Healthcare Fraud Defense Attorney

Federal Defense for Medical Professionals and Healthcare Businesses

Arkady Bukh represents physicians, medical professionals, practice owners, healthcare executives and businesses facing federal healthcare fraud investigations and criminal charges.

Healthcare fraud cases may involve Medicare, Medicaid, private insurance claims, medical billing, patient records, prescription activity, referrals, laboratory testing, durable medical equipment and allegations that services were not provided or were not medically necessary.

Representation may begin before formal charges are filed and continue through:

Federal healthcare fraud investigations
HHS Office of Inspector General inquiries
Medicare and Medicaid audits
Target letters and interview requests
Grand jury subpoenas
Search warrants
Requests for medical and billing records
Payment suspensions and account restraints
Pre-indictment negotiations
Indictment and arraignment
Discovery and pretrial motions
Plea negotiations
Federal jury trial
Sentencing
Restitution and asset-forfeiture proceedings
Matters involving professional licensing and program exclusion

A healthcare fraud defense attorney should examine the complete medical and billing process rather than isolated claim data. Important questions may include who provided the services, who selected the billing codes, what the medical records show, whether the provider relied on billing personnel and whether the government can prove knowing and willful participation in fraud.

Who This Attorney Represents

Arkady Bukh represents individuals and organizations involved in federal healthcare investigations, including:

Physicians and surgeons
Dentists and other licensed healthcare professionals
Medical practice owners
Clinic and treatment-center operators
Hospital administrators
Pharmacies and pharmacy personnel
Medical laboratories
Durable medical equipment suppliers
Home health and hospice providers
Behavioral and mental health providers
Telemedicine businesses
Medical billing companies
Healthcare executives and compliance personnel
Employees accused of following improper billing instructions
Investors and business partners in healthcare organizations
International medical professionals facing charges in the United States

The role of each participant must be examined separately. A physician, practice owner, billing employee, outside coding company and referring provider may have different responsibilities and access to information.

A professional title or ownership interest does not automatically establish personal knowledge of every claim submitted by a healthcare business.

What Is Federal Healthcare Fraud?

Federal healthcare fraud generally involves an alleged scheme to defraud a healthcare benefit program or to obtain money or property controlled by such a program through false or fraudulent representations.

The allegations may concern federal programs such as Medicare and Medicaid, as well as private health plans when the conduct falls within federal criminal jurisdiction.

Common allegations include:

Billing for services that were not performed
Submitting claims for medically unnecessary services
Billing for a more expensive service than the one provided
Separately billing services that should have been combined
Submitting duplicate claims
Using inaccurate patient or provider information
Falsifying or altering medical records
Billing under another provider’s identification number
Paying or receiving unlawful referral compensation
Submitting claims based on allegedly improper prescriptions or orders
Concealing the actual owner or operator of a healthcare business
Using patient identities without authorization
Making false statements during an audit or investigation

Not every incorrect or unsupported claim is criminal fraud. Billing errors may result from coding disagreements, incomplete records, misunderstood program rules, software problems or mistakes by employees and outside contractors.

The difference between an improper claim and a criminal case may depend on whether the government can prove that the client knowingly and willfully participated in a fraudulent scheme.

Medicare Fraud Investigations

Medicare investigations may concern services, equipment, testing, medications or other items billed to the federal program.

Investigators may examine allegations involving:

Services that were not rendered
Medically unnecessary treatment
Durable medical equipment
Laboratory and diagnostic testing
Home health services
Hospice care
Telemedicine consultations
Prescription medications
Repeated or unusually high billing
Claims submitted for deceased or ineligible patients
Services allegedly ordered without a valid medical relationship
Kickbacks connected with patient referrals
Billing through multiple related entities

A high billing volume does not by itself prove fraud. The defense may need to compare the provider’s specialty, patient population, services, geographic coverage and documentation with the government’s statistical analysis.

Medicare claims data may identify unusual patterns, but claim data alone may not show why a service was ordered, what occurred during the patient encounter or what information the billing department possessed.

Medicaid Fraud Investigations

Medicaid cases may involve federal authorities, state agencies or both because Medicaid is jointly funded and administered through federal and state systems.

