False Claims Act

Legal Considerations for Healthcare Billing

Published on: April 25, 2025 | By Conaway & Strickler, P.C.

Billing to the United States government presents a unique set of legal requirements for healthcare professionals. Physicians who participate in federal healthcare programs like Medicare and Medicaid are subject to strict billing regulations. Even inadvertent errors can lead to severe legal consequences, including criminal charges. Understanding these laws and the potential risk of noncompliance is crucial for healthcare providers.

When the federal government is paying for items or services rendered to Medicare or Medicaid beneficiaries, federal fraud and abuse laws apply. Healthcare professionals influence what services patients receive and are responsible for the documentation of those services. That documentation is the basis for bills sent to insurers, and ultimately, the Government’s payment of a beneficiary’s medical claims.

If a physician knew or should have known that the submitted claim was false, the attempt to collect unearned money constitutes a violation. Federal fraud and abuse laws include the following:

Deferred Prosecution Agreements in the Health Care Field

Published on: March 8, 2025 | By Conaway & Strickler, P.C.

The federal government may target organizations and businesses as well as individuals for violations of federal criminal statutes. For example, in the health care realm, cases can include office managers, practitioners from doctors, nurses to pharmacists to all other aspects of the medical industry. Recent federal investigations have targeted pill mills, medicaid fraud, and accepting kickbacks among others.

Experienced federal criminal defense attorneys like those at Conaway & Strickler, PC may suggest early on about the possibility of entering into a “deferred prosecution agreement” which is essentially a contract with the Department of Justice. DPAs are frequently used in cases involving corporate fraud, bribery, and antitrust violations. These pretrial agreements may involve an admission of wrongdoing, the payment of fines, and the implementation of compliance measures. Charges may be dropped if the defendant complies with the requirements of the agreement. Generally, the Assistant United States Attorney will file the criminal complaint and the DPA with the court, so it is of public record. This will be accompanied by a formal request to the court that any prosecution be delayed according to the terms of the DPA, allowing the defendant to fulfill its agreed-upon actions. This is very similar to conditional discharge / pre trial diversion agreements found at the state level.

An example of a DPA would be one that was entered in to by the DOJ and Teva Pharmaceuticals USA, Inc in August 2023 in response to the company’s involvement in a price fixing conspiracy involving several pharmaceuticals. As seen in this example, terms can include paying a fine, waiving certain rights, agreeing to a factual basis for the charges, and an agreement to cooperate and compliance monitoring and of course, agreeing to what will happen if there is a breach of the agreement.

What are the current DOJ priorities?

Published on: April 1, 2022 | By Conaway & Strickler, P.C.

Attorney General Merrick Garland made recent comments about what he considered to be the Department of Justice’s top priorities for 2022. Since taking office in March 2021, Garland has tried to combat crime in a tumultuous time. He has been criticized for his handling of January 6 investigation and has stated it’s the most urgent probe in history.

With all of this going on, the US Attorney’s office increased its prosecutions of individuals of white collar crimes in the year 2021. White collar charges like fraud, theft, corruption, bribery, environmental crime, tax fraud, health care fraud, procurement fraud, money laundering, PPP loan fraud, etc will continue to get more attention from the Department of Justice.

What does this mean? It means that investigations of any sort need to be taken seriously and that you should contact a lawyer immediately if any wrongdoing is alleged.

Whistleblower / Qui Tam cases in Health Care

Published on: September 11, 2021 | By Conaway & Strickler, P.C.

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Health Care Qui Tam cases

What does Qui Tam mean?

Qui tam is short for the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which roughly translates to “he who brings an action for the king as well as for himself.”

NEWEST DEVELOPMENTS – PPP Loan Fraud

Published on: February 24, 2021 | By Conaway & Strickler, P.C.

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As we continue to see in the news, many cases are being charged by the Department of Justice for PPP (Payroll Protection Program) issues. There continues to be a lot of confusion out there over the Paycheck Protection Program (PPP). Understandable since information continues to change about how to apply, whether to apply for forgiveness, and the second round of PPP loans being rolled out. Due to the rules and the program itself changing frequently, it is important to not fall under scrutiny by the DOJ.

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The Department of Justice (DOJ) has already charged and convicted many cases of PPP loan fraud. But, the purpose of this post is that, recently, the DOJ announced the first (publicized) civil settlement resolving PPP loan fraud allegations against a company and its owner. The owner and SlideBelts, Inc was required to pay a $100k civil penalty per FIRREA civil penalty provision 12 USC 1833a and the False Claims Act (FCA) 31 USC 3729 in the Eastern District of California. The DOJ continues to be aggressive and swift in bringing criminal charges, but, this is the first public civil settlement. Please see https://www.justice.gov/usao-edca/press-release/file/1352931/download to read it in its entirety.