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.