Medicaid Fraud · MFCU · FCA Defense · Nationwide
State MFCU subpoenas, HHS-OIG investigations, DOJ Civil Investigative
Demands, qui tam complaints, and extrapolated state Medicaid audits rarely
arrive without warning signs. The providers who fare best are the ones who
get experienced federal and state counsel involved before the government
finishes building its case.
A letter from a state Medicaid Fraud Control Unit, a subpoena from HHS-OIG, or a call from an investigator asking to “just clarify a few billing questions” is not a routine administrative matter. It is often the opening move in a case that can end a provider’s ability to bill Medicaid or Medicare at all.
We defend healthcare providers, home health and hospice agencies, behavioral health practices, and Medicaid-enrolled businesses nationwide against fraud allegations at both the state and federal level. In broader billing and compliance matters, experienced healthcare fraud defense lawyers can help address the full scope of exposure.Our team includes a former Assistant U.S. Attorney who prosecuted federal white-collar cases before moving to the defense side, giving us direct insight into how these investigations are built and where they can be challenged.
This page explains how Medicaid fraud allegations arise, who investigates them, what separates civil exposure from criminal exposure, and what to do — and avoid doing — if you’ve been contacted.
Medicaid fraud generally means knowingly submitting, or causing someone else to submit, false or misleading information to obtain a Medicaid payment the provider was not entitled to receive.
The word “knowingly” matters. Billing errors, coding mistakes, and documentation gaps happen in every practice. Fraud requires proof of intent, or at minimum reckless disregard for the truth of a claim.
State Medicaid programs are administered individually, so the specific billing rules, provider agreements, and enrollment requirements vary by state. What triggers scrutiny in one state’s program may be handled differently in another, which is one reason these cases require attorneys who understand both the state Medicaid framework and the overlapping federal statutes.
Medicaid and Medicare fraud get treated as interchangeable terms, but they are not the same program, and they are not investigated by the same primary agency.
Medicare is a federal program. Medicare fraud cases are typically built and prosecuted by federal agencies — HHS-OIG, the FBI, and the Department of Justice — under statutes like 18 U.S.C. § 1347, the federal health care fraud statute.
Medicaid is a joint state-federal program, funded partly by the federal government but administered by each state. Because of that structure, Medicaid fraud is usually investigated first at the state level, by a state Medicaid Fraud Control Unit, even though federal money and federal law are also implicated.
A provider enrolled in both programs can face parallel investigations — a state MFCU looking at Medicaid claims and a federal task force looking at Medicare claims for the same conduct — at the same time. In those situations, experienced Medicare fraud defense attorneys may need to be involved alongside counsel addressing the Medicaid side. We evaluate both angles from the start rather than treating a case as purely a state matter.
Every state, along with the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, operates an MFCU. These units are required to sit inside the state Attorney General’s office (or a comparable state agency) and to operate separately from the state Medicaid agency itself, which keeps the investigators independent from the payer.
MFCUs employ investigators, auditors, and attorneys, and they receive partial federal funding through HHS-OIG, which also certifies and reviews each unit’s performance annually.
MFCU investigations typically start from a referral — a complaint from a patient or employee, a data-analytics flag from the state Medicaid agency, a managed care organization’s internal audit, or information from Adult Protective Services. Federal law generally limits MFCUs to investigating providers, not individual Medicaid recipients, unless a recipient is conspiring with a provider.
That data-analytics flag is doing more of the work than it used to. State agencies and federal investigators increasingly scan billing patterns across thousands of providers at once, looking for statistical outliers instead of waiting for a complaint to land. A provider doesn’t need a disgruntled employee to trigger scrutiny anymore — a billing profile that looks different from peers in the same specialty can be enough to open a file.
Russell Lorfing saw this pattern from the government’s side of the table. Among the healthcare fraud cases he handled as a federal prosecutor, most were caught the same way — the billing data started standing out statistically before any single complaint ever came in. His practical advice to providers: a real internal audit, done at least annually, tends to catch the same anomalies a regulator would flag, while there’s still time to fix them internally.
