Author Archives: Jay Butchko
Defending Against Stark Law And AKS Charges: Key Strategies In Complex Regulatory Criminal Cases
Healthcare fraud prosecutions involving the Stark Law and the Anti-Kickback Statute rarely begin with a simple accusation. They usually develop from years of physician contracts, referral relationships, ownership interests, medical director agreements, consulting payments, lease arrangements, laboratory referrals, durable medical equipment orders, or compensation formulas that prosecutors later claim were designed to reward patient… Read More »
From Audit To Indictment: How Routine Billing Reviews Escalate Into Criminal Cases
Many healthcare providers assume that billing audits are administrative matters. A request for records from Medicare, a Recovery Audit Contractor (RAC) review, or a dispute with a commercial insurer is often viewed as a compliance issue rather than a legal threat. In many situations, that assumption is correct. Audits are a routine part of… Read More »
The Right To Remain Silent In Florida: How To Use It And When It’s Misunderstood
“You have the right to remain silent.” Virtually everyone recognizes this phrase from popular media, yet many Floridians misunderstand its critical importance in criminal proceedings. This constitutional protection is designed to safeguard individuals from self-incrimination, but improper invocation can unintentionally empower prosecutors. Given the potentially severe consequences of a misunderstanding or misapplication of your… Read More »
How Whistleblower Claims Lead To Embezzlement Prosecutions
Whistleblower complaints inside a company can begin as an internal workplace dispute, a disagreement over accounting practices, or a report to human resources about suspicious financial activity. Once the complaint suggests missing funds, altered records, unauthorized transfers, or misuse of company accounts, the matter can move quickly from internal review to criminal investigation. For… Read More »
Defending Against Retrial: When Does Double Jeopardy Bar A Second Prosecution?
A few moments in a criminal case can feel as exhausting as learning that the prosecution wants a second trial. A defendant may have already endured months or years of investigation, pretrial litigation, jury selection, witness testimony, and the emotional strain of trial. When a case ends without a clean acquittal, prosecutors may decide… Read More »
Durable Medical Equipment (DME) Cases: How Physicians Get Pulled Into Supplier Fraud Investigations
Federal healthcare fraud investigations involving durable medical equipment (DME) have become a recurring feature of Department of Justice enforcement initiatives. Large-scale prosecutions routinely target companies that market, distribute, and bill for orthotic braces, wheelchairs, diabetic supplies, and other medical equipment. Yet many of these investigations do not stop with the suppliers themselves. Physicians who… Read More »
How Federal Wiretap Orders Work: Probable Cause, Minimization, And Defending Against Electronic Surveillance
Federal wiretap evidence can change the entire direction of a criminal case. A recorded call, intercepted text, or monitored electronic communication gives prosecutors the ability to place a defendant’s own words at the center of the case. For the person accused, the pressure can feel immediate and unforgiving because the government is not relying… Read More »
“Incident-To” Billing Violations: When Supervision Gaps Become Federal Fraud Allegations
“Incident-to” billing under Medicare can be a legitimate and efficient way for physician practices to deliver care through nurse practitioners, physician assistants, and other qualified staff while billing under a supervising physician’s provider number. But the rules are technical, the supervision requirements are strict, and small misunderstandings can carry outsized consequences. In today’s enforcement… Read More »
Laboratory Referral Schemes: Defending Physicians In Toxicology And Genetic Testing Investigations
Federal enforcement efforts have increasingly focused on laboratory referral arrangements, particularly in the areas of toxicology screening and genetic testing. What often begins as a seemingly legitimate clinical workflow, such as ordering tests to diagnose, monitor, or guide treatment, can be reframed by prosecutors as part of an unlawful referral scheme. Physicians who rely… Read More »
Phantom Billing Allegations: Defending Against Claims Of Services Never Rendered
Among the most serious accusations a healthcare provider can face is “phantom billing,” which is the claim that services were billed to Medicare or other payors but never actually provided. Unlike disputes over medical necessity or coding interpretation, phantom billing allegations strike at the core of a provider’s integrity. Prosecutors often present these cases… Read More »
