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. 

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.

We have handled many licensing issues including: (but NOT limited to)

-If you have been arrested for a DUI or any type of illegal substance, the Board will want to know. It is always a good idea to have an attorney assist you in notifying the Board and keeping them abreast of your criminal case and dealing with resolving any issues with the Board caused by the arrest

-If you have already received a disciplinary action, call us immediately, so we can help you navigate through the process which includes, potentially, a formal investigation, ALJ hearing and/or appeal

-If you failed to disclose prior issues and the Board is now contacting you

-If you have been accused of sexual misconduct

-If you have tried to renew or register and are having issues with the new State of Georgia’s licensing system called GOALS

The Georgia State Board of Physical Therapy has the authority to investigate and discipline licensees based on criminal conduct, even if it’s unrelated to your clinical practice. For example, a single criminal charge, including DUI, drug offenses, or fraud, can trigger a Board review that could lead to suspension or permanent revocation of your license. Once the Board is notified of criminal activity, they can open an investigation, require a response, and possibly schedule a hearing. Any disciplinary action they take becomes public record, damaging your reputation and threatening your ability to earn a living. Trying to navigate both a criminal case and a professional license investigation at the same time is overwhelming—and risky without the right legal defense. At Conaway & Strickler, we defend licensed professionals facing criminal charges and protect their right to practice. We understand how the Georgia State Board operates and how criminal accusations can escalate into professional consequences. If you’re on the verge of losing your license, don’t wait. Contact us now so we can fight for you and your future in physical therapy.

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.

Who makes up the Composite Board? The Board is made up of fifteen members appointed by the Governor. Thirteen of those members are physicians, and two of those members are public representatives who have no ties to medicine. Each Board member typically serves a four-year term.

What does the Board do? The Board’s functions include screening candidates for licensure, issuing licenses to qualified professionals, developing rules and guidelines for healthcare practice, and disciplining licensees when necessary. In Georgia, the Composite Board licenses and monitors healthcare professionals including the following: Medical doctors (MDs), Doctors of osteopathic medicine (DOs), Physician assistants (PAs), Anesthesiologist assistants (AAs), Acupuncturists, and pain management clinics. However, the Composite Board does not license or regulate podiatrists, chiropractors, dentists, marriage and family therapists, social workers, professional counselors, physical therapists, registered nurses, or licensed practical nurses – those professions are regulated by the Office of the Secretary of State.

As a healthcare professional, should you retain a lawyer for interacting with the Board? When your professional license could be at stake, an experienced attorney can assist you with navigating the Board’s procedures and hearings. For licensing applicants, there may be issues from the past that require disclosure to the Board. For example, while a past criminal conviction will not necessarily prevent an applicant from obtaining a healthcare license, the failure to make an adequate and timely disclosure could jeopardize licensure and require a hearing before the Board. For licensed healthcare professionals, the Board will handle challenges to your license that arise from allegations of any professional or criminal misconduct. Once the Board has notified you of a pending disciplinary action, consulting with legal counsel is crucial to best protect your license and career.

At Conaway & Strickler, we have experience representing healthcare professionals before the Board in matters including the disclosure and mitigation of criminal issues and the defense of alleged professional misconduct. If your healthcare license is at stake, our attorneys can help guide you through the process of safeguarding your career. Schedule a free consultation to discuss potential issues facing your professional license.