Healthcare Fraud & Audit Defense Attorneys

Healthcare Fraud Investigation Defense

At Hendershot Cowart P.C., our Texas-based healthcare fraud attorneys have defended healthcare providers against civil fraud allegations nationwide for nearly 40 years. We focus on resolving Medicare fraud investigations, False Claims Act cases, and regulatory enforcement actions before they become criminal matters.

The full roster of federal fraud defense matters we handle: 

• False Claims Act investigations and qui tam whistleblower lawsuits
• Anti-Kickback Statute violations
• Stark Law (self-referral) violations
• OIG Civil Investigative Demands
• DME fraud
• EKRA (Eliminating Kickbacks in Recovery Act) investigations
• Telemedicine fraud
• FDA investigations (compounding pharmacies, medical devices, prescription drugs)
• Compounding pharmacy fraud

Common Healthcare Audit and Investigation Triggers

Healthcare fraud investigations begin when red flags alert federal agencies, state programs, or private insurers to potential violations:

• Data analytics: Billing patterns deviating from peer benchmarks, unusually high service volumes, rapid increases in billing complexity, or aberrant coding
• Whistleblowers: Qui tam lawsuits, employee reports, competitor complaints, or patient allegations
• Audit escalations: RAC, UPIC, or other Medicare contractor audits uncovering systematic issues, significant extrapolated overpayments, or failure to repay within 60 days
• Law enforcement referrals: State Medicaid Fraud Control Units, FBI Healthcare Fraud Task Force, DEA prescription investigations, or medical board complaints
• Private insurance red flags: Special Investigation Unit (SIU) detection of unusual billing patterns, documentation deficiencies, or multi-payer scheme indicators

Our Defense Approach to Healthcare Fraud Investigations

When you contact us about a civil fraud investigation, we immediately:

• Assess criminal risk and implement strategies to keep the matter civil
• Analyze allegations for elements of intent vs. error
• Secure and preserve documentation showing good faith compliance efforts
• Proactively communicate with federal and state agencies
• Recommend voluntary disclosure when appropriate
• Negotiate civil resolutions, including repayment and corrective actions
• Protect your professional licenses and Medicare billing privileges

We work to demonstrate to investigators that issues stem from billing errors, compliance gaps, or misunderstandings – not criminal intent – keeping cases in the civil realm where they can be resolved through repayment, corrective action plans, and administrative remedies.

Medicare & Medicaid Audit Defense

When Medicare contractors audit your practice, immediate action is critical to protect your billing privileges and prevent overpayment demands.

• RAC audits: Recovery Audit Contractors like Cotiviti and Performant audit claims on a post-payment basis using statistical sampling and medical chart reviews
• UPIC audits: Unified Program Integrity Contractor investigations by Qlarant, Noridian, and other UPICs look for high-risk billing patterns
• Medicare audit defense: Comprehensive defense against improper billing allegations and overpayment demands
• Medicaid audit defense: State and federal Medicaid audit defense, including dental fraud investigations and managed care audits by the Texas Attorney General’s Office Civil Medicaid Fraud Division
• TRICARE audits: Military healthcare program audit defense for providers serving veterans and active-duty personnel
• Medicare recoupment: Defending against overpayment recovery demands and recoupment actions
• Medicare payment suspension: Emergency relief from payment holds during investigations into questionable billing patterns or fraud

Medicare Enrollment & Billing Privileges

Loss of Medicare billing privileges can devastate your practice. We help providers maintain and restore their enrollment status.

• Medicare enrollment denial appeals: Appealing CMS enrollment denials and revalidation issues
• Medicare billing privilege revocations and appeals: Restoring your right to bill Medicare after revocation
• Medicare exclusions: Preventing OIG exclusions and defending against List of Excluded Individuals and Entities (LEIE) placement
• Medicare exclusion reinstatement: Applying for reinstatement after exclusion period ends
• Provider enrollment issues: PECOS enrollment problems, revalidation disputes, and enrollment moratoria

Private Insurance & SIU Investigations

Commercial insurance companies conduct aggressive investigations that can threaten your provider contracts and reputation.

• SIU investigations: Special Investigation Unit defense for private insurance fraud allegations
• Commercial insurance audits: Private payor audit defense and documentation review
• Insurance fraud allegations: Defending against allegations of fraudulent billing or unnecessary services
• Private payor recoupment: Overpayment disputes with commercial insurance companies
• Records requests: Strategic response to insurance company document demands and information requests

Medical & Professional License Defense

Your licensing board doesn't work like a court. The process is different, the stakes are just as high, and the outcome affects not just this job – but every job you'll ever have. Protecting your professional license is our top priority when state boards investigate complaints or regulatory violations.