Allegations may concern:

Billing for services not provided
Inflated hours or units of service
Personal care and home health services
Transportation claims
Behavioral health treatment
Dental services
Pharmacy claims
Duplicate billing
Patient eligibility information
Improper use of provider numbers
Claims submitted in violation of state program requirements

State Medicaid rules and billing systems may differ. The defense should identify the precise rule allegedly violated, which person was responsible for compliance and whether the alleged conduct was intentional rather than an administrative or documentation problem.

HHS OIG Investigations

The Office of Inspector General for the U.S. Department of Health and Human Services investigates fraud, waste and abuse involving HHS programs, including Medicare and Medicaid.

An OIG investigation may involve:

Interviews with employees, patients and providers
Requests for billing and medical records
Grand jury subpoenas
Search warrants
Analysis of Medicare and Medicaid claims data
Coordination with federal prosecutors
Coordination with the FBI and other agencies
Review of ownership and financial relationships
Examination of referral and compensation arrangements
Review of prescribing and ordering activity

A provider may first learn of an investigation when OIG agents visit a practice, request an interview or contact current and former employees.

Before participating in an interview, the client should understand the purpose of the meeting, the client’s status and whether a criminal, civil or administrative investigation is underway.

Parallel Criminal, Civil and Administrative Proceedings

A healthcare investigation may lead to several proceedings arising from the same billing activity.

Possible proceedings include:

A federal criminal investigation
A civil False Claims Act case
An administrative audit
A Medicare or Medicaid overpayment demand
Suspension of payments
Revocation of billing privileges
Exclusion from federal healthcare programs
Professional licensing proceedings
Private insurance litigation
Contract termination
A state Medicaid investigation

These proceedings have different legal standards and potential consequences.

A response prepared for an audit or licensing board may later become relevant to a criminal investigation. For this reason, explanations and document productions should be coordinated across all pending matters.

How a Healthcare Fraud Investigation May Begin

Healthcare fraud investigations may continue for months or years before an indictment is filed.

The first indication may be:

A target letter
A grand jury subpoena
A request for a voluntary interview
A visit from OIG or FBI agents
A search warrant
A Medicare or Medicaid audit
A request for patient records
A demand for repayment
Suspension of healthcare-program payments
Revocation or suspension of provider enrollment
Questions directed to employees or patients
Notice that a billing company or business partner is under investigation
Information that a former employee is cooperating with the government
A civil investigative demand
A licensing-board inquiry

By that time, investigators may already possess claims data, bank records, electronic communications, provider-enrollment documents and information from employees or cooperating witnesses.

The client should not assume that an audit is necessarily limited to billing corrections. In some matters, audit findings or produced records may become part of a broader civil or criminal investigation.

Pre-Indictment Healthcare Fraud Defense

Pre-indictment representation begins before a federal grand jury returns formal charges.

At this stage, defense counsel may:

Contact prosecutors and clarify the client’s status
Identify the programs, claims and billing periods under review
Respond to subpoenas and document requests
Coordinate the collection of medical and billing records
Prepare the client for a possible government interview
Advise whether an interview or proffer session is appropriate
Review the execution of a search warrant
Conduct an independent investigation
Interview employees and other relevant witnesses
Preserve favorable records and electronic data
Review claims and patient files
Retain coding, billing and medical experts
Analyze the government’s statistical claims
Present factual or legal information to prosecutors
Address payment suspensions and seized property
Prepare for a possible indictment, arrest or voluntary surrender

Early representation cannot guarantee that charges will be avoided. It may help prevent incomplete productions, inconsistent explanations and decisions made without understanding the criminal and administrative risks.

Grand Jury Subpoenas and Document Requests

A federal grand jury subpoena may require testimony or the production of medical, financial and electronic records.

A request may include:

Patient charts
Electronic health records
Billing and coding data
Claims-submission records
Provider-enrollment documents
Prescriptions and medical orders
Referral records
Contracts with billing companies
Employee records
Ownership documents
Bank statements
Communications with patients and providers
Emails and text messages
Audit records
Compliance policies
Records involving Medicare and Medicaid payments

A subpoena should not be ignored. Before responding, counsel should determine:

Which records are covered
Whether the deadline is reasonable
Where electronic information is stored
Whether patient privacy rules affect the production
Whether documents are protected by privilege
Whether the request can be clarified or narrowed
Whether the company and individual employees have different interests
Whether the production may affect another investigation

Medical and business records must not be deleted, altered, backdated or concealed after an investigation becomes known.

