Healthcare Fraud · Anti-Kickback · False Claims Act
Audit notices, CIDs, target letters, and search warrants rarely arrive without
warning signs. The providers who fare best are the ones who get
experienced federal counsel involved before the government finishes
building its case.
If federal agents have contacted you, your practice received a subpoena, or you learned that Medicare or Medicaid flagged your billing for audit, you need to understand what is happening before you say or sign anything else. In cases centered on federal program billing, speaking with experienced Medicare fraud defense lawyer early can make a major difference.Healthcare fraud investigations move fast, involve multiple federal agencies, and can turn a billing dispute into a criminal case within months.
Our firm defends physicians, practice owners, billing companies, and healthcare executives against federal fraud allegations nationwide. We built our practice around former federal prosecutors and a retired federal judge who understand exactly how the government builds these cases — because they built and presided over cases like them.
If you are already under investigation, do not wait for charges to be filed before getting legal representation. Contact our office today for a confidential case review.
Healthcare fraud is not one single crime. It is a category of federal offenses built around how a provider bills, refers, or documents care paid for by government or private health programs.
Most federal cases rely on a handful of statutes. Knowing which one the government is using against you changes the entire defense strategy.
If your case is being investigated or charged in the Southern District of Texas, our Houston healthcare fraud defense lawyers can help you understand the statute, the exposure, and the defense options that may apply.
The core federal statute, 18 U.S.C. § 1347, makes it a crime to knowingly and willfully execute, or attempt to execute, a scheme to defraud a health care benefit program or to obtain money from one through false or fraudulent pretenses.
The government does not need to prove you knew you were breaking this specific law. Prosecutors only need to show you knowingly submitted false information to get paid.
Penalties under this statute can reach 10 years in federal prison per count. That exposure increases to 20 years if the fraud is connected to serious bodily injury, and up to life if a patient’s death is involved.
Three other federal frameworks come up constantly in healthcare fraud cases:
These laws overlap constantly. A single billing arrangement can trigger scrutiny under all three at once.
Federal healthcare fraud investigations are not limited to hospital administrators or large corporations. We regularly work with:
Investigators often start with the person who submitted the claim, but the case can expand quickly to owners, supervisors, and anyone who signed a certification, even if they never personally billed a claim.
Federal agents and auditors tend to build cases around a recognizable set of patterns:
Not every one of these allegations reflects actual fraud. Coding errors, documentation gaps, and outdated compliance training cause many of the same red flags that fraud does.
One of the most important distinctions in any healthcare fraud matter is whether the government is pursuing civil or criminal liability — or both at the same time.
Civil healthcare fraud exposure typically involves:
Criminal healthcare fraud exposure typically involves:
A case can start on the civil side and shift toward criminal exposure depending on what investigators find, or run on both tracks simultaneously. That is especially true in cases involving government program billing, where Medicaid fraud defense lawyers may be needed to address both civil and criminal exposure. Early legal involvement may help influence which direction a case takes, depending on the facts.
Understanding the stages of a federal healthcare fraud investigation helps explain why the earliest moves in your case matter so much.
Why investigations start earlier than they used to. DOJ has shifted from whistleblower-driven fraud cases toward data-first detection. Billing patterns across thousands of providers are scanned automatically for statistical outliers. A provider does not need an angry employee to trigger a review anymore — a billing profile that looks different from peers, in utilization modifiers or reimbursement per patient, can be enough on its own.
Russell Lorfing saw this pattern from the other side of the table. As a former federal prosecutor, the healthcare fraud cases that crossed his desk — upcoding, medically unnecessary services, billing that became more aggressive over time — most often got caught because the billing data started standing out. In this space, you don’t want to be an outlier. His view: most of these schemes could have been prevented with a regular internal audit, done at least once a year.
Hypothetical Example: A hospice agency owner receives a letter noting that Medicare has suspended payments pending a review of hospice eligibility certifications. Weeks later, two HHS-OIG agents appear at the office asking to speak with the intake coordinator. This pattern — audit, payment suspension, then agent contact — is a common early sequence in hospice and home health fraud investigations.
This is the stage where a defense attorney can have the most influence on the outcome. If you have received any subpoena, audit notice, or investigator contact, reach out before responding on your own.
We regularly see the same errors compound a provider’s exposure:
Two of these mistakes stand out because they close off options that would otherwise still be on the table. The first is destroying or altering records once you sense a problem. That does not make the underlying billing issue disappear — it creates a second, often easier problem for the government to prove: obstruction.
Prosecutors can show what existed, what was removed, and when it happened. The second is doing nothing. While a provider waits and hopes an issue resolves itself, investigators are often already reviewing bank records and billing data, and talking to current or former staff.
By the time it feels real, the case may be much further along than it appears from the outside. Preserved evidence, produced strategically through counsel, can work in your favor — it is often one of the few real advantages a provider has.
None of these mistakes are unusual — they are natural reactions for someone who has never dealt with a federal investigation. That is exactly why early legal guidance matters.
If you have reason to believe federal investigators are looking at your billing practices, referral arrangements, or a former employee’s complaint, waiting rarely helps. Here is where we would start:
This timing question matters more than most providers realize. The Department of Justice has also shifted its focus toward pursuing individuals — physicians, executives, and decision-makers — rather than settling only with the practice or company. Voluntary self-disclosure, made early and strategically, is not about beating a deadline. It is about deciding how your case unfolds instead of reacting once the government has already built its file.
Most healthcare fraud discussions online stop at “up to 10 years in prison.” That number is a ceiling, not a forecast. Actual federal sentences are calculated under the U.S. Sentencing Guidelines, and healthcare fraud is sentenced under the general fraud guideline, USSG §2B1.1. Understanding how that guideline actually works is often more useful than knowing the statutory maximum.
Federal fraud sentencing starts at a base offense level of 7 — relatively minor on its own. From there, the court applies “specific offense characteristics” that add levels on top of that base:
These add up quickly. A case that looks minor at a base level of 7 can climb into the mid-20s once enhancements stack, and the difference between offense levels is not academic. It is often the difference between a short sentence and years in federal prison.
Loss amount usually does more to set your sentence than any other single factor. The guidelines also distinguish between actual loss (what was really lost) and intended loss (what the government argues you were trying to take). Prosecutors can pursue the higher intended-loss figure even when a scheme was only partially successful, or failed for reasons that had nothing to do with the provider’s own actions.
The government’s loss number is not handed down from on high. It is a calculation built on assumptions, and it can be challenged. Common angles include:
Reducing a loss calculation by even $50,000 can mean years of difference in sentencing exposure. This is often where fraud cases are actually won or lost — not at trial, but in the math behind the loss figure.
If a case involves 10 or more victims, the offense level goes up. If it involves 50 or more, it goes up again. The guidelines define “victim” broadly enough that anyone temporarily affected by a billing scheme can end up on the list.
That makes the victim list itself worth scrutinizing. We look for duplicate entries, patients or payers who were already made whole, and losses that were actually caused by something other than the conduct at issue.
“Sophisticated means” sounds like it should require an elaborate scheme. In practice, courts applying this enhancement have found far more ordinary conduct sufficient — for example, moving money between multiple accounts to mask where it came from can be enough to trigger it, even without any technical or digital complexity involved.
Defense strategies against this enhancement include:
The following is a hypothetical illustration only — not a real case or client result.
Imagine a provider is alleged to have submitted $300,000 in fraudulent billing to a federal health care program. Fraud sentencing starts at a base offense level of 7. A $300,000 loss could add roughly 12 levels under the guidelines. If prosecutors also allege the billing involved a falsified provider identity or credential (adding 2 levels) and sophisticated means (adding another 2 levels), the offense level could reach 23 — a guideline range of roughly 46 to 57 months at Criminal History Category I.
Challenging just the sophisticated-means enhancement, combined with acceptance of responsibility, could bring that same hypothetical down to roughly level 18 or 19 — a meaningful reduction in exposure. This is why we describe sentencing defense as litigating the math, not just negotiating a plea.
During an audit or early investigation, our attorneys review the billing patterns at issue, communicate with auditors and investigators on your behalf, and work to keep a documentation dispute from escalating into a criminal referral.
After a subpoena or civil investigative demand, we manage document production, assert applicable privileges, and make sure responses do not create new exposure.
Before and during agent interviews, we advise clients on their rights, including the right to have counsel present, and help prevent voluntary statements from being used against them later.
If a search warrant is executed, we move quickly to understand the scope of the warrant, protect privileged materials, and begin building a defense record in real time.
During grand jury proceedings, we prepare witnesses, respond to subpoenas, and evaluate whether pre-indictment negotiations with prosecutors may be possible.
