Practice Insights
Healthcare Fraud Defense Insights
Analysis for healthcare providers, owners, executives, and professionals responding to federal scrutiny of billing, referrals, medical necessity, or program participation. These articles address investigative tools, individual exposure, False Claims Act risk, charging decisions, and trial preparation.
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8 articles
A Government Request Arrives: Understanding Healthcare Fraud Investigations
Understand subpoenas, civil investigative demands, warrants and program notices, with the timing and representation questions to discuss with counsel.
Private Equity and Healthcare Fraud Exposure: Conduct, Knowledge and Governance
How investor conduct and knowledge can matter in healthcare FCA cases, with the Patient Care America example and questions for boards and sponsors.
The Anti-Kickback Statute and the False Claims Act in the Eleventh Circuit: Elements, Standards, and the Open Causation Question
The Eleventh Circuit's Anti-Kickback and False Claims Act elements and standards, with the one causation question the Circuit has left open.
Healthcare Fraud Investigations in South Florida: Parallel Proceedings and Provider Consequences
How federal healthcare fraud proceedings can intersect with Florida professional licensure, Medicaid participation and payment issues.
How a Federal False Claims Act Case Works: Qui Tam, the Elements, and the Bars That End Cases Early
How a federal qui tam case runs from sealed filing to resolution, with the Eleventh Circuit elements, pleading standard, and bars that end cases early.
Eleventh Circuit Rejects the Appointments Clause Challenge to the False Claims Act's Qui Tam Provisions
On September 1, 2026, the Eleventh Circuit held that False Claims Act relators are not “Officers of the United States,” rejecting the Appointments Clause challenge a Florida court had used to dismiss a qui tam case. The narrow ruling forecloses that defense in the circuit for now but leaves the Vesting and Take Care Clause theories open. What it means for defendants.
Novel Medicare Advantage Fraud Theory Falters in HealthSun Case
Defense sought to admit government’s exhibits to educate jury Prosecution didn’t have much to show in the way of motive Prosecutors offered surprisingly little
Miami-Dade healthcare manager found not guilty at Medicare fraud trial
Two years ago, Kenia Valle Boza’s life was upended when prosecutors accused her of conspiring with others to assign falsified codes to medical diagnoses that ca