Search Warrants at Medical Practices and Healthcare Businesses

Federal agents may execute search warrants at medical offices, clinics, pharmacies, laboratories, billing companies, warehouses and private residences.

Agents may seize:

Computers and mobile devices
Servers and electronic storage
Patient records
Billing and coding files
Prescription and ordering records
Financial documents
Provider-enrollment materials
Contracts
Employee records
Cash and other property

A search can interrupt patient care and ordinary business operations.

After a search, defense counsel may examine:

Whether the warrant was supported by sufficient probable cause
Whether it adequately described the places and records to be searched
Whether agents remained within the authorized scope
Whether privileged communications were seized
How patient information was copied and protected
Whether several employees used the same device
Whether electronic activity can reliably be attributed to the client
Whether essential records can be copied or returned
Whether evidence should be challenged through a pretrial motion

Clients should not interfere with agents or provide unplanned explanations during the search.

Billing Allegations

Healthcare fraud cases frequently focus on billing practices.

Billing for Services Not Provided

The government may allege that claims were submitted for appointments, procedures, tests, equipment or treatment that patients did not receive.

The defense may examine:

Appointment and scheduling records
Patient sign-in information
Medical notes
Laboratory or imaging results
Equipment delivery records
Employee testimony
Electronic health record audit trails
Whether claims were later corrected or reversed
Whether the patient or government data is accurate

A missing document does not necessarily prove that a service did not occur, although the absence of documentation can create significant billing and evidentiary issues.

Medically Unnecessary Services

Investigators may claim that treatment, testing, equipment or medication was not medically necessary.

Medical necessity can involve professional judgment. The defense may review:

The patient’s symptoms and diagnosis
Treatment history
Clinical guidelines
Medical literature
Information available to the provider at the time
The provider’s specialty
The patient’s response to earlier treatment
Program coverage standards
Opinions from qualified medical experts

A later disagreement with a clinical decision does not automatically prove that the original provider intended to submit a fraudulent claim.

Upcoding

Upcoding allegations generally involve billing for a more complex or expensive service than the service actually provided.

The defense may determine:

Which billing code was selected
Who selected it
What documentation supported the code
Whether coding guidance was ambiguous
Whether a billing company made the decision
Whether the provider reviewed the final claim
Whether the alleged coding pattern resulted from software or templates
Whether corrected claims were submitted

Unbundling

Unbundling allegations involve separately billing procedures or services that the government claims should have been combined under one code.

A defense review may require detailed examination of coding rules, modifiers, payer guidance and the actual services provided.

Duplicate and Repeated Billing

Duplicate billing may result from deliberate conduct, but it may also result from resubmission procedures, software errors, denied claims, changes in billing companies or incorrect patient information.

The complete claim history should be reviewed before determining whether a repeated submission was fraudulent.

Phantom Billing

Phantom billing generally refers to claims for services, equipment or treatment that allegedly never occurred.

Relevant evidence may include patient records, delivery confirmations, device data, appointment information and testimony from patients and staff.

Billing Under Another Provider’s Number

The government may allege that claims were submitted under a provider who did not perform or supervise the service.

The defense may examine applicable supervision, incident-to billing, reassignment and group-practice rules, as well as the actual relationship among the providers.

Medical Records and Documentation

Medical records are often central to a healthcare fraud case.

Investigators may compare:

Clinical notes
Diagnoses
Procedure codes
Prescriptions
Test orders
Treatment plans
Patient histories
Signature and authentication data
Time records
Claims submitted for payment
Information entered by different employees

Electronic records may contain audit trails showing when an entry was created, opened, modified or signed.

An entry made after the date of service is not automatically fraudulent. Providers may complete documentation after an appointment. The timing, reason and ordinary practice of the organization should be examined.

Records should never be altered or recreated to respond to an investigation. If an error is discovered, any correction should preserve the original information and follow applicable recordkeeping procedures.

Responsibility for Claims Submitted by Billing Personnel

Healthcare providers often rely on employees or outside billing companies to select codes and submit claims.

