Why an Experienced Health Care Fraud Attorney Matters

How can a Healthcare Fraud Attorney assist ? 

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.