Fraud is the intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. It is estimated that over 60 billion dollars are lost annually due to healthcare fraud and abuse. Healthcare fraud involves intentionally deceptive practices to obtain financial gain, while abuse includes activities that are not necessarily fraudulent but violate professional standards or waste resources, like unnecessary procedures. With decades of experience in fraud investigations, we are uniquely equipped to offer our services in matters pertaining to criminal, civil, qui tam, administrative enforcement, and foreign corrupt practices act violations.  We bring together our investigative expertise, regulatory knowledge, and insight from a team with decades of experiences in the private and public sectors.  Some examples of healthcare fraud are as follows:

Healthcare fraud and abuse lead to wasted taxpayer dollars, increased healthcare costs, and potentially harm to patients by providing unnecessary or substandard care.  Healthcare entities are subject to numerous regulatory requirements, including:

• False Claims Act (FCA): The FCA imposes liability on those who defraud governmental programs.

• Anti-Kickback Statute (AKS): The AKS prohibits financial payments or incentives for referring patients or generating federal healthcare business.

• Physician Self-Referral Law: Also called the Stark Law, this set of regulations prohibits healthcare providers from gaining financially by referring patients for health services payable by Medicare or Medicaid.