Category Archives: Healthcare Fraud
Pharmacy Compounding And Prescribing Patterns In Prescription Scheme Cases
Compounded medication can be prescribed for reasons that begin and end with patient care. A patient may need a medication without an ingredient that caused a reaction. Another may need a topical preparation after oral medication led to side effects. In a medical practice, those decisions can reflect ordinary clinical judgment rather than any… Read More »
Cosmetic Medicine And Cash-Based Practices Can Create Unexpected Federal Fraud Risks
Cosmetic medicine often runs on a private-pay rhythm. Patients choose aesthetic care expecting to pay directly, finance the procedure, or use a package purchased through the practice. Because many of these services are elective, a physician-owned med spa or cosmetic surgery office may not expect the same fraud scrutiny that follows Medicare, Medicaid, or… Read More »
The Signature You Can’t Take Back
Telehealth Orders, Signed Certifications, and Federal Fraud Exposure A note for physician clients on the criminal risk in signing telemedicine orders and prescriptions For a physician, signing a doctor’s order can feel like the smallest act of the day. The patient information is already filled in, the equipment is already selected, and all that… Read More »
When “Medically Unnecessary” Becomes a Federal Crime
What Physicians Should Understand About Medical Necessity as a Theory of Criminal Liability A note for physician clients on how medical-necessity-based prosecutions work and where the real exposure lies Every physician makes judgment calls about what a patient needs. A brace, a cardiac workup, a wound graft, a genetic test: these decisions turn on… Read More »
You’re a Data Point Now – How CMS Analytics Identifies Physicians Before an Investigation Begins
A note for physician clients on the shift to data-driven healthcare fraud enforcement In May 2026, a federal jury in Los Angeles convicted a Glendale physician of a $45 million Medicare fraud scheme built around Botox injections. What should arrest the attention of every practicing physician is not the size of the loss. It… Read More »
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 »
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 »
“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 »