An investigation should determine:

What information the provider gave the biller
Whether the biller changed or added codes
Whether the provider reviewed claims before submission
What training the billing personnel received
Whether compliance concerns were reported
Whether the provider corrected known errors
Whether the billing company handled several providers in the same manner
Who had access to the claims-submission system

A provider is not automatically criminally responsible for every mistake made by an employee or contractor. The government must prove the client’s personal knowledge and participation under the applicable criminal statute.

Referral and Kickback Allegations

Healthcare fraud investigations may include allegations that compensation was paid or received in exchange for patient referrals, prescriptions, tests, equipment or services billed to a federal healthcare program.

The disputed arrangement may involve:

Marketing agreements
Medical-director payments
Consulting contracts
Patient recruiters
Laboratory relationships
Pharmacy relationships
Durable medical equipment suppliers
Telemedicine companies
Compensation based on referral volume
Payments to patients or beneficiaries

The existence of a financial relationship does not automatically prove an unlawful kickback.

The defense may examine whether:

Legitimate services were provided
Compensation reflected fair market value
Payments were documented
The arrangement met an applicable exception or safe-harbor requirement
The client knew how referrals would be handled
Compensation was actually connected with federal program business
The government has accurately characterized the relationship

Kickback allegations may also affect the government’s position concerning claims submitted after the disputed referral.

Prescription and Controlled-Substance Allegations

Some healthcare investigations involve prescriptions, pharmacy claims or allegations that medications were ordered without a legitimate medical purpose.

These matters may include:

Prescription records
Patient examinations
Telemedicine encounters
Pharmacy dispensing information
Prescriber registration records
Communications with patients
Referral and marketing arrangements
Claims submitted to Medicare or Medicaid

Prescription-related cases may involve healthcare fraud charges together with separate controlled-substance or false-statement allegations.

The defense should distinguish questions concerning medical judgment, documentation, billing and the legal requirements of the specific criminal charge.

Evidence Used in Healthcare Fraud Cases

Federal prosecutors may rely on:

Medicare and Medicaid claims data
Patient files
Electronic health record audit trails
Billing and coding records
Prescription data
Referral and marketing agreements
Bank statements
Emails and text messages
Recorded conversations
Employee testimony
Patient testimony
Cooperating witnesses
Search-warrant evidence
Provider-enrollment documents
Audit findings
Expert medical and coding analysis
Evidence showing how payments were transferred or spent

Data analysis may identify unusual billing patterns, but statistical differences do not by themselves prove fraud.

The defense should compare government summaries with the original patient records, claims, clinical decisions and operational structure of the practice.

What the Government May Need to Prove

The required elements depend on the particular criminal statutes charged.

Disputed questions may include whether:

A scheme to defraud existed
The program involved qualified as a healthcare benefit program
The defendant knowingly and willfully participated
A claim contained materially false information
The service was actually provided
The service was medically necessary
The defendant knew the billing code was inaccurate
The defendant personally caused the claim to be submitted
The defendant knew about an allegedly improper referral arrangement
The government has accurately calculated the amount involved
The client knowingly joined a conspiracy

The government must prove each element of each criminal charge beyond a reasonable doubt.

Possible Healthcare Fraud Defense Strategies

There is no universal defense for every healthcare fraud case. The strategy depends on the medical records, billing data, witness testimony and client’s actual role.

Lack of Criminal Intent

The client may not have knowingly or willfully participated in fraud.

Records may show that the provider believed the services were medically necessary, relied on billing specialists or understood that the claims complied with applicable rules.

Billing or Coding Error

A claim may contain an incorrect code because of clerical mistakes, ambiguous coding guidance, software problems or decisions made by billing personnel.

An error does not automatically establish intentional fraud.

Services Were Provided

Patient records, appointment data, test results, delivery confirmations and employee testimony may show that the billed service or item was actually provided.

Medical Necessity

The treatment, testing or equipment may have been supported by the patient’s symptoms, history and the provider’s clinical judgment.

Qualified medical experts may be needed to evaluate the government’s conclusions.

Reliance on Billing and Compliance Professionals

A provider may have relied on an outside billing company, coding specialist, administrator, accountant or compliance adviser.