The U.S. Department of Health and Human Services Office of Inspector General has independent authority to investigate healthcare fraud affecting federal programs, and it works closely with the FBI and DOJ on cases that cross state lines or involve larger-dollar schemes.
HHS-OIG also holds exclusion authority under 42 U.S.C. § 1320a-7, separate from any criminal case, which is why a provider can face exclusion from federal healthcare programs even without a conviction.
Because Medicaid draws on both state and federal funds, a single billing pattern can attract attention from a state MFCU and a federal agency at the same time. Coordination between state and federal authorities is common in larger schemes, particularly those involving multiple states, telehealth billing, or durable medical equipment.
We do not claim to hold licensure in every state, and every state’s Medicaid enforcement process has its own procedural rules. What we bring to a case is deep experience with the federal statutes, agencies, and prosecutorial thinking that shape these investigations regardless of which state initiated them, paired with local counsel coordination where needed.
If you’ve received any written notice from a state Medicaid Fraud Control Unit or a federal agency, the safest next step is a confidential conversation with defense counsel before you respond in any form. Contact us to talk through what you’ve received and what it likely means.
Allegations vary by provider type, but the recurring categories include:
Hypothetical example: A home health agency bills Medicaid for skilled nursing visits documented as completed, but an MFCU auditor cross-references GPS data from the agency’s own scheduling software and finds several visits logged as completed while staff were, according to the data, elsewhere. This kind of documentation mismatch is a common trigger for a formal MFCU investigation, and it illustrates why early legal involvement in responding to an audit request matters — the agency’s own records can become the government’s primary evidence.
One of the most consequential decisions in a Medicaid fraud matter is whether the government pursues it as a civil matter, a criminal matter, or both.
Civil exposure typically arises under state false claims statutes or, where federal funds are implicated, the federal False Claims Act. When a billing dispute turns into a whistleblower or qui tam matter, our False Claims Act defense lawyers can help shape the response early.Civil cases can be brought by the government directly or initiated by a whistleblower (relator) in a qui tam lawsuit. Civil liability does not require proof beyond a reasonable doubt — a lower evidentiary standard applies — and remedies include repayment, civil penalties per false claim, and treble damages.
Criminal exposure arises when prosecutors believe they can prove knowing and willful fraud under state criminal statutes or federal statutes such as 18 U.S.C. § 1347. Criminal cases carry the possibility of prison time, criminal fines, and a felony record, in addition to program exclusion.
A single set of facts can generate both civil and criminal exposure simultaneously, and it’s not unusual for a case to begin as a civil audit and evolve into a criminal referral once investigators believe the conduct was intentional. Recognizing which track a matter is on — or could move to — shapes how we respond to every document request and interview from day one.
The consequences of a Medicaid fraud finding extend well beyond a single case outcome.
Criminal penalties vary by statute and state law but can include years of imprisonment and substantial fines, particularly where the federal health care fraud statute applies.
Civil penalties under false claims statutes can include per-claim penalties plus triple the amount the program actually paid on the fraudulent claims, which can turn a modest billing dispute into a large financial exposure once claims are aggregated.
Program exclusion is separate from any court sentence. HHS-OIG can impose mandatory exclusion from Medicare and Medicaid for certain offenses, including program-related fraud convictions, felony health care fraud, and patient abuse or neglect convictions. Mandatory exclusions generally run a minimum of five years and can be extended based on aggravating factors. Once excluded, no federal health care program will pay for services a person or entity furnishes, orders, or prescribes — a consequence that can end a career or a business regardless of whether prison time is involved.
Licensing board referrals frequently follow Medicaid fraud allegations. State licensing boards for physicians, nurses, dentists, and other regulated professionals often open parallel disciplinary proceedings, meaning a provider can be defending a state MFCU matter, a federal exclusion proceeding, and a licensing board investigation at the same time.
These overlapping consequences are why we evaluate a case across all four tracks — criminal, civil, exclusion, and licensing — from the first meeting rather than addressing them one at a time. If you’re facing any combination of these proceedings, reach out to discuss how they intersect in your situation.