• Texas Medical Board (TMB) defense: Physician license protection during TMB investigations, complaint responses, and board hearings
• Self-reporting arrests, criminal history, disciplinary actions, or adverse peer reviews to licensing boards
• Texas Board of Nursing defense: Nursing license protection and defense against BON investigations
• Physician Assistant license defense: Texas PA board investigation defense and compliance counseling
• Texas Behavioral Health Executive Council defense
• Professional license defense: License protection for all healthcare professionals, including pharmacists, dentists, occupational and physical therapists, and licensed clinical social workers and psychologists
• License suspension and revocation appeals: Emergency relief and appellate representation for suspended or revoked licenses

Don't draft your response alone. Contact us before you submit anything to your licensing board.

Texas Healthcare Regulatory Defense

State agencies conduct investigations that can result in license sanctions, exclusions, and civil penalties.

• Texas Health and Human Services investigations: Texas HHS investigation defense and regulatory compliance counseling
• Texas HHS-OIG self-disclosure protocol: Proactively resolve compliance errors uncovered by internal audits
• Texas Medicaid fraud defense: Defense against Texas Attorney General Medicaid Fraud Control Unit, dental fraud, home health, and pharmacy fraud investigations and prosecutions
• MCO fraud investigations: Managed Care Organization audit defense for Texas Medicaid providers

Who We Represent in Healthcare Audit & License Matters

Most providers we work with aren't fraudsters. They're nurses, physicians, and business owners doing their best in a complex billing environment. We can help you respond correctly, protect billing privileges, and – when possible – reduce or avoid repayment demands altogether.

Our healthcare audit defense attorneys represent medical professionals and healthcare entities nationwide facing fraud allegations or licensing board notices:

Healthcare Professionals:

• Physicians (all specialties) 
• Nurse practitioners and physician assistants
• Dentists and dental practices
• Pharmacies and pharmacists
• Physical therapists and occupational therapists
• Chiropractors and podiatrists
• Licensed clinical social workers (LCSW), psychologists, licensed professional counselors (LPC), and licensed marriage and family therapists (LMFT) 

Healthcare Businesses:

• Durable medical equipment (DME) suppliers
• Physician practices
• Med spas and IV hydration clinics
• Home health agencies
• Hospice agencies
• Long-term care facilities
• Wound care providers
• Diagnostic testing laboratories
• Applied behavior analysis (ABA) providers
• Ambulatory surgery centers (ASC)
• Free-standing emergency departments (FSED)
• Hospitals and health systems
• Medical billing companies

Why Choose Our Healthcare Audit Defense Lawyers

Proven Medicare Audit Defense Experience

Since 1987, our attorneys have represented thousands of healthcare providers in complex Medicare audits, RAC audits, and administrative proceedings at both the state and federal levels. We have successfully:

• Represented hundreds of healthcare practices through the rebuttal and appeals process in MAC or RAC overpayment and recoupment demands 
• Challenged statistical sampling errors, misinterpretations of coverage policy, and demonstrated medical necessity in multi-million-dollar Medicare overpayment demands 
• Prevented Medicare exclusions and restored billing privileges for numerous providers
• Defended Texas Medical Board and Texas Board of Nursing investigations resulting in dismissals or minimal sanctions
• Resolved UPIC investigations without referral to OIG or DOJ

Administrative Law Focus

Unlike criminal defense firms, we focus exclusively on administrative proceedings, audits, and civil matters. We understand:

• Medicare's five-level appeals process
• Administrative law judge (ALJ) hearings
• State medical board procedures
• CMS regulations and coverage policies
• Documentation requirements and medical necessity standards

Texas Medical Board Experience

Our attorneys have extensive experience with Texas Medical Board investigations and have successfully defended physicians against:

• Standard of care violations
• Unprofessional conduct allegations
• Nontherapeutic prescribing claims
• Failure to maintain adequate medical records
• Violations of TMB rules
• Peer review actions

Contact Our Healthcare Audit & License Defense Attorneys

From Records Request to Recoupment Defense – We Handle Every Stage 

Healthcare audits and license investigations move quickly. The sooner we intervene, the better we can protect your practice, billing privileges, and professional license.

Our audit defense attorneys usually respond within 24 hours to schedule an initial consultation to assess your situation and decide on the next steps. We handle audit appeals, license defense matters, and administrative proceedings throughout Texas and nationwide for federal and Medicare matters.

We do not handle criminal defense but work aggressively to keep civil matters from becoming criminal cases. If your case has already been referred for criminal prosecution, we can refer you to qualified criminal defense counsel while continuing to handle the civil and administrative aspects.

Call (713) 783-3110 now or contact us online for immediate assistance.