Reliance does not automatically eliminate liability, but it may be relevant to the client’s knowledge and intent.

Lack of Personal Participation

An owner or medical director may not have selected the codes, reviewed the claims or known about the disputed activity.

Ownership or supervisory status alone does not prove knowing participation.

Inaccurate Data Analysis

The government’s statistical model may fail to account for the provider’s specialty, patient population, geographic reach or referral patterns.

The defense may challenge whether the selected comparison group is appropriate.

Incomplete or Misinterpreted Medical Records

Medical notes may have been interpreted without considering other parts of the chart, information from another provider or the clinical context.

Unreliable Cooperating Witnesses

Former employees, business partners or other defendants may cooperate with prosecutors in exchange for favorable treatment.

Their statements should be compared with records, previous accounts and objective evidence.

Lawful Compensation or Referral Arrangement

The disputed payment may have been for legitimate services and may not have been intended to purchase patient referrals.

Contracts, work records and compensation data may be relevant.

No Agreement to Join a Conspiracy

A provider or employee may have performed ordinary professional duties without agreeing to participate in a fraudulent scheme.

Unlawful Search or Improperly Obtained Statements

The defense may seek to exclude evidence obtained through an unlawful search or statements taken in violation of the client’s rights.

Disputed Loss Calculation

The government’s claimed loss may include services that were provided, medically necessary or otherwise payable.

The defense may examine:

Correctly payable claims
Reversed or refunded claims
Partial value provided
Claims outside the charged period
Duplicate calculations
Amounts not caused by the client
Payments attributable to other providers

Related Federal Charges

Healthcare fraud may be charged together with:

Conspiracy
Wire fraud
Mail fraud
False statements involving healthcare matters
False Claims Act allegations
Anti-kickback violations
Money laundering
Aggravated identity theft
Controlled-substance offenses
Tax offenses
Obstruction of justice
Asset-forfeiture allegations

Each count has separate legal elements and should be analyzed individually.

For allegations focused specifically on claims submitted to private or government insurers, visit the Health Insurance Fraud Defense Attorney page.

Indictment and Federal Court Proceedings

If a grand jury returns an indictment, the case may proceed through:

Arrest or voluntary surrender
Initial appearance
Detention or release proceedings
Arraignment
Discovery
Pretrial motions
Plea negotiations
Trial
Sentencing

An indictment is a formal accusation and does not establish guilt.

Healthcare fraud discovery may include thousands of patient files, claims databases, electronic communications, financial records and expert reports.

The defense should match each count to the specific patient, service, claim and evidence on which the prosecution relies.

Plea Negotiations and Federal Trial

A plea proposal should be evaluated only after the evidence, possible defenses and professional consequences are understood.

Negotiations may concern:

Charges that will remain
The facts the defendant will admit
The alleged loss
Restitution
Forfeiture
The number of disputed claims
The client’s role
Cooperation provisions
Sentencing recommendations
Dismissal of related counts

The effect on professional licenses, provider enrollment and federal program participation should also be considered.

If an acceptable resolution cannot be reached, the defense must prepare for trial.

At trial, prosecutors must prove every element beyond a reasonable doubt. The defense may challenge patient and employee testimony, claims analysis, medical necessity findings, coding conclusions and evidence of the client’s knowledge or intent.

Professional Licensing Consequences

A healthcare investigation or conviction may affect a physician, pharmacist, nurse, dentist or other licensed professional.

Possible licensing issues include:

A board investigation
Mandatory reporting obligations
Suspension or restriction of a license
Revocation proceedings
Limits on prescribing authority
Probation or monitoring
Restrictions on ownership or management
Disciplinary action based on an underlying conviction

Licensing proceedings are separate from the federal criminal case. A criminal resolution should be evaluated for its possible effect on professional status before it is accepted.

The exact consequences depend on the profession, jurisdiction, charges and licensing rules.

OIG Exclusion and Program Participation

HHS OIG has authority to exclude individuals and organizations from participation in federally funded healthcare programs.

An exclusion may prevent federal healthcare programs from paying for items or services furnished, ordered or prescribed by an excluded individual or organization.