When Medicaid fraud is charged federally — or a state follows a similar sentencing framework — the number that ends up mattering most isn’t the charging statute. It’s the sentencing guideline calculation, and Medicaid fraud typically falls under the general federal fraud guideline, USSG §2B1.1.
That guideline starts low and can climb fast. Medicaid cases have a few features — government-program status, patient counts, and layered billing structures — that can make the climb steeper than providers expect.
Under §2B1.1, fraud starts at a base offense level of 7. From there, the guideline adds points, called specific offense characteristics, for things like loss amount, number of victims, sophisticated means, and misrepresenting a connection to a government agency or program.
These add-ons stack on top of each other. Ten or more victims can add points on their own, and 50 or more adds even more. Sophisticated means can add more. And because Medicaid is a joint state-federal program, misrepresenting a provider’s affiliation, credentials, or standing within the program can trigger its own enhancement, on top of everything else. A case that looks like straightforward billing fraud at a base level of 7 can reach the mid-20s in offense level once these are added together — the difference between a sentence measured in months of probation and one measured in years in custody.
Loss amount typically does the most damage to an offense level. Once the loss crosses certain thresholds, the guidelines add levels in sharp jumps, almost like rungs on a ladder.
The guidelines also draw a line between actual loss and intended loss. The government can pursue the higher intended-loss figure even when a scheme only partly succeeded or a claim was flagged and reversed before Medicaid actually paid it. A provider who submitted claims for services never rendered can face a loss calculation based on everything billed, not just what the program actually paid out.
That number isn’t fixed the moment an auditor writes it down. The government’s loss figure is a calculation built on assumptions, and it can be challenged. Relevant angles include credit for the value of services a provider actually did provide, catching claims that were counted twice across multiple alleged victims, and pushing back on speculative or inflated intended-loss figures. Reducing a loss calculation by even a modest amount can translate into a meaningfully different sentencing range.
The victim-count enhancement can add significant points once a case involves 10 or more victims, and more again at 50 or more. The government’s definition of “victim” is broad, so the list it uses to justify that enhancement deserves close review — for duplicate entries, claims that were already reimbursed, or losses actually caused by something other than the conduct at issue. An inflated or inaccurate victim count can push an offense level higher than the facts actually support.
Prosecutors reach for the sophisticated-means enhancement often, and it doesn’t take an elaborate scheme to trigger it. Courts applying this enhancement have found that simply moving money between multiple accounts to mask its source can be enough, even without any real technical complexity.
There are ways to push back. If the accounts or entities involved served a legitimate business purpose, that undercuts the idea that they existed to hide fraud. If the conduct was actually simple and repetitive rather than layered, that matters too. Proportionality can matter to a judge as well — routine bookkeeping decisions look different from a coordinated effort to launder proceeds. When the underlying conduct is genuinely routine, the enhancement shouldn’t apply.
Here’s a hypothetical, for illustration only, showing how quickly these pieces can combine.
A provider is accused of $300,000 in fraudulent Medicaid billing. The base offense level is 7. The $300,000 loss amount alone adds 12 levels. If the government also alleges the provider misrepresented its status or affiliation within the Medicaid program, that adds 2 more levels. If the government further alleges sophisticated means — say, routing reimbursements through multiple accounts — that adds 2 more. That reaches an offense level of 23, which at Criminal History Category I carries a guideline range of roughly 46 to 57 months.
Now suppose defense counsel successfully challenges the sophisticated-means enhancement and the provider receives credit for acceptance of responsibility. Those two changes together can bring the offense level down to roughly level 18 or 19 — a meaningfully different range than 46 to 57 months. This is a hypothetical, not a promise of any particular result in any actual case, but it illustrates why the guideline math is worth litigating rather than accepting at face value.
These calculations aren’t just a sentencing-day exercise. They shape plea negotiations, they influence whether a case resolves civilly or criminally, and they shape how aggressively we push back on a loss figure or an enhancement at every stage of a case. Understanding the guideline math early — not after a presentence report is already written — is part of how we evaluate a Medicaid fraud case from the first conversation.