If charges are filed, we build a defense strategy around the specific statute alleged — 18 U.S.C. § 1347, the Anti-Kickback Statute, Stark Law, or the False Claims Act — and represent clients through negotiation, trial, or sentencing.
On the civil side, we work to resolve False Claims Act exposure, program exclusion issues, and repayment demands in a way that protects a provider’s ability to keep practicing, depending on the facts of the case.
Federal healthcare fraud cases are investigated and prosecuted by the same agencies our attorneys once worked inside.
Our broader team includes former federal prosecutors, former federal public defenders, former FBI agents, former IRS criminal investigators, and a retired federal judge — people who have seen healthcare fraud investigations built from the government’s side as well as defended from ours. We have worked with healthcare organizations and physicians to review billing practices, strengthen compliance systems, and engage strategically with investigators when concerns arose over billing discrepancies or regulatory scrutiny.
Russell Lorfing, Managing Partner, is a former Assistant U.S. Attorney who prosecuted federal cases and led a human trafficking task force on Saipan. The U.S. Attorney’s Office designated him a Cyber Hacking Intellectual Property Prosecutor in 2017, and he has trained federal agents and prosecutors for the FBI, IRS, DEA, and DOJ on handling electronic evidence — the same type of evidence at the center of most healthcare fraud investigations. He is recognized nationally for his work on white-collar investigations involving the IRS, Homeland Security, and the FBI, serves as the 2024 Co-Chair of the Texas Criminal Defense Lawyers Association’s Federal Criminal Defense Committee, and is a 2024 Super Lawyers Honoree. He is admitted to practice in Texas, the District of Columbia, the Fifth Circuit, the Northern, Western, and Southern Districts of Texas, and the U.S. Supreme Court.
Trey Keith, Founding Partner, has spent more than 20 years defending clients accused of federal and state crimes, with numerous not-guilty verdicts including in money laundering and financial crime cases.
Hon. E. Scott Frost (Ret.), Of Counsel, brings more than 30 years of federal courtroom experience to every case strategy discussion, having seen how federal healthcare fraud cases are argued and decided from the bench.
Because healthcare fraud is prosecuted under federal law, this experience applies no matter where in the country your investigation is taking place.
Facing a federal healthcare fraud investigation or subpoena? Talk to our attorneys before your next conversation with an investigator.
What is the penalty for healthcare fraud under federal law?
Under 18 U.S.C. § 1347, a conviction can bring up to 10 years in federal prison per count, rising to 20 years if the offense involves serious bodily injury and up to life imprisonment if a patient’s death is involved. Related charges under the Anti-Kickback Statute carry up to 10 years and fines up to $100,000 per violation. Civil penalties under the False Claims Act can include treble damages and per-claim fines.
Is healthcare fraud always a felony?
Federal healthcare fraud under 18 U.S.C. § 1347 is a felony. However, not every billing issue results in criminal charges — many cases are resolved civilly or administratively, depending on the facts and the government’s assessment of intent.
Can honest billing errors turn into fraud allegations?
Yes. Coding mistakes, documentation gaps, and outdated compliance training can trigger the same audit flags as intentional fraud. The key legal distinction is whether the government can show knowing and willful conduct, which is why documentation and a clear compliance history matter early in any review.
What should I do if I receive a subpoena or civil investigative demand?
Do not respond, produce documents, or speak with investigators before consulting a defense attorney. How you respond to the initial request can affect the entire trajectory of the investigation.
Will hiring a defense attorney make me look guilty?
No. Retaining counsel early is a standard, expected step for anyone contacted by federal investigators, including healthcare executives, hospital compliance officers, and physicians with no history of wrongdoing.
Can a healthcare fraud case be resolved without going to trial?
Many cases resolve through civil settlement, a corporate integrity agreement, a declination, or a negotiated plea, depending on the strength of the evidence and the stage at which an attorney becomes involved. We cannot promise a particular result, but early representation may open options that are not available once charges are filed.
How long do healthcare fraud investigations typically take?
Timelines vary widely. Some audits resolve in a matter of months, while grand jury investigations involving multiple providers or large billing companies can take one to several years before charges are filed or the case is closed.
Do I need a federal defense attorney, or can any criminal defense lawyer handle this?
Healthcare fraud is prosecuted in federal court under federal statutes and involves federal agencies such as the FBI, HHS-OIG, and DOJ. Experience specifically with federal procedure, federal sentencing guidelines, and these agencies’ investigative methods is important when choosing counsel.
If you are dealing with a healthcare fraud investigation anywhere in the country, contact our office for a confidential consultation. Federal law applies nationwide, and so does our experience defending against it.
Speak with our federal investigations team confidentially.
24/7 Crisis Line: 325-480-8100
Engagements nationwide
The Team

