Civil Healthcare Fraud Defense Attorney | Medicare & Medicaid Fraud Lawyers

Facing a Medicare fraud investigation or health insurance fraud allegations? When federal investigators, state agencies, or insurance companies target your medical practice with fraud charges, you need experienced civil healthcare fraud defense lawyers who can resolve the matter administratively and prevent escalation to criminal prosecution.

At Hendershot Cowart P.C., our Texas-based healthcare fraud attorneys have defended healthcare providers against civil fraud allegations for over 35 years. We focus on resolving Medicare fraud investigations, False Claims Act cases, and regulatory enforcement actions before they become criminal matters.

Our federal healthcare fraud defense attorneys represent medical providers throughout the United States in healthcare fraud investigations involving Medicare, Medicaid, TRICARE, and private insurance programs.

Call (713) 783-3110 or contact us online to speak with a healthcare fraud lawyer immediately.

Nationwide Healthcare Fraud Defense Services

Our healthcare fraud lawyers defend against all types of civil medical fraud and health insurance fraud allegations:

Federal Healthcare Regulatory Defense

• False Claims Act Violations: Defense against civil False Claims Act investigations or enforcement actions
• Anti-Kickback Statute Violations: Defending against illegal referral and kickback allegations
• Stark Law Violations: Physician self-referral law compliance and defense
• OIG Investigations: Department of Health and Human Services (HHS) Office of Inspector General (OIG) healthcare fraud investigations
• DME Fraud: Durable medical equipment fraud and abuse defense for suppliers and providers
• EKRA Defense: Eliminating Kickbacks in Recovery Act investigations, usually led by the Department of Justice
• Telemedicine Fraud: Telehealth billing compliance and fraud defense
• FDA Investigations: Defending fraud claims involving prescription drugs, medical devices, and other FDA-regulated products

Medicare and Medicaid Audit and Investigation Defense

• Medicare Fraud: Defending against audits and investigations into improper billing, upcoding, and unnecessary services allegations
• Medicaid Fraud: State and federal Medicaid fraud investigations and prosecutions, including defense for dental professionals
• TRICARE Audit Defense: Military healthcare fraud defense for providers serving veterans
• Medicare Audits: Legal guidance through document requests and audits by RACs, MACs, SMRCs, and other Medicare contractors
• UPIC Audits and Investigations: Unified Program Integrity Contractor (such as Qlarant and Noridian) investigations (formerly ZPIC)
• Medicare Recoupment: Overpayment recovery defense and appeals
• Medicare Exclusions: Preventing Medicare/Medicaid exclusions and applying for reinstatement by the OIG
• Medicare Billing Privileges: Revocation defense and appeals 
• Enrollment Denials: Medicare enrollment denial appeals and provider enrollment

Texas Healthcare Compliance & Regulatory Defense

• Texas Health and Human Services Defense: Investigation defense and regulatory compliance
• Texas Medical Board Investigations: Medical license defense in response to patient complaints of regulatory violations
• Texas Board of Nursing: License defense and protection
• Texas Medicaid Fraud Unit: Defending against Medicaid fraud investigations into prescription fraud, dental fraud, home health agencies, etc.
• MCO Fraud Investigations: Defense for Medicaid fraud investigations by Managed Care Organizations

Private Insurance Investigations and SIU Audits

• Private Health Insurance Fraud Claims: Defending against allegations of private health insurance fraud or abuse
• Record and Documentation Requests: Responding to requests for records from private payors, often the first step in an SIU investigation
• SIU Investigations: Commercial insurance fraud allegations and investigations
• Recoupment Demands: Private payor recoupment defense and appeals

Who We Defend in Healthcare Fraud Cases

Our healthcare fraud attorneys represent medical professionals and healthcare entities facing civil fraud allegations nationwide:

Healthcare Providers:

• Individual physicians and specialists
• Psychiatrists and behavioral health providers 
• Physician groups and medical practices
• Nurse practitioners and physician assistants
• Pharmacists
• Dentists
• Physical therapists and occupational therapists 

Healthcare Practices and Businesses:

• Durable medical equipment (DME) companies
• Pain management clinics 
• Urgent care centers 
• Pharmacies and compounding pharmacies
• Hospitals and health systems
• Ambulatory surgery centers
• Long-term care facilities and home health agencies
• Medical device manufacturers
• Diagnostic testing facilities and laboratories
• Medical billing companies
• Concierge medicine practices 
• Telemedicine providers

Civil vs. Criminal Healthcare Fraud

We represent healthcare providers and businesses facing:

• Civil False Claims Act investigations and qui tam lawsuits
• Administrative audits and overpayment demands
• Civil Investigative Demands (CIDs) from federal agencies
• State Medicaid civil fraud investigations
• Civil monetary penalties and exclusion proceedings
• Voluntary self-disclosure processes

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.