Most Medicaid fraud matters do not start with an arrest. They start with a records request, a subpoena, a civil investigative demand, or an investigator asking to schedule an interview.
At this stage, we review the scope of what’s being requested, manage all communication with the requesting agency, and evaluate whether the request signals a routine audit or the early stage of a fraud investigation. We also advise on whether and how to respond to interview requests, since informal conversations with investigators are frequently used as evidence later.
Investigations used to start with whistleblowers and spreadsheets. Now they often start with data analytics, and by the time a provider senses a problem, investigators may already be reviewing years of billing records. That shift is why we encourage providers to be proactive rather than wait for a subpoena. A privileged internal review of billing practices, done before any government contact, can catch and fix a problem while it’s still a compliance issue instead of a criminal one.
Our broader team includes former federal prosecutors, former federal public defenders, former FBI agents, and former IRS criminal investigators, along with a retired federal judge. We’ve worked with healthcare organizations and physicians to review billing practices, strengthen compliance systems, and engage strategically with investigators when questions about billing first surface — often before an informal inquiry ever becomes a formal investigation.
Once an investigation is confirmed, our work includes reviewing billing records and documentation before the government does, identifying legitimate explanations for flagged claims, and, where appropriate, opening a dialogue with the MFCU or federal agency to present context before a charging decision is made.
Russell Lorfing’s background as a former federal prosecutor who trained agents and prosecutors for the FBI, IRS, DEA, and DOJ informs how we assess an investigation’s direction and strength from the government’s side of the table, not just the defense side.
Enforcement priorities have also shifted. For years, healthcare fraud enforcement leaned heavily on holding the entity — the agency, the practice, the billing company — responsible. Increasingly, MFCUs and federal agencies are focused on individuals: the executive, medical director, or billing supervisor who approved or directed the conduct. A provider who assumes the practice is the target, while they personally are just a witness, is often misreading their own exposure.
Timing matters more than most providers realize, too. Coming forward to disclose a billing problem before the government identifies it independently can create real leverage in how a matter gets resolved. Once investigators find the issue first, the provider is reacting to the government’s version of events instead of shaping the conversation. Whether and when self-disclosure makes sense is a judgment call that has to be made with counsel, case by case.
If a matter moves to charges or a civil complaint, our focus shifts to case strategy: challenging the government’s evidence, negotiating resolutions where appropriate, and litigating in federal or state court when a case should be tried. Trey Keith has spent more than 20 years defending clients accused of complex financial crimes, including securing not-guilty verdicts in money laundering cases, and Hon. E. Scott Frost (Ret.) brings over three decades of federal courtroom experience to case strategy and trial preparation.
Agreeing to an interview without counsel present. Investigators are permitted to ask for a “voluntary” conversation. Nothing about that conversation is off the record, and there is no requirement to agree to it without an attorney.
Turning over records beyond what’s requested. Providing more documentation than a subpoena or request actually covers can expand the scope of an investigation unnecessarily.
Altering or “cleaning up” records after learning of an investigation. Any change made to records after an investigation begins can itself become evidence of obstruction, separate from the original billing allegations. Destroying or editing billing records doesn’t make a problem go away — it usually creates a second, easier-to-prove problem, because the government can often show what existed, what was removed, and when it happened. Preserved records, produced strategically through counsel, can work in a provider’s favor instead of against it.
Assuming an audit will stay an audit. Civil audits regularly develop into criminal referrals once auditors flag a pattern they believe was intentional. Treating early contact as low-stakes because it hasn’t been labeled “criminal” yet is a common and costly mistake.
Waiting to get counsel involved. The earlier defense counsel is involved, the more options exist — including addressing an issue before it becomes a formal case. Waiting until charges are filed removes many of those options. Investigations build quietly. By the time a provider becomes aware one exists, investigators may already have reviewed years of billing data, spoken with former employees, and subpoenaed financial records. Getting experienced counsel involved immediately, and making sure every future communication with the MFCU or federal investigators runs through counsel rather than informally, is one of the most protective steps a provider can take.
