Medicare Fraud · FCA · Strike Force Defense · Nationwide
Medicare Strike Force indictments, HHS-OIG subpoenas, DOJ Civil
Investigative Demands, and UPIC audits 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.
A letter from a Medicare contractor, a subpoena from the U.S. Attorney’s Office, or a visit from federal agents rarely comes with a warning. By the time a provider hears from the government, the investigation has usually been running for months.
We represent physicians, clinic owners, billers, pharmacists, and home health and hospice operators who are facing Medicare fraud allegations at every stage, and we also advise clients who need experienced healthcare fraud defense lawyers for broader federal billing and compliance investigations. Medicare fraud is a federal matter no matter where in the country a practice is located, because the program and the statutes that protect it are federal. That means the strength of your defense depends on federal court experience, not your zip code.
If you’ve received a subpoena, a Civil Investigative Demand, or a visit from OIG or FBI agents, the choices you make in the first days shape everything that follows. We encourage providers to call before answering any questions, not after.
Medicare fraud is prosecuted primarily under the federal health care fraud statute, 18 U.S.C. § 1347. The statute 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 that program through false or fraudulent pretenses.
The word “knowingly” matters. Fraud requires intent. A mistaken code, a documentation gap, or a disagreement over medical necessity is not automatically a crime.
Conduct that federal investigators typically classify as fraud includes:
By contrast, honest billing errors, coding mistakes caught during self-audits, and good-faith disagreements about documentation standards are compliance issues, not fraud. The distinction turns on intent and pattern, which is exactly what investigators are trying to establish when they open a file.
Medicare fraud investigations are not limited to large hospital systems. In our experience, individual providers and small to mid-size practices are frequently the target because their billing patterns are easier to isolate and their internal compliance resources are thinner.
Providers commonly investigated include:
Hypothetical Example: A home health agency bills Medicare for skilled nursing visits during a period when a patient was hospitalized. A UPIC contractor’s data analytics flag the overlapping dates automatically, well before any human reviewer looks at the chart. That single data mismatch can trigger a broader audit of every claim the agency has submitted in the last several years.
Most cases we see fall into a handful of recurring categories:
Medicare fraud cases rarely start with a knock on the door. They typically move through several stages before a provider even knows they are a target.
CMS and its contractors run every claim through predictive analytics and statistical modeling designed to detect outlier billing patterns. A provider billing at a volume or a code level well outside their peer group is the most common trigger for a closer look.
This shift is real, not theoretical. Russell Lorfing, our Managing Partner and a former Assistant U.S. Attorney, has watched fraud investigations move away from being whistleblower-driven toward being data-first. The Department of Justice now scans billing patterns across thousands of providers and flags statistical outliers automatically. A provider doesn’t need an angry employee to draw scrutiny anymore. A billing profile that looks different from peers on utilization modifiers or reimbursement per patient can be enough to land on a list.
That pattern held up from the prosecution side too. In the Medicare and health care fraud cases Lorfing handled as a federal prosecutor, the schemes involved upcoding, medically unnecessary services, or billing that quietly became more aggressive over time. Almost all of them got caught the same way: the billing numbers started standing out from everyone else’s. In Medicare billing, you don’t want to be an outlier.
Unified Program Integrity Contractors (UPICs), which have replaced Zone Program Integrity Contractors (ZPICs) in most regions, conduct the on-the-ground audit work. UPICs review claims data, request medical records, and sometimes conduct unannounced site visits across Medicare Parts A and B, DME, home health, and hospice billing. A UPIC audit letter is not a routine paperwork request; it is often the first visible sign of a fraud referral already underway.
Many investigations begin with a former employee, competitor, or patient filing a complaint. Under the False Claims Act, private individuals (relators) can file a sealed qui tam lawsuit on the government’s behalf and share in any recovery, which gives billing staff, office managers, and even business partners a financial incentive to report suspected fraud.
Once the government believes it has enough to justify formal process, providers typically receive a grand jury subpoena, an administrative subpoena, or a Civil Investigative Demand (CID) for records. How these are answered, and whether they are answered before counsel is involved, often shapes the rest of the case.
In more advanced cases, agents from the FBI, HHS-OIG, or DEA may execute a search warrant at the practice or attempt to interview the provider or staff directly, sometimes without notice. When controlled-substance prescribing or recordkeeping is part of the inquiry, experienced DEA audit defense attorneys should be involved immediately. These visits are almost always the product of a long-running investigation, not the start of one.
