If you are a doctor facing federal criminal charges, you need experienced lawyers immediately. Our team includes federal lawyers who understand the government's playbook from the inside. We know how federal agents will work on building healthcare fraud cases against physicians, and we know how to defend against them. When your life, reputation, and livelihood is on the line, you need federal lawyers who understand how to defend doctors against federal prosecution

What Does Federal Healthcare Fraud Prosecution Mean for Doctors Facing It?

If you are a doctor under federal investigation, you need to understand that healthcare fraud prosecutions is one of the government's highest priorities. The Fifth Amendment to the Constitution guarantees your right against self-incrimination, and the Sixth Amendment ensures your right to counsel (we discuss the importance of invoking these rights immediately, below). In plain English, this means that when federal agents come knocking—whether it's the FBI, OIG-HHS, or DEA—you have Constitutional rights that can mean the difference between keeping your medical license and spending years in federal prison.

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Table of Contents

1. What is Federal Healthcare Fraud?
2. Understanding Your Target Letter
3. What Does It Mean to Receive a Federal Grand Jury Subpoena?
4. Do I Need to Comply with Federal Investigators?
5. What to Expect After Being Indicted
6. Strategies for Defending Your Medical Practice
7. How Does Federal Sentencing Work for Healthcare Fraud?
8. Why Do Clients Trust Harrison Defense Group?

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What is Federal Healthcare Fraud?

Federal healthcare fraud covers a broad range of alleged criminal conduct that can involve submitting false claims to government healthcare programs. This includes Medicare fraud, Medicaid fraud, and violations of the Anti-Kickback Statute (42 U.S.C. § 1320a-7b). Understanding that healthcare fraud prosecutions usually involve multiple federal statutes is important when you're rtying to build an effective defense strategy. When you bill Medicare or Medicaid, you are making claims to the federal government about services you rendered. The government takes the position that any false statement—irrespective of whether it was intentional—can form the basis for criminal charges. This is why mechanical compliance with billing procedures needs to be taken seriously by every practicing physician. Healthcare fraud affects not just individual doctors but entire medical practices. In essence, the government views healthcare fraud as theft from taxpayer-funded programs that serve vulnerable populations. That being said, the line between aggressive billing and criminal fraud is often blurrier than prosecutors would have you believe.

Understanding Your Target Letter

If you receive a target letter from the U.S. Attorney's Office, it means that prosecutors have identified you as the target of a Grand Jury investigation. A federal target letter is designed to notify you that you are under investigation for federal crimes (which can include 18 U.S.C. § 1347 healthcare fraud, 18 U.S.C. § 1343 wire fraud, or 18 U.S.C. § 1001 false statements). There are three categories of individuals in federal investigations:

1. Witness - Someone who has inf relevant to the investigation
2. Subject - Someone whose actions are within the scope of the investigation
3. Target - Someone who prosecutors believe has committed federal crimes

Upon being listed as a target, your risk of indictment increases substantially. Target letters often come before indictments by only a matter of weeks or months. The government's choice to send you a target letter means that prosecutors believe they have substantial evidence against you (or, as is often the case, they are trying to pressure you into cooperation).

What Does It Mean to Receive a Federal Grand Jury Subpoena?

A federal grand jury subpoena demands you to appear before a Grand Jury or give up documents. There are two types: Subpoena ad testificandum - This forces you to testify before the Grand Jury. If you are a target of the investigation, testifying without immunity is almost always a mistake. The Fifth Amendment protects your right to remain silent. Subpoena duces tecum - This forces you to produce documents and files. Compliance with a subpoena duces tecum can be a time-consuming process that requires careful attention to detail. Grand jury secrecy is very important, the government takes this seriously. Federal Rule of Criminal Procedure 6(e) prohibits disclosure of grand jury proceedings, but this applies primarily to the government—not to witnesses or targets. Nonetheless, discussing your testimony can sometimes backfire strategically.

Do I Need to Comply with Federal Investigators?