If you or your practice has received any contact from a Medicaid Fraud Control Unit, HHS-OIG, or DOJ, the most protective step is a confidential consultation before you respond, produce documents, or sit for an interview.
Medicaid fraud cases sit at the intersection of state administrative law, federal criminal statutes, and civil false claims exposure. Few defense teams have handled all three sides of that intersection from the inside.
Russell Lorfing served as an Assistant U.S. Attorney and was designated a Cyber Hacking Intellectual Property Prosecutor by the U.S. Attorney’s Office. He has trained federal agents and prosecutors for the FBI, IRS, DEA, and DOJ, is recognized nationally for white-collar investigation work involving the IRS, Homeland Security, and the FBI, and currently co-chairs the Federal Criminal Defense Committee of the Texas Criminal Defense Lawyers Association. He is admitted to practice in Texas, the District of Columbia, the Fifth Circuit, and the Northern, Western, and Southern Districts of Texas, as well as before the United States Supreme Court.
Trey Keith has spent more than two decades defending clients accused of serious financial crimes, and Hon. E. Scott Frost (Ret.) adds more than 30 years of federal courtroom experience to how we prepare and try cases.
We’re candid about the scope of our practice: we are not licensed in every state, and Medicaid fraud cases are frequently investigated jointly by state authorities and federal agencies. What we offer is deep, verifiable experience with the federal side of health care fraud enforcement and the judgment to coordinate effectively with local counsel when a matter requires it. We never promise a particular outcome — every case turns on its own facts — but we can tell you plainly what we see in the government’s approach and what your realistic options are.
If you’re facing a Medicaid fraud investigation or related civil claim, schedule a confidential consultation to discuss your situation.
Is receiving an audit request the same as being under investigation?
Not necessarily, but the line between a routine program audit and the start of a fraud investigation is not always visible from the provider’s side. An audit that uncovers a pattern an auditor believes was intentional can be referred to a Medicaid Fraud Control Unit or HHS-OIG. Treating any audit request as potentially significant, and getting counsel involved early, protects your position either way.
Does a subpoena mean I'm going to be charged with a crime?
No. A subpoena means the government is gathering information, which can result in no action, a civil resolution, or criminal charges depending on what the evidence shows. How you and your counsel respond to the subpoena can influence which of those outcomes follows.
Can Medicaid recipients, not just providers, be investigated for fraud?
Federal law generally limits Medicaid Fraud Control Units to investigating providers rather than individual recipients, unless a recipient is alleged to be conspiring with a provider. Recipient fraud allegations are typically handled through separate state processes.
Will disclosing a billing problem to the state before it's discovered help my case?
Self-disclosure can sometimes reduce exposure, but it also has real risks and is not appropriate in every situation. Whether disclosure makes sense depends heavily on the specific facts, the strength of the government’s existing knowledge, and applicable program rules, which is why this decision should be made with defense counsel, not unilaterally.
How long do Medicaid fraud investigations typically take?
Timelines vary widely depending on the complexity of the billing at issue, the number of claims involved, and whether multiple agencies are coordinating. Investigations involving large healthcare organizations or multi-state conduct often take longer than single-provider matters.
Will hiring a defense attorney before an interview make me look guilty?
No. Retaining counsel before speaking with investigators is a standard, expected step for any business or individual facing a government inquiry, and it protects your ability to respond accurately and completely if and when a conversation does happen.
What happens if I'm excluded from Medicaid or Medicare?
Exclusion means no federal health care program will pay for services you furnish, order, or prescribe, directly or indirectly, for the exclusion period. Mandatory exclusions generally last a minimum of five years and can affect employment, ownership interests, and licensing status well beyond the underlying case.
Do I need a different attorney for the civil case and the criminal case?
Not necessarily, but your attorney needs to understand how the civil and criminal tracks interact, since decisions made in one can affect the other. We evaluate both angles together rather than treating them as separate matters handled by separate teams.
Speak with our federal investigations team confidentially.
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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
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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
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