Partner
Russell Lorfing Former Federal Prosecutor

Partner
Brandi Young Former Federal Prosecutor

Partner
David Sloan Former Federal Defender
He put his trial skills to work in the courtroom, prosecuting cases for Ellis County and the District Attorney’s office in Waxahachie. His skills were recognized by the trial lawyers around him, and he went from a misdemeanor prosecutor to lead counsel on murder trials in less than three years.

Of Counsel
C. Richard Baker Former Assistant United States Attorney

Of Counsel
Hon. Scott Frost (Ret.) Former Federal Judge
Keith served as an FBI Special Agent in Lubbock for 27 years, focusing on human trafficking, crimes against children, and terrorism. Known for his collaborative leadership and relentless pursuit of justice, he now brings his expertise to our firm as Special Investigator.

Of Counsel
Eric Gerard Former Federal Prosecutor
Keith served as an FBI Special Agent in Lubbock for 27 years, focusing on human trafficking, crimes against children, and terrorism. Known for his collaborative leadership and relentless pursuit of justice, he now brings his expertise to our firm as Special Investigator.

Of Counsel
Chris Solis Former Federal Prosecutor

Senior Associate
Shane Chriesman Former Federal Prosecutor

Strategic Advisor
Javier Rocha Family Office Executive & Attorney
A family office executive and attorney with over a decade leading privately held businesses and executive teams across complex organizations. His career has focused on governance, investments, operations, and long-term stewardship for family office functions involving billions in assets, advising billion-dollar enterprises on internal investigations, investment diligence, and succession planning. Serves as Board of Directors Chairman for Heritage School and Assistant Scoutmaster for Troop 137.
Advisors & Investigators
A bench of former federal agents, prosecutors, and senior advisors who provide investigative
depth and strategic counsel on the firm’s most complex matters.

Strategic Investigator
Arthur Gonzales Former FBI Supervisory Special Agent
Nearly three decades with the FBI in leadership roles spanning counterterrorism, organized crime, and financial crimes. Recognized nationally and internationally for expertise in complex federal investigations, crisis management, and undercover operations, and served as an instructor at the FBI Academy. Provides strategic consulting and investigative support in federal criminal defense and white-collar investigations.

Strategic Investigator
Michael Orndorff Retired FBI Special Agent

Strategic Investigator
Travis Thorson Retired IRS-CI Special Agent & FBI Task Force Officer
Over two decades of federal investigative experience focused on complex financial crimes, money laundering, and organized criminal enterprises. A former IRS Special Agent whose forensic accounting work was critical in tracing illicit financial activity and building federal prosecutions. Provides strategic consulting for federal criminal defense, forensic accounting, and money laundering investigations.

Special Investigator
Keith Quigley Former FBI Special Agent
Keith served as an FBI Special Agent in Lubbock for 27 years, focusing on human trafficking, crimes against children, and terrorism. Known for his collaborative leadership and relentless pursuit of justice, he now brings his expertise to our firm as Special Investigator.

Strategic Investigator
Jenifer Sparks Retired FBI Special Agent & Certified Profiler
Nearly three decades of FBI experience specializing in violent crime investigations, behavioral analysis, and crimes against children. Served as a Special Agent, Supervisory Special Agent Profiler, and Coordinator of the FBI’s Child Exploitation Task Force. Provides strategic consulting in federal criminal defense, human trafficking investigations, witness credibility assessment, and behavioral analysis.

