescribers of Nuedexta in the country, who were involved in the kickback scheme.  So, the company itself entered in to a DPA but there was still fall out with respect to some individuals and receiving criminal indictments.

Early intervention is key in a successful resolution in health care criminal matters.  We have extensively blogged about health care fraud.   Contact us if you need an experienced federal criminal defense litigator.  Our firm has vast experience in white collar criminal investigations including False Claims Act and antitrust investigations.

1. NPDB Reports. Licensing boards are generally required to report such these informal agreements involving physicians to the National Practitioners Data Bank (“NPDB”). (See45 CFR § 60.8). Hospitals and other entities are required or permitted to check the NPDB during the physician credentialing process. An NPDB report can permanently tarnish a physician’s record and career, unless it is removed, and it may also result in the additional actions outlined below.
2. Reciprocal Actions by Other State Licensing Boards. Many if not all state licensing boards automatically impose reciprocal sanctions against providers who were sanctioned in another state; thus, the action in one state may result in similar actions in other states in which the provider is licensed. That, of course, compounds the physician’s problems.
3. Adverse Action by Other Agencies. Other agencies may initiate their own investigation based on the board’s order. For example, an order with terms relevant to prescribing practices can trigger an investigation by the state pharmacy board. A stipulation involving inappropriate conduct with the patient might lead to criminal charges by the local law enforcement agency. Although such collateral investigations are fairly rare and are usually limited to situations involving egregious facts, there is no guarantee that the physician will be able to avoid lengthy and costly investigations or proceedings by other agencies.
4. Adverse Employment Action. Employment contracts often condition employment on an unrestricted license and require the provider to disclose or represent that the provider has not been the subject of adverse licensure action. Depending on the language of the contract and the mood of the employer, a seemingly innocuous board order may result in loss of employment. At the very least, it will likely undermine the provider’s position with the employer.
5. Adverse Credentialing Actions. Like employment contracts, hospitals or other facilities consider adverse licensure actions in their credentialing decisions. Depending on the medical staff bylaws and credentialing policies, licensure stipulations may allow the hospital or facility to deny, suspend, restrict, or terminate a provider’s medical staff membership or privileges, thereby limiting the provider’s practice options. Such adverse credentialing actions may also adversely affect the physician’s employment or relationships with payers who are affiliated with the hospital.
6. Adverse Publicity. In most states, the licensing board is permitted or required to publish the action. Colleagues, patients and others in the community are likely to learn of the stipulation, resulting in professional embarrassment, diminished reputation, and loss of business.
7. Malpractice Insurance. Depending on underwriting requirements, a board order may adversely affect the provider’s ability to secure or maintain professional liability insurance or the premiums charged for such insurance.
8. Litigation. Finally, the stipulation may result in civil lawsuits. The stipulation may spark suits by plaintiffs affected by the underlying concerns. In addition, plaintiffs’ lawyers may attempt to use the stipulation in subsequent litigation against the provider. Even though the stipulation will likely be irrelevant and inadmissible to most malpractice cases, it can still cause discomfort and increase the costs of defense.

Given the potential penalties, providers should carefully consider the consequences of any consent order entered into with the Board. If there is no effective defense to the allegations, the provider may have little choice but to agree to an appropriate stipulation to minimize costs and avoid potentially worse sanction; however, the provider should attempt to negotiate the terms in the stipulation to minimize his or her exposure. For example, the board might be willing to agree to a private censure or public reprimand instead of imposing restrictions or conditions on licensure. Alternatively, the provider might be able to modify the stipulation to confirm that it does not constitute a restriction on the license, does not limit the physician’s practice, and there was no harm or risk to patients. The provider might try to include other provisions that mitigate the harm or minimize the need for future disclosures. As appropriate, the provider should work with a knowledgeable attorney to help evaluate the risks and craft the stipulation in a manner to minimize the damage it will undoubtedly cause. For a consultation, contact us today.

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.

1. Mishandling/misuse of drugs. This includes diverting medications intended for patients, taking medications for your own use, failing to document or inventory medications correctly, or submitting unauthorized prescriptions to pharmacies.
2. Sexual misconduct. This could include allegations of inappropriate sexual relationships with patients or sexually harassing colleagues.
3. Patient abuse or neglect. If a nurse physically, verbally, or mentally abuses a patient, or fails to provide them with timely or sufficient treatment, this could result in the loss of the nurse’s license.
4. Fraud. This may include allegations of falsifying patient records, misrepresenting credentials like education credits or diplomas, sending incorrect or inflated bills to insurance companies, etc.
5. Criminal convictions. Many convictions can disqualify nurses from practicing (such as driving under the influence or drug possession). Importantly, you can also lose your license if you do not disclose a past conviction (see below for more on the license renewal process).