If federal agents contact you or arrive at your practice, you are entitled to have an attorney present before you answer any questions. That right exists whether the visit feels routine or urgent.
Medicare fraud allegations can proceed on two separate tracks, and the same underlying conduct can trigger both at once.
Civil exposure typically arises under the False Claims Act. When a billing dispute turns into a whistleblower case or sealed qui tam investigation, our False Claims Act defense lawyers can help protect both the company and the individuals involved.The government, or a whistleblower on its behalf, can seek treble damages and substantial per-claim penalties for false claims submitted to Medicare. Civil cases do not require proof of intent to defraud at the same level as a criminal case, and they do not carry a risk of prison, but a civil judgment can still be financially devastating and can trigger permissive exclusion from federal health programs.
Criminal exposure arises under 18 U.S.C. § 1347 and related statutes, including the Anti-Kickback Statute and health care fraud conspiracy charges. Criminal cases require the government to prove the provider acted knowingly and willfully. A conviction can carry felony consequences, prison time, and mandatory exclusion.
Continuing the Medicare Fraud Defense Attorney article body from where it cut off:
It is common for the Department of Justice to pursue a matter civilly against some individuals or entities while pursuing others criminally out of the same set of facts. Whether a case stays civil or crosses into criminal territory often depends on how the provider and their counsel respond early on.
The penalties tied to a Medicare fraud conviction extend well past a courtroom sentence.
Criminal penalties under 18 U.S.C. § 1347 include imprisonment of up to 10 years, increasing to up to 20 years if the offense results in serious bodily injury, and up to life if it results in death. Fines, mandatory restitution to Medicare, and forfeiture of fraud proceeds typically accompany a conviction.
Program exclusion is often the consequence that ends a career even after a sentence is served. Under 42 U.S.C. § 1320a-7, HHS-OIG can exclude a provider from Medicare, Medicaid, and every other federal health care program. Mandatory exclusion applies automatically to certain convictions, including program-related crimes and felony health care fraud, and generally lasts a minimum of five years. Permissive exclusion gives OIG discretion to exclude for a broader range of conduct, including license loss or lesser offenses. Once excluded, no federal health program can pay for services a provider furnishes, orders, or prescribes, which as a practical matter forces most providers out of a federal-program-dependent practice entirely.
Licensing consequences follow separately. State medical, nursing, and pharmacy boards routinely open their own proceedings after a federal fraud allegation or conviction, independent of anything the Department of Justice does.
Business and reputational impact rounds out the exposure. Referral relationships, hospital privileges, payer contracts, and malpractice coverage can all be affected once an investigation becomes public, sometimes before any charges are filed.
If a Medicare fraud case ends in a federal conviction, the sentence isn’t set by the statutory maximum alone. It’s set by the U.S. Sentencing Guidelines, and specifically by the general fraud guideline at USSG §2B1.1. Medicare fraud convictions, like other federal health care fraud convictions, are sentenced under this same guideline used for financial fraud generally.
Understanding how that guideline actually works is often more important to a provider’s real-world exposure than the charge itself.
Every fraud case starts at a base offense level of 7. From there, the guideline adds points for specific offense characteristics, and those points stack on top of each other.
A case that looks minor on paper, a base level of 7, can climb into the twenties once these enhancements stack. That difference isn’t measured in months. It’s often the difference between a lower-security sentence and a much longer one.
Loss amount is the single biggest driver of a fraud sentence. Under the guidelines, crossing certain loss thresholds adds levels in fixed steps that get steeper as the dollar figure grows.
One distinction matters more than any other: actual loss versus intended loss. The government can seek credit for what a provider intended to bill Medicare, not just what Medicare actually paid out. A billing scheme that was caught early, or that only partially succeeded, can still be scored using the higher intended-loss figure if the government can show that was the target.
This enhancement shows up often in Medicare fraud cases, and it doesn’t require anything close to a criminal mastermind. Courts applying the sophisticated-means enhancement have found that moving money between multiple accounts to mask where it came from can be enough on its own, even without any real technical complexity to the underlying scheme.
There are ways to push back on it:
If the underlying conduct was routine, the enhancement shouldn’t automatically apply.
Victim-count enhancements can move a sentence as much as the loss amount does. Ten or more victims adds levels; fifty or more adds more.