Why Choose Our Healthcare Fraud Lawyers

Since 1987, the attorneys at Hendershot Cowart P.C. have represented thousands of individuals and companies in complex and high-stakes audits, investigations, and other civil and administrative proceedings at both the state and federal levels.

Our experience includes:

• Medicare and Medicaid fraud investigations
• False Claims Act qui tam whistleblower lawsuits
• OIG Civil Investigative Demands and civil monetary penalty proceedings
• Anti-Kickback Statute and Stark Law violations
• Private insurance fraud and SIU investigations
• Multi-million-dollar settlement negotiations
• Medical license defense coordination
• Medicare exclusion prevention and reinstatement

We understand the importance of early intervention when it comes to resolving medical fraud claims as quickly as possible, mitigating your exposure to penalties, and preventing audits or civil investigations from being referred for criminal prosecution.

Regulators, auditors, and others who initiate healthcare fraud actions are highly sensitive to spotting inconsistencies and unusual patterns, and aggressive in pursuing potential violations. They also work to stay a step ahead: When agencies come knocking on your door, chances are they have already invested significant time investigating your case.

Speak with an attorney as soon as possible after receiving notice of any action, audit, or medical fraud investigation. Acting quickly to establish lines of communication with the investigating body is critical.

Civil Healthcare Fraud Defense: Our Approach 

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.

Healthcare Fraud Investigation Process

When federal agencies investigate healthcare fraud, the process typically involves:

1. The Initial Trigger: Government contractors flag unusual billing patterns, whistleblowers file a report, or a patient or family member files a complaint
2. Data Analysis: Sophisticated software identifies potential fraud indicators
3. Document Requests: Subpoenas for medical records and billing documentation
4. Interviews: Government agents interview staff and patients
5. Expert Review: Medical experts evaluate the care provided and billing practices
6. Prosecution Decision: Agencies decide whether to pursue civil or criminal charges

What Triggers Healthcare Fraud Investigations?

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

Common Investigation Triggers

• 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

What to Do When You're Under a Healthcare Fraud Investigation

If you've been contacted by federal or state investigators, insurance SIU investigators, or received legal demands related to healthcare fraud, take these critical steps immediately:

1. Do Not Speak to Investigators Without Legal Counsel. 

Even if agents say you're only a witness or "not the target," anything you say can and will be used against you.

What to say instead:

"I'd like to cooperate, but I need to speak with my attorney first. Please provide your contact information, and I'll have my attorney reach out to you."

Our civil defense attorneys handle all communications with investigators, protecting you from self-incrimination while demonstrating appropriate cooperation.

2. Do Not Destroy or Alter Documents

Document destruction during an investigation constitutes obstruction of justice, a separate federal crime. 

Preserve all records, including: 

• Billing records and claims submissions 
• Medical records and patient documentation 
• Communications with referral sources 
• Financial arrangements and contracts 
• Email, text messages, and electronic records

3. Contact a Civil Healthcare Fraud Defense Attorney Immediately

The earlier we engage, the more options we have to prevent criminal referral and negotiate a favorable civil resolution.

While our office is based in Houston, Texas, our civil healthcare fraud attorneys handle Medicare and Medicaid fraud investigations, False Claims Act cases, and administrative proceedings throughout the United States.

If you've been contacted about a Medicare fraud investigation, call (713) 783-3110 or contact us online for immediate guidance.

Time-Sensitive. Confidential. Immediate Action Required.

Don't face healthcare fraud allegations alone. The sooner you contact our healthcare fraud attorneys, the better we can protect your practice, reputation, and resolve matters civilly before they escalate.

Our healthcare fraud lawyers are available immediately to discuss your case and begin your defense. We handle healthcare fraud matters throughout the United States.

Call (713) 783-3110 now or contact us online 24/7 for a confidential consultation.