Question: What happens when a complaint is filed against you?

Answer: If a complaint is filed against you with the board of nursing, the Board will review the complaint and open an investigation. If the allegations are serious, the board can issue an emergency temporary suspension of your license during the disciplinary process. Depending on the allegations, an investigator may be appointed to gather all necessary information, including documents, witness testimony, etc. The board may also ask you to submit a written response to the allegations in the complaint, along with any supporting evidence. The board will then decide whether there is enough evidence to support the allegations against you and move forward.

The Board may offer a consent order, allowing you to accept penalties without a formal hearing. The consent order typically involves admission to the wrongdoing and submitting to the disciplinary action recommended. If you decline, a formal hearing will be held, and disciplinary actions may follow. If no consent order is agreed to, you will be asked to appear at a formal hearing to defend yourself against the charges. After the hearing, the board will make a final determination. This could range from public reprimand to the suspension or revocation of your license. Even a minor disciplinary action can become a matter of public record, affecting your career and permanent reputation. It is critical to have a qualified attorney guiding you through this process.

Question: Why hire a nursing license defense attorney?

Answer: When a complaint is filed against you, the board of nursing does not consider you innocent until proven guilty, immediately putting you at a disadvantage. The Nursing Board’s primary goal is to protect the public, not defend nurses. With your career at stake, navigating the complexities of an investigation without legal assistance can be risky. Retaining a nursing license defense attorney ensures that your rights are protected, representing your best interests every step of the way.

Question: What if you are concerned about the license renewing process?

Answer: If you’ve been arrested or convicted since your last renewal, you need to proactively address these issues with the board. Building a mitigation packet and addressing any concerns early can significantly increase your chances of renewing your license without penalties. At Conaway & Strickle, PC, we are experienced in working with professionals to mitigate adverse Board actions related to arrests, substance abuse, and mental health issues. We can assist with not only getting your criminal case reduced or dismissed, but also renewing your license without sanctions.

Question: How can a DUI affect your nursing license in Georgia?

Answer: A DUI conviction in Georgia can result in probation and other penalties, such as random alcohol screenings, mental health evaluations, and restrictions on your nursing practice. These probationary conditions can last for years, depending on the severity of the case.

Below is a list of common probationary conditions that can be place on you following a DUI or an impaired driving under the influence of drugs charge in Georgia.

• Three years minimum probation (must be three years of continuous compliance, so the probationary period could be extended if you slip up)
• Psychotherapy Evaluation by a physician board certified in addiction medicine
• Psychotherapy Course of Treatment completion
• Quarterly Reports from Psychotherapist
• Mental and Physical Evaluation, with favorable finding pertaining to ability to perform duties
• Continuing Education Coursework
• Quarterly Reports from Employer
• Quarterly Reports from yourself
• Quarterly Reports from a Substance Abuse Treatment Aftercare program approved by the Board of Nursing
• Monthly PEth (blood alcohol) testing for first 12 months
• Bi-monthly random urine drug screens for duration of probationary period
• Random alcohol screens
• Enrollment in an Affinity Program, like the one offered by the Georgia Nurses Association
• Restrictions on nursing practice, often including an inability to practice in the following areas without prior Board of Nursing Approval: Agency/Pool Assignments; Private Duty Nursing; In-Home Nursing; Internal Float Pools; Travel Nursing; In-Home Hospice.
• Abstaining from alcohol, and mood-altering substances, including controlled substances unless prescribed.
• If prescribed any medication, providing a letter from the prescriber to both the Board of Nursing and the treatment/aftercare provider within 10-days of receiving such subscription.

Conclusion

If you’re facing challenges related to your nursing license, it’s important to act quickly. With the complexities of nursing board investigations and the potential damage to your reputation, having an experienced nursing license defense attorney is crucial. For more information, contact us today.

But, also he made sure to point out that in addition to the charges and arrests being announced, that the government also seized over $230 million in cash, luxury vehicles, gold, and other assets in connection with these cases.

The government comes after you with search warrants, warrants to freeze and seize your assets and subpoenas for your records. Do not attempt to deal with these things alone Contact us so we can protect your license, your livelihood and your assets.