When federal agents arrive at your office or home, you have three options available to you. Each option carries different risks and benefits: Comply with the feds. Full cooperation might seem like the path of least resistance, but speaking to federal agents without your lawyer present is dangerous. Remember that 18 U.S.C. § 1001 makes it a federal crime to make false statements to federal agents—even if you're not under oath. Challenge the feds. You can challenge subpoenas on various grounds. Potential grounds include:

• The subpoena is overly broad or unduly burdensome
• Attorney-client privilege or work product protection
• Constitutional violations
• Lack of relevance to legitimate investigation

Ignore the feds. This is a mistake. Ignoring federal investigators or subpoenas will result in contempt proceedings and potentially obstruction of justice charges under 18 U.S.C. § 1512. It is not uncommon for physicians to believe that cooperation will make the investigation go away. In such a case, doctors often provide statements that later form the basis for additional charges. Accordingly, the decision whether to cooperate needs to be made with experienced counsel who knows the government's playbook.

What to Expect After Being Indicted

If you are indicted for federal healthcare fraud, the following will occur:

1. Arrest and Initial Appearance - Within 24-48 hours of indictment, federal agents will arrest you. The Pretrial Services Office will interview you to determine conditions of release.
2. Arraignment - You will enter a plea of not guilty. The Court will set initial deadlines and potentially modify your release conditions.
3. Discovery Process - The government must produce its evidence against you. In healthcare fraud cases, this often includes thousands of patient files, billing records, and email communications.
4. Motion Practice - Your attorney will file pretrial motions challenging evidence, seeking dismissal of charges, or limiting the government's case.
5. Plea Negotiations - Over 95% of federal cases resolve through plea agreements. Understanding when to negotiate versus when to fight is crucial.
6. Trial Preparation - If your case proceeds to trial, preparation typically takes 6-12 months. Healthcare fraud trials are document-intensive and require extensive expert testimony.
7. Sentencing - Federal sentencing guidelines for healthcare fraud are harsh. The loss amount (alleged fraudulent billings) drives the guideline range.
8. Appeal - If convicted, you have the right to appeal both conviction and sentence to the Circuit Court of Appeals.

At this point, your medical license will also be in jeopardy. State medical boards typically initiate administrative proceedings upon federal indictment. Fighting on multiple fronts requires coordinated strategy.

Strategies for Defending Your Medical Practice

Successful defense of healthcare fraud charges requires a three-pronged approach: Develop comprehensive defense strategy immediately upon learning of investigation. This includes:

• Conducting internal audit to identify vulnerabilities
• Preserving all relevant documents and communications
• Identifying potential witnesses who can support your position
• Engaging healthcare billing experts early

Document preservation is critical. The government will look at any destruction of records as potential obstruction. You need to:

• Issue litigation hold to all staff
• Preserve electronic data including emails and text messages
• Maintain patient files in their original form
• Gather and prepare exculpatory evidence

Trial preparation in healthcare fraud cases is intensive. Successful clients:

• Work closely with attorneys to understand every billing decision
• Help identify medical necessity for questioned procedures
• Provide context for treatment decisions that prosecutors mischaracterize
• Remain disciplined about communications during investigation

As mentioned above, the government's theory often relies on statistical analysis that ignores legitimate medical judgment. Your defense needs to humanize the care you provided and demonstrate that billing decisions reflected actual treatment—not fraudulent intent.

How Does Federal Sentencing Work for Healthcare Fraud?

Federal sentencing for healthcare fraud follows the United States Sentencing Guidelines. The primary factor is loss amount—meaning the total dollar value of allegedly fraudulent claims submitted. Understanding that loss calculations often become a battle of experts is important for strategic planning. Base offense level for healthcare fraud starts at level 6 but increases dramatically based on:

• Loss amount (every $550,000 adds 2 levels)
• Number of victims (over 10 victims adds 2 levels)
• Sophisticated means (+2 levels)
• Abuse of position of trust (+2 levels)

Why would judges impose harsh sentences? Federal judges view healthcare fraud as stealing from programs designed to help the elderly and indigent. That being said, effective advocacy can result in significant departures or variances from guideline ranges. Sentencing advocacy needs to begin early. Character letters, demonstration of community service, and evidence of legitimate medical practice can humanize you before the Court. It is important to understand that federal judges have discretion to vary from guidelines—but only if given compelling reasons.