Healthcare Fraud

The Law Offices of David Berg defends physicians, healthcare executives, billing professionals, and healthcare organizations facing healthcare fraud charges or investigations in Texas and nationwide.

A healthcare fraud investigation can move from an inquiry to a criminal indictment faster than most people expect. If you’ve received a subpoena, been contacted by federal agents, or learned that your practice or organization is under scrutiny, your decisions from this point forward can impact your career and your business.

Situations We Handle

David Berg has defended clients across the full range of healthcare fraud allegations. Common situations include:

• Physicians, practice owners, or billing staff under investigation for Medicare or Medicaid billing violations
• Healthcare executives facing a DOJ or HHS-OIG inquiry into reimbursement practices across a hospital system or network
• Home health agencies, pharmacies, or durable medical equipment suppliers accused of submitting false claims to federal programs
• Individuals or organizations targeted in a federal qui tam lawsuit filed by a former employee or competitor
• Physicians or facilities alleged to have billed for services not rendered, upcoded procedures, or ordered medically unnecessary tests
• Healthcare businesses subject to parallel civil and criminal investigations arising from the same conduct

If your situation involves both a civil False Claims Act exposure and a parallel criminal investigation, that overlap requires careful, coordinated strategy from the outset.

How David Berg Approaches Healthcare Fraud Cases

Healthcare fraud cases are built by prosecutors over months or years before charges are filed. By the time a subpoena arrives or an agent makes contact, the government typically has a substantial record. The response to that record, and how it’s framed and contested, determines the outcome.

David Berg has spent more than 50 years trying cases in state and federal courts. His approach is to build a defense from the first day of the engagement that is prepared to go all the way to trial, because that preparation changes how every stage of the case unfolds, including pre-indictment.

What that means in practice: a thorough review of the conduct at issue, the government’s theory, the applicable billing rules and regulatory frameworks, and the actual evidence. Healthcare fraud cases often turn on genuinely contested questions, including what was medically necessary, what the applicable billing standards required, and whether any compliance failures were willful or inadvertent. Those distinctions matter enormously to the outcome, and they require counsel who can present them credibly to a jury if it comes to that.

What You’re Up Against

Healthcare fraud is prosecuted primarily under the False Claims Act, the Anti-Kickback Statute, the Stark Law, and 18 U.S.C. § 1347 (the federal healthcare fraud statute). Investigations are typically led by the Department of Justice, the HHS Office of Inspector General, the FBI, or a combination of these agencies. They are often initiated by qui tam whistleblower complaints filed by current or former employees.

Convictions under the federal healthcare fraud statute carry potential sentences of up to 10 years per count, or up to 20 years if the fraud results in serious bodily injury. Civil penalties and exclusion from Medicare and Medicaid programs are often imposed alongside criminal charges, and professional licensing consequences may run parallel to the federal case.

Why Early Engagement Matters

Healthcare fraud investigations frequently take a year or more to conclude before charges are filed. The period between the start of the investigation and indictment is often the most consequential window in the entire case. 

Retaining counsel early allows you to understand what the government has, to make informed decisions about how to respond to document requests and agent interviews, and to present your side of the story before the record is closed. Although it does not guarantee a particular outcome, it does change the options available to you.

If you have reason to believe you are under investigation, or if your organization has received a subpoena or a CID (Civil Investigative Demand), contact us to discuss your situation.

Why David Berg

David Berg has been recognized in Best Lawyers in America for White Collar Criminal Defense for decades, and the National Law Journal has named him to its “Who’s Who of Criminal Defense Nationwide.” He is the author of The Trial Lawyer: What It Takes To Win, Second Edition, published by the American Bar Association in 2018. That book is used by trial lawyers across the country. He has been trying criminal cases for more than 50 years, in Houston and in federal courts nationally.

Healthcare fraud cases are both legally technical and factually complex. They require counsel who understands how prosecutors build these cases, how to identify weaknesses in the government’s theory, and how to present a credible defense to a jury. David Berg has done that work, across decades, in courts that matter.

Frequently Asked Questions

What is healthcare fraud under federal law?

Federal healthcare fraud is broadly defined as knowingly submitting false or fraudulent claims to federal healthcare programs, including Medicare, Medicaid, and TRICARE. It encompasses billing for services not provided, upcoding, unbundling, and paying or receiving kickbacks in connection with federal program referrals.

What agencies investigate healthcare fraud?

Federal healthcare fraud investigations are typically led by the Department of Justice, the HHS Office of Inspector General, and the FBI. The HHS-OIG maintains a dedicated fraud enforcement unit, and many investigations are coordinated through the Health Care Fraud Prevention and Enforcement Action Team (HEAT).

What is the difference between a civil and criminal healthcare fraud case?

A civil healthcare fraud case, typically brought under the False Claims Act, seeks monetary penalties and repayment rather than imprisonment. A criminal case can result in incarceration, fines, and mandatory exclusion from federal programs. The two can proceed simultaneously, and the same underlying conduct can give rise to both.

Can a healthcare fraud charge be resolved without going to trial?

Many federal healthcare fraud cases are resolved through negotiated agreements, including civil settlement agreements and, in criminal matters, plea agreements. Whether a negotiated resolution is the right outcome in your case depends on the facts, the strength of the government’s evidence, and your objectives. David Berg builds every defense prepared to go to trial, which affects the outcome of negotiations as well.

What happens to my medical license if I’m charged with healthcare fraud?

A federal healthcare fraud charge can trigger state medical licensing proceedings independent of the criminal case. State medical boards have the authority to suspend or revoke a license upon conviction or, in some states, upon indictment. These proceedings run on a separate track and require separate attention from the outset.

Does the Law Offices of David Berg handle both individual and corporate clients?

Yes. David Berg has defended both individual practitioners and corporate defendants in major commercial and criminal matters. The firm has represented clients ranging from individual physicians to large institutional clients in complex federal proceedings.

Talk to David Berg About Your Case

A healthcare fraud investigation is a serious matter. The Law Offices of David Berg has spent more than 50 years defending clients in exactly these situations, in Houston and in federal courts across the country.

If you or your organization is under investigation or has been charged, contact us to discuss your case. There is no obligation. We will tell you plainly what we see and what your options are.