Exclusion can affect:

Medicare and Medicaid billing
Employment by participating providers
Ownership and management roles
Prescribing and ordering services
Hospital privileges
Contracts with healthcare organizations
The continued operation of a medical practice

Some exclusions are mandatory after particular convictions, while others may be imposed under discretionary authority.

The criminal case, exclusion proceeding and provider-enrollment issues should be evaluated together.

Payment Suspensions, Revocation and Overpayment Demands

A provider may face administrative action before the criminal investigation is resolved.

Possible actions include:

Suspension of Medicare or Medicaid payments
Revocation of provider enrollment
Termination from a program
Demand for repayment of alleged overpayments
Recoupment from future claims
Prepayment review
Increased claim scrutiny
Termination of private-insurer contracts

An improper payment finding is not automatically proof of criminal fraud. The defense should identify whether the dispute concerns documentation, coverage, coding, medical necessity or intentional deception.

Administrative deadlines may be much shorter than the timeline of a criminal case. These matters should be addressed without making statements that unnecessarily affect the federal defense.

Asset Seizure and Forfeiture

Federal authorities may seek to restrain, seize or forfeit property allegedly connected with healthcare fraud.

Property at issue may include:

Bank accounts
Medicare or Medicaid payments
Cash
Real estate
Vehicles
Medical equipment
Business interests
Property purchased with disputed funds
Assets transferred to another person or company

The defense may examine:

The source of the property
Whether legitimate and disputed funds were mixed
Who legally owns the asset
Whether third parties have valid interests
Whether the property can be traced to the alleged offense
Whether the government’s valuation is accurate
Whether required procedures were followed

A seizure or account restraint is not necessarily a final determination that the property belongs to the government.

Potential Consequences

The possible consequences depend on the statutes charged, the number of claims, the amount involved, the client’s role and other circumstances.

They may include:

Federal imprisonment
Criminal fines
Restitution
Asset forfeiture
Supervised release
Civil False Claims Act liability
Administrative monetary penalties
Medicare and Medicaid exclusion
Payment suspension
Revocation of provider enrollment
Professional licensing action
Loss of hospital privileges
Contract termination
Civil lawsuits
Immigration consequences for non-U.S. citizens

Criminal, civil and administrative proceedings have different standards and remedies. They should not be described as a single process.

How Healthcare Fraud Allegations Can Affect a Business

A medical organization may experience significant disruption before the allegations are resolved.

Possible effects include:

Frozen bank accounts
Suspended Medicare or Medicaid payments
Loss of access to medical and billing records
Seizure of computers and devices
Difficulty paying employees and vendors
Loss of insurer contracts
Licensing and accreditation inquiries
Increased claim review
Employee departures
Patient and referral-source concerns
Civil litigation
Costs of responding to subpoenas and audits
Criminal charges against the company or individual employees

The defense strategy should address both the federal investigation and the ability of the organization to continue providing lawful services.

Internal Review During an Investigation

A healthcare organization may need to conduct an internal review after receiving a subpoena, audit request or notice of investigation.

The review may include:

Preserving medical and billing records
Identifying relevant employees and contractors
Reviewing claims data
Examining medical necessity documentation
Evaluating coding practices
Reviewing ownership and referral relationships
Comparing medical charts with submitted claims
Investigating employee complaints
Determining whether refunds or corrections were previously made
Identifying conflicts between the company and individual employees

An internal review should be conducted carefully. Interview notes, reports and communications may raise privilege and disclosure issues.

Bukh Law Firm Healthcare Fraud Defense Services

Federal Investigation Defense

Representation during OIG, FBI, DOJ, Medicare and Medicaid investigations.

Pre-Indictment Representation

Communication with prosecutors, response to subpoenas, preparation for interviews and presentation of information before formal charges.

Medicare and Medicaid Fraud Defense

Defense involving allegedly false claims, medically unnecessary services, durable medical equipment, laboratory testing, home health, hospice and other program billing.

Billing and Coding Defense

Review of upcoding, unbundling, duplicate billing, phantom billing and provider-number allegations.

Medical Record Review

Analysis of patient charts, electronic audit trails, diagnoses, treatment plans, orders and documentation supporting claims.

Medical Necessity Defense

Work with qualified medical professionals to evaluate treatment decisions and government expert conclusions.