Strategic Investigator
Jennifer Cejpek Former FBI Special Agent & Certified Fraud Examiner
More than two decades of federal investigative and intelligence experience specializing in healthcare fraud, financial crimes, and public corruption. As a former FBI Special Agent, she led complex federal investigations in close coordination with the Department of Justice. Background includes service as an Electronic Warfare and Intelligence Analyst in the U.S. Army and expertise in forensic interviewing. Advises on federal criminal defense, white-collar crime, and compliance matters.

Strategic Advisor
William Luttrell Financial Analyst & CPA
Financial analyst and Certified Public Accountant advising the firm on complex financial matters, forensic accounting, and the analysis of records central to federal white-collar and financial crime defense.
Recognition
Internal Revenue Service
For prosecutorial accomplishments on financial investigations
National Recognition
Recognized nationally for white-collar investigations work
U.S. Department of Justice
Decades of distinguished service at the U.S. Department of Justice
Combined Team Experience
Combined experience across DOJ, FBI, and the federal bench
Accolades & Accreditations
Client Reviews
I had a dear family friend retain Russell behind some very serious criminal charges. Russell listened and maintained contact through the whole process to assure he felt comfortable and in the loop. With Russell’s help, the case/investigation was dismissed and innocence ensured. We are so grateful for Russell’s dedication and professionalism. Would definitely recommend
Our personal experience could not have been better. These attorneys worked diligently and stayed in constant contact with us regarding the developments in our case. We always had the final say in any offers made by the prosecution. If I could only say one thing about them it would be “they listen” I always felt that my opinion was heard and considered. We discussed everything good and bad. When a decision was finally agreed on we felt it was the very best and truthfully an almost unbelievable outcome. I never want to find my family in the midst or subject of a criminal case ever again but if it happens my first and only call will be to this law firm. Big thanks to Russell and Chris on a job well done. And the office staff are simply amazing! Always polite, knowledgeable, and professional. Thank you all for treating us as family and working so hard to bring this case to a great conclusion.
I had a legal case that was difficult for me, and Russell Lorfing was very helpful throughout the process, advocating for me and working with me throughout the whole process. He was quite accessible as well whether by phone or email, and his staff was also quite helpful to reach out to. Russell was very systematic in going through the evidence that we had in building a case and gave pragmatic explanations on his views considering all the evidence. He also gave me the confidence several times during the process that the evidence for my case was sufficient in building a strong defense. I appreciate very much that he did not sugarcoat my situation and was patient in addressing concerns I had along the way. I strongly recommend Russell for anyone going through a difficult legal battle.
Russell was representing another client in federal court and my family saw him in action and we immediately fired our lawyer and hired Russell on the spot. One of the best decisions we’ve ever made. My brother’s case was very serious as he was looking at 40 years Fed for distribution of methamphetamine. Russell is very connected and well respected when it comes to law. He has great history in the courts with judges and prosecutors. Russell will not sell you a dream—he will shoot you straight and will not sugar coat anything. Russell was able to get my brother’s sentence cut in HALF to something way more reasonable.
Russell Lorfing is THE guy you hire if you’ve been charged with a federal crime in West Texas. My fiancé was charged with a serious federal charge and we needed an experienced defense lawyer. He is one of the most honest lawyers you will find—he tells you exactly how things are and answers your questions honestly. He was looking at 13+ years, and now is looking at 5 years thanks to Mr. Lorfing, who did not rest until he was able to get him something better.
My son is on State and Federal Parole. He was in a lot of trouble that could have landed him in prison for many years. Russell took my son’s case and has done a great job. Russell was able to get the state charges against my son dismissed—my son was looking at a minimum of twenty-five years. Russell also got my son a great plea deal with my son’s federal case. The Keith & Lorfing team treated us as if we were family. I recommend Keith & Lorfing to everybody.
My entire experience with Keith and Lorfing has been great. I was facing the possibility of a 15 year MINIMUM sentence. Mr. Lorfing was very honest and made no promises but he reassured me that his main goal was to keep me out of prison. He did just that and I was able to sign for 6 years probation instead. I highly recommend Keith and Lorfing for anyone in need of a confident and experienced defense attorney.
