Litigation & Arbitration

Healthcare Litigation

Civil and trial representation of physicians, executives, and healthcare companies in False Claims Act actions, government investigations, and disputes turning on billing and regulatory compliance.

Overview

Healthcare is one of the most heavily regulated and most aggressively litigated sectors in the country, and the Southern District of Florida is among the most active enforcement districts in it. The litigation rarely stays in one lane. A False Claims Act case can run alongside a criminal investigation; a civil settlement can carry exclusion consequences; a billing dispute can become a fraud allegation. Defending a healthcare client requires lawyers who understand the regulatory frameworks, the way the government builds these cases, and how to try one if it comes to that.

Fridman Fels & Soto brings a rare depth to this work. Daniel Fridman served as Special Counsel for Health Care Fraud at the Department of Justice, coordinating enforcement across the Civil Division, Criminal Division, U.S. Attorney's Offices, and the FBI, and has testified before the U.S. Senate Special Committee on Aging and the House Energy and Commerce Subcommittee on Health on healthcare fraud enforcement. The firm has handled the full range, from civil False Claims Act litigation to jury trials to appellate reversals.

Because the firm's partners have worked both sides, healthcare litigation here is built around the connection between the civil case and everything around it. A False Claims Act matter is defended with an eye on parallel criminal exposure. A civil recovery is pursued with the leverage of the government's own findings. And when the right answer is to try the case, the firm tries it.

Our Approach

Healthcare cases are won on command of the rules. The line between a billing error, a regulatory violation, and actionable fraud turns on Medicare and Medicaid requirements, coding standards, and documentation practices. We engage medical, coding, and billing experts early to test the government's or the plaintiff's theory and to build the record that supports good-faith compliance.

We treat the civil and any parallel government track as one problem. A False Claims Act defendant who also faces a criminal inquiry has Fifth Amendment and disclosure decisions that affect the civil case, and a settlement on the civil side can carry licensure and exclusion consequences. We coordinate those moving parts from the first day rather than reacting to them.

When a healthcare client has been the victim of fraud rather than the target, the same skill set drives recovery. The firm uses government findings, civil claims, and trial-ready preparation to pursue the people responsible.

Representative Matters

Publishable

Patient Care America (CEO): False Claims Act and related proceedings

Represented the chief executive of a compounding pharmacy in connection with a TRICARE compounding matter. The civil False Claims Act case was resolved by settlement in September 2019. In the later related proceeding, after a four-day sentencing in February 2024, the court held the sentence to the 0 to 6 month range against the government's request for 15 months.

False Claims Act + related proceeding | Civil settled Sept 2019 | Daniel Fridman (civil), Adam Fels (sentencing) | Publishable

Publishable

Dr. Vanja Abreu: Eleventh Circuit reversal of a healthcare-fraud conviction

Represented, pro bono, a woman from the Dominican Republic who had been wrongfully convicted of a healthcare-fraud conspiracy and imprisoned for roughly three years until the Eleventh Circuit reversed the conviction. The firm then litigated a novel wrongful-imprisonment compensation claim and assisted her successful U.S. citizenship application.

Lead: Daniel Fridman | 11th Circuit reversal | Pro bono | Publishable

Frequently Asked Questions

What is the False Claims Act and why does it dominate healthcare litigation?

The False Claims Act imposes liability, including treble damages and per-claim penalties, on those who submit false claims to federal programs such as Medicare and Medicaid. It also lets private whistleblowers (relators) sue on the government's behalf in qui tam actions and share in any recovery. Because nearly every healthcare provider bills federal programs, the statute reaches an enormous range of conduct, which is why it is the central tool in civil healthcare enforcement.

How can a civil False Claims Act case turn into a criminal matter?

The same conduct that supports a civil False Claims Act case, knowingly submitting false claims, can support criminal healthcare fraud charges. The DOJ frequently runs parallel civil and criminal tracks, and statements or documents produced on the civil side can end up in the criminal case. That overlap is why healthcare litigation has to be defended with both proceedings in mind from the outset, not treated as a purely civil dispute.

Is a billing or coding mistake the same thing as fraud?

No. Liability under the False Claims Act and the healthcare fraud statutes requires knowledge, meaning actual knowledge, deliberate ignorance, or reckless disregard. An honest billing error, a good-faith interpretation of an ambiguous rule, or reasonable reliance on a coder or compliance process is not fraud. A central part of the defense is demonstrating the difference, which often turns on the documentation, the regulatory ambiguity, and the client's compliance practices.

Can a healthcare company recover when it is the victim of fraud rather than the target?

Yes. A provider or company harmed by an employee's or vendor's fraud, kickbacks, or misconduct can pursue civil recovery through fraud, breach of fiduciary duty, and civil RICO claims, and can use any government findings as leverage. The firm's litigators handle both sides of healthcare disputes, including affirmative recovery for the harmed party.

Team

Facing a government investigation?

Time matters. Contact us before the first interview request.

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