The guideline’s definition of “victim” is broad, and in a Medicare case that can sweep in individual beneficiaries as well as the program itself. That breadth cuts both ways. It also means the list the government relies on is worth checking line by line, for duplicate entries, beneficiaries whose claims were already reimbursed, or losses actually tied to something else, like a UPIC finding rooted in a documentation issue rather than a fraudulent claim.
The government’s loss number doesn’t come down from anywhere official. It’s a spreadsheet, built on assumptions, and every one of those assumptions can be tested.
Areas worth examining closely in a Medicare fraud case include:
A $50,000 reduction in the loss figure sounds small next to a multi-million-dollar Medicare billing dispute. In sentencing terms, it can mean years.
The following is a hypothetical, built only to show how the math works. It is not a real case or client result.
Imagine a Medicare billing scheme involving $300,000 in fraudulent claims, built on a pattern of upcoding and billing for services at an inflated frequency. The base offense level is 7. A $300,000 loss amount adds 12 levels under the guidelines, putting the offense level at 19. Add 2 levels for a sophisticated-means enhancement tied to how the billing entity moved reimbursements between accounts, and 2 more levels because the claims involved more than 10 Medicare beneficiaries, and the offense level reaches 23.
At Criminal History Category I, that lands in a 46-to-57-month guideline range, before any credit for acceptance of responsibility or a successful challenge to an enhancement.
Now suppose defense counsel successfully challenges the sophisticated-means enhancement and the client receives credit for acceptance of responsibility. Litigating that one enhancement, combined with acceptance of responsibility, can bring the offense level down to roughly level 18 or 19, a meaningfully lower guideline range. This is exactly why the sentencing math, not just the underlying facts, is worth fighting over.
We regularly see the same missteps compound an already serious situation.
Two of these mistakes deserve extra attention because they tend to compound the fastest.
Destroying or altering billing and medical records doesn’t make a billing problem go away. It creates a second problem, obstruction, that is often easier for the government to prove than the underlying billing issue, because investigators can show what existed, what was removed, and when it happened. Preserved records, produced strategically through counsel, can become leverage. Destroyed records almost never do.
The other mistake is treating silence as safety. Investigations move quietly long before a provider knows one is underway. Billing data gets pulled, financial records get reviewed, and staff get interviewed while the practice keeps operating as usual. By the time it feels real, the government is often much further along than the provider realizes.
If you are unsure whether a letter, audit, or visit requires a lawyer, treat it as though it does until you’ve had it reviewed. The cost of that call is far lower than the cost of the wrong response.
Our approach depends on where a matter stands when we’re brought in, and we’d rather get involved before a problem becomes a subpoena. Investigations today start with data, not a disgruntled employee, and by the time a provider learns one exists, investigators may already be reviewing years of billing records. Providers who bring in counsel early to review billing practices and shore up compliance are in a materially different position than those who wait for a letter to arrive.
Before formal contact. We help providers respond to internal audit findings, RAC or UPIC record requests, and payer inquiries in a way that limits exposure and documents good-faith compliance efforts.
At the subpoena or CID stage. We manage the document production, communicate with the U.S. Attorney’s Office or OIG on the client’s behalf, and work to understand the government’s theory before our client says a word.
During the investigation. We work to keep matters on a civil track where the facts support it, negotiate the scope of records requests, and prepare clients and staff for any interviews that do occur.
If charges are filed. We build a defense around intent, documentation, and the government’s data, since most Medicare fraud cases rise or fall on whether the government can prove knowing and willful conduct rather than a coding disagreement.
On exclusion and licensing matters. We pursue reinstatement applications and respond to state board proceedings that often run in parallel with the federal case.
The Department of Justice has also shifted who it targets in health care fraud matters. For years, the focus stayed largely on the practice or corporate entity. Increasingly, the government focuses on the individuals who approved the billing practices at issue: physicians, office managers, and executives. That shift changes how we think about individual versus practice exposure from the start of an engagement.
It also changes how we think about self-disclosure. Coming forward before the government finds a billing issue independently isn’t about beating a deadline. It’s about who controls the conversation. Once investigators find a problem on their own, a provider is reacting to the government’s narrative instead of shaping it. We help clients get a realistic assessment of that timing question before it’s decided for them.
We do not promise outcomes, and no responsible attorney should. What we bring is direct experience with how these cases are built and prosecuted, from the inside of the U.S. Attorney’s Office to the defense table.