OIG Investigation Defense

Representation during interviews, record requests, subpoenas and investigations involving federal healthcare programs.

Search Warrant Response

Review of the warrant, seized property, electronic-data procedures and potential challenges to evidence.

Kickback and Referral Defense

Representation in matters involving marketing agreements, referral payments, medical-director arrangements and related claims.

Financial and Claims Analysis

Review of claims data, bank records, payment flows and government loss calculations.

Professional Licensing Coordination

Evaluation of how the federal case may affect medical licenses, provider enrollment and program participation.

Federal Court Representation

Defense during indictment, arraignment, pretrial proceedings, negotiations, trial and sentencing.

Restitution and Forfeiture Defense

Representation concerning alleged losses, seized accounts, ownership disputes and forfeiture claims.

What to Do During a Healthcare Fraud Investigation

Do not destroy, alter, backdate or conceal medical, billing or financial records.

Preserve:

Patient charts
Electronic health record data
Billing and coding files
Claims-submission records
Emails and text messages
Prescription and order records
Referral agreements
Contracts with billing companies
Bank statements
Provider-enrollment documents
Audit correspondence
Employee and ownership records

Before speaking with investigators or producing documents, determine which agencies are involved, which claims are under review and whether you are considered a witness, subject or target.

Arkady Bukh represents medical professionals and businesses before and after federal healthcare fraud charges are filed, including during investigations, grand jury proceedings, indictments, asset seizures, trials and sentencing.

Healthcare Fraud Defense FAQ

Is Arkady Bukh a healthcare fraud lawyer?

Yes. Arkady Bukh represents medical professionals, executives and healthcare businesses in federal investigations and criminal proceedings involving Medicare, Medicaid, billing and related allegations.

When should I contact a healthcare fraud attorney?

Legal advice may be needed after receiving a target letter, subpoena, audit notice, interview request, search warrant, payment-suspension notice or request for patient and billing records.

Does a Medicare or Medicaid billing error automatically constitute fraud?

No. An improper claim may result from a documentation, coding, coverage or administrative issue. A criminal case generally requires proof of the mental state and conduct specified by the charged statute.

Can a physician be charged for claims submitted by a billing company?

A physician may be investigated when claims are submitted under the physician’s provider number. However, the government must still prove the physician’s knowledge and participation. The relationship with the billing company and the claim-review process should be examined.

What is medical necessity fraud?

The government may allege that a provider knowingly billed for treatment, tests, equipment or other services that were not medically necessary. The defense may review the patient’s condition, clinical judgment, program requirements and expert opinions.

What should I do if OIG agents request an interview?

Determine the purpose of the interview and your status before providing answers. Relevant records should be reviewed with counsel, particularly if a criminal investigation may be underway.

Can healthcare providers be excluded from Medicare and Medicaid?

Yes. HHS OIG may exclude individuals and organizations from participation in federally funded healthcare programs under circumstances provided by law. Some exclusions are connected with specified criminal convictions.

Does an audit mean that criminal charges will follow?

No. Many audits remain administrative matters. However, audit records and explanations may be referred to investigators, so the response should be prepared with possible parallel proceedings in mind.

Can medical records be used as evidence?

Yes. Investigators may compare medical records, electronic audit trails, billing codes and submitted claims. The defense should review the complete record and clinical context.

Can an incorrect billing code be a defense?

An incorrect code may support a defense when it resulted from error, ambiguous guidance, software or decisions by billing personnel rather than intentional fraud. The complete claim process must be examined.

Can Medicare or Medicaid payments be suspended before trial?

Program payments may be suspended or otherwise restricted in some circumstances before a criminal case is resolved. Administrative options and deadlines should be evaluated separately from the criminal defense.

What is the difference between healthcare fraud and health insurance fraud?

Healthcare fraud is the broader category and may involve Medicare, Medicaid, healthcare providers, medical necessity, referral arrangements and federal program billing. Health insurance fraud is a narrower category focused primarily on false or improper claims submitted to insurers.

Does an indictment mean the provider is guilty?

No. An indictment is a formal accusation approved by a grand jury. The prosecution must still prove each criminal charge beyond a reasonable doubt unless the case is otherwise resolved.