My husband and I had a great experience working with Russell Lorfing. He managed to get my brother-in-law’s federal case dismissed in a short period of time. Mr. Lorfing is caring and is in constant contact with you and your family. He is a great federal defense lawyer. He is highly recommended!
I wanted to express my deepest gratitude for the incredible support and expertise you provided to my family member. Your dedication and hard work made a world of difference during a challenging time. Thank you for going above and beyond to ensure the best possible outcome. We will strongly encourage anyone that is experiencing any case to consider Russell Lorfing Esq. to represent them.
At the first of our situation we were scared and didn’t know where to begin. My wife made a phone call to Keith & Lorfing just to see where to begin—turned out to be the best decision! Russell and Chris from Keith & Lorfing were absolute professionals. They were the smartest and most prepared in the courtroom. Extremely impressed! They gave us our life back and could not thank them enough for what they did!
I had the privilege of working with Keith and Lorfing for my criminal defense case, and I cannot recommend them highly enough. From the initial consultation to the courtroom proceedings, Keith and Lorfing demonstrated a deep understanding of the law and a commitment to protecting my rights. Thanks to their diligent efforts and sharp legal acumen, they successfully navigated the complexities of my case and ultimately secured a dismissal.
Russell was recommended to me by several people and we are so lucky to have found him! He was able to get a potential 7 year sentence down to only 9 months. Not to mention he and everyone at the law firm was so kind and helpful. It felt more like a family than a law firm. Would recommend to anyone who is in a tough spot.
A referral that I am very glad I was given. Not only did he meet the expectations I had heard from the referral, but exceeded them beyond measure. The process was simple and I was very comfortable and confident throughout. Mr. Lorfing and his associates are amazing and helpful. 10/10 recommended for their honesty and assistance.
Absolutely the best lawyer and staff I’ve ever met. He was more concerned with telling me the facts of where I stood legally than taking my case just for his financial gain. If I ever need any more legal help, I will go to their firm.
I am truly thankful for all you have done for me and my case. My family and I greatly appreciate everything you have done. I am greatly and truly impressed with the outcome. You were great at getting the answers for any question I had and explaining what everything meant. You are very outstanding and have done an amazing job. Thank you so much Russell!
Russell did an amazing job. My case truly was a hail Mary. Lots of threading the needle and moving parts was an understatement. It’s a true testament that if someone wants to really change and will help him help themselves, he can and will.
Russell was an incredible advocate for my family. He regularly communicated with us and made us feel like we were his priority. My brother was looking at a mandatory minimum ten years in federal prison with a maximum possible sentence of life. He ended up pleading to a much less serious crime and serving less than a year. If you’ve been charged with a federal crime in West Texas, Russell Lorfing is THE ATTORNEY you hire.
After I was initially charged, I was swimming in a pool of despair. After my initial intake appointment there was a welcoming presence and a pedigree of honesty with my circumstances. Nothing was sugarcoated but they never made me feel like what I wanted was out of question. I couldn’t be more thrilled about the outcome—Keith literally reached into the depths of the justice system and pulled me out untarnished.
Thank you Mr. Lorfing for your work getting my family member’s Federal MTR Dismissed. We know the time crunch made communication difficult so a special shout out to his legal assistant Wendi as well for getting back with me and reassuring our family things were getting done behind the scenes. We couldn’t have asked for a better outcome.
Mr. Lorfing is AMAZING! He is truly a miracle worker! My brother got into deep trouble, so we contacted the best lawyer to represent him. While most lawyers bring up payment options first, he listened to our story first. Mr. Lorfing resolved it before it got way worse and treated us like family. The Lorfing Law Firm is the way to go. He saved my brother and saved my family from heartaches.
Mr. Lorfing is different. He really cares about justice being served. He did a wonderful job with my son as his client. Mr. Lorfing doesn’t accept the usual outcomes of a case. He delves into all possibilities and outcomes for his clients and puts forth great effort when representing his clients. He is a very good lawyer.
I had a complicated case and this man really did his job—and did it in no time. I’m so happy with his professionalism and empathy towards me. He really had my back. Thank you Mr. Lorfing.
Confidential Consultation
Early strategic intervention can significantly impact the course of a federal investigation. Contact our investigations team for a confidential consultation.