What is Georgia Medicaid? Medicaid is a “medical assistance program that helps many people who cannot afford medical care pay for some or all of their medical bills. Medicaid is administered by the Georgia Department of Community Health and pays medical bills with state and federal tax money.”

What is Medicaid Fraud?

Medicaid Fraud can come in many different forms – some elaborate and some not so elaborate.

What are some types of fraud?

-Billing for Unnecessary Services or Items -Intentionally billing for unnecessary medical services or items. -Billing for Services or Items Not Provided – Intentionally billing for services or items not provided. -Unbundling Billing for multiple codes for a group of procedures that are covered in a single global billing code. -Upcoding Billing for services at a higher level of complexity than provided. -Card Sharing -Knowingly treating and claiming reimbursement for someone other than the eligible beneficiary. -Collusion – Knowingly collaborating with beneficiaries to file false claims for reimbursement. Kickbacks -Offering, soliciting, or paying for beneficiary referrals for medical services or items. Program Eligibility – Knowingly billing for an ineligible beneficiary

Who prosecutes these cases?

The DOJ’s Health Care Unit. or in Georgia, the Georgia Medical Fraud Division of the Office of the Attorney General

What are some examples of prosecutions?

Opioid prosecutions National Health Care Fraud Enforcement – “The Department of Justice announced today criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various health care fraud schemes that resulted in approximately $1.4 billion in alleged losses.”

In the 2019 Operation Brace yourself prosecution press release, the DOJ had a call to action stating, “Any doctors or medical professionals who have been involved with alleged fraudulent telemedicine and DME marketing schemes – including Video Doctor USA, AffordADoc, Web Doctors Plus, Integrated Support Plus and First Care MD should call to report this conduct to the FBI. Nope, call a lawyer first!

Conaway & Strickler, PC has experienced healthcare fraud defense lawyers ready to assist if you receive a subpoena, a “friendly visit by agents”, a request for some patient files, or an interview request from the Medicaid Fraud Control Unit. Contact us to learn more – do not go at this alone.

J.D. Candidate, Class of 2025 The George Washington University Law School

Health care fraud consists of an individual, a group of people, or a company knowingly misrepresenting the type, scope, or nature of the medical treatment or service provided, for the purpose of making illicit profits or benefits. These crimes can be committed by medical providers and patients alike, with both parties using different methods for their respective roles. Common fraud committed by medical professionals can include:

* Double billing, in which multiple claims for the same service are submitted to an insurance company

* Phantom billing, where a medical provider bills for a service visit or supplies the patient never received,

* Unbundling, which involves Submitting multiple bills for the same service, and Upcoding, where a patient is Billed for a more expensive service than what they actually received.

Common fraud committed by patients or other individuals can include

* false marketing to convince people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan

* Identity theft/identity swapping by using another person’s health insurance or allowing another person to use your insurance

* Impersonating a health care professional through providing or billing for health services or equipment without a license

Health care fraud is governed by Title 18 of the United States Code, Section 1347, which makes it a federal crime to defraud any health care benefit program or obtain, by fraudulent means, any money or property from a health care benefit program. (18 U.S.C. § 1347). The FBI is the primary agency responsible for investigating healthcare fraud, for both federal and private insurance programs. The FBI investigates these crimes in partnership with: Federal, state, and local agencies, Healthcare Fraud Prevention Partnership, and insurance groups such as the National Health Care Anti-Fraud Association and the National Insurance Crime Bureau.

The consequences of a health care fraud conviction are severe and carry many penalties along with the possibility of a lengthy prison sentence. For medical professionals convicted of health care fraud, there is a high likelihood of losing a medical license or being blackballed by the industry. Under the federal exclusion statute, individuals may be excluded from participating in any federal healthcare program if they were convicted of a criminal offense related to the delivery of an item or service under Medicare or a state health care program. These exclusions may also be mandatory, as the Office of the Inspector General (OIG) has no discretion in imposing the mandatory exclusions if the elements are satisfied.

Navigating the federal criminal system is a task that should not be endured alone. If you have a health care fraud matter that you would like to discuss with experienced federal criminal defense lawyers, please contact our team today for more information about what we can do to help.

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.

Conaway & Strickler, PC has a long history of handling fraud cases of all varieties and is well equipped at fighting the DOJ in their overzealous prosecutions. Please feel free to contact us so that we can help you avoid future headaches.