Fraud occurs when someone deliberately deceives others for financial gain or to deprive victims of their rights. Healthcare fraud and abuse costs an estimated $60 billion annually. Fraud involves intentional deception for financial benefit, while abuse encompasses practices that may not be fraudulent but violate professional standards or waste resources, such as performing unnecessary procedures.

With decades of fraud investigation experience, our team is exceptionally qualified to handle matters involving criminal, civil, qui tam, administrative enforcement, and Foreign Corrupt Practices Act violations. We combine investigative expertise, regulatory knowledge, and insights from professionals with extensive private and public sector experience. Common examples of healthcare fraud include:

Healthcare fraud and abuse wastes taxpayer money, drives up healthcare costs, and potentially harms patients through unnecessary or substandard care. Healthcare organizations must comply with 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.