Healthcare fraud attorneys assist medical professionals who are facing allegations of False Claim Act violations. The False Claims Act “FCA” is an act that holds any person who knowingly submits, or causes to submit, false claims to the government civilly liable.  In general, such claims come from problematic practices related to billing federal government programs such as Medicare, Medicaid, and/or Tricare.  Any violation of federal regulations can cause issues.  

What types of Healthcare Fraud does the Government Target?

In general, the government will investigate situations involving:

-Billing for services not rendered

-Billing under the incorrect code

-Billing for services derived from illegal monetary kickbacks 

-Billing for services that are not medically necessary.  

How can the government Bring a Claim?

The Falsc Claims Act “FCA” is an act that holds any person who knowingly submits, or causes to submit, false claims to the government civilly liable.  

How can an individual purse a claim? 

In addition to allowing the government to pursue investigations on its own, the FCA allows private citizens to file suits on behalf of the government (called “qui tam” suits) against those who have defrauded the government.  Private citizens who successfully bring qui tam actions may receive a portion, (normally around 30 % of the recovered funds) of the government’s recovery.  Many DOJ investigations arise from qui tam actions.

What are the damages under the civil FCA?

If a lawsuit filed under the FCA is lost, the doctor or medical business owner will be liable for damages.  The district court is required to award damages in two ways: 

1. Triple the actual value of the fraudulently obtained funds and 
2. Mandatory fine per false claim submitted.  

A recent press release by the DOJ show settlements and judgments under the False Claims Act exceeded $6.8 billion in the fiscal year ending Sept. 30, 2025.  

It is important to reach out and secure counsel, such as the experienced health care fraud attorneys at Conaway & Strickler PC as soon as practicable.  It is always the hope to navigate the situation prior to the situation being investigated for criminal charges. 

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.