Medicare fraud is a federal crime under federal law, which means it is prosecuted the same way whether a provider practices in a major metro area or a small town, and it means providers anywhere in the country can rely on attorneys with deep federal court experience rather than searching for someone admitted only in their home state.
Russell Lorfing, Managing Partner, is a former Assistant U.S. Attorney who was designated a Cyber Hacking Intellectual Property Prosecutor by the U.S. Attorney’s Office in 2017. He has trained federal agents and prosecutors for the FBI, IRS, DEA, and DOJ, and he is recognized nationally for his work on white-collar investigations involving the IRS, Homeland Security, and the FBI. He serves as 2024 Co-Chair of the Federal Criminal Defense Committee for the Texas Criminal Defense Lawyers Association and is admitted to practice in Texas, Washington D.C., the Fifth Circuit, the Northern, Western, and Southern Districts of Texas, and the United States Supreme Court.
Trey Keith, Founding Partner, has spent more than 20 years defending clients accused of federal and state crimes, including securing not-guilty verdicts in money laundering cases.
Hon. E. Scott Frost (Ret.), Of Counsel, brings more than 30 years of federal courtroom experience to case strategy from the bench’s perspective.
That combination, a former federal prosecutor who trained the agencies now conducting these investigations, a trial attorney with two decades of federal defense experience, and a retired federal judge, gives clients insight into how the government builds a Medicare fraud case and how to respond to it.
Our broader team adds to that bench: former federal prosecutors, former federal public defenders, former FBI agents, and former IRS criminal investigators, alongside our retired federal judge. We’ve drawn on that combined experience to work with healthcare organizations and physicians nationwide on reviewing billing practices, strengthening compliance systems, and engaging strategically with investigators when Medicare billing questions come up.
If you’ve been contacted about a Medicare billing issue, schedule a consultation before you respond to the government. We also handle related matters including Healthcare Fraud Defense, Medicaid Fraud Defense, and False Claims Act & Qui Tam Defense.
What's the difference between a billing error and Medicare fraud?
Fraud requires knowing and willful intent to obtain money through false or fraudulent claims. A documentation gap, a coding mistake, or a good-faith interpretation of a coverage rule is a compliance issue, not a crime, unless the government can show the provider knew the claim was false and submitted it anyway.
I received a UPIC or ZPIC audit letter. Does that mean I'm being criminally investigated?
Not necessarily, but it should be taken seriously. UPIC audits are civil administrative reviews, but an unfavorable finding can be referred to OIG, the FBI, or the DOJ for further investigation. We recommend involving counsel as soon as an audit letter arrives, not after the results come back.
Can I be prosecuted for Medicare fraud if I didn't intend to defraud anyone?
Criminal liability under 18 U.S.C. § 1347 requires proof of knowing and willful conduct. Civil liability under the False Claims Act has a lower intent standard and can apply to reckless disregard of a claim’s truth or falsity, which is why civil exposure is often broader than criminal exposure for the same conduct.
What should I do if I receive a subpoena or Civil Investigative Demand?
Contact an attorney before producing documents or answering questions. How a subpoena response is handled, including what records are gathered and how communications with staff are managed, can affect whether a matter stays civil or escalates.
Can a civil Medicare fraud case turn into a criminal case?
Yes. The Department of Justice regularly evaluates the same conduct for both civil and criminal liability, and a case that starts as a civil audit or whistleblower complaint can be referred for criminal review if the evidence supports it.
What is exclusion from federal health care programs, and how long does it last?
Exclusion under 42 U.S.C. § 1320a-7 bars a provider from billing Medicare, Medicaid, or any other federal health program. Mandatory exclusions, which apply to certain convictions including felony health care fraud, generally last a minimum of five years. Permissive exclusions vary in length based on OIG’s discretion and the underlying conduct.
Do I need a lawyer if I'm confident the audit was just a billing error?
Even confident, well-documented providers benefit from counsel managing the response. Investigators are building a record, and an unrepresented response can create ambiguity that gets read against the provider later.
How quickly should I contact a defense attorney after being contacted by investigators?
Immediately, and before responding substantively to any request for records or an interview. Early involvement gives an attorney the ability to shape the response to a subpoena or agent inquiry rather than clean up after one.
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
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Early strategic intervention can significantly impact the course of a federal investigation. Contact our investigations team for a confidential consultation.