Category Archives: Healthcare Fraud
How Electronic Health Records (EHR) Issues Can Trigger Fraud Allegations
Electronic Health Records (EHR) have transformed the practice of medicine. They have improved access to patient information, streamlined documentation, enhanced communication among providers, and simplified billing. Yet the very features that make EHR systems so efficient can also become the focus of healthcare fraud investigations. Federal prosecutors and investigators increasingly examine EHR data when… Read More »
Key Differences Between Civil and Criminal Healthcare Fraud Investigations
Healthcare providers who become the subject of a government investigation have a pressing question: Is this a civil matter or a criminal one? The answer can significantly affect everything from the government’s investigative tactics to the potential consequences a provider faces. Unfortunately, the distinction is not always obvious. A healthcare fraud investigation may begin… Read More »
Sneaky Ways Contractors Can Expose Providers to Fraud Liability
Healthcare providers often assume that if they are not personally submitting false claims or directing improper billing practices, they are insulated from healthcare fraud liability. Unfortunately, that assumption can be dangerously wrong. Many healthcare organizations rely on outside contractors for essential business functions, including billing, coding, marketing, consulting, compliance, patient recruitment, and revenue cycle… Read More »
Top 10 Red Flags Prosecutors Look for in Healthcare Billing Audits
Healthcare billing audits are often viewed as administrative matters focused on reimbursement, documentation, and compliance. However, some audits evolve into something far more serious. When auditors uncover findings that suggest intentional misconduct rather than simple mistakes, those findings may be referred to federal or state prosecutors for criminal investigation. For healthcare providers, physicians, clinic… Read More »
How Coding Errors Can Lead to Fraud Investigations — and Defenses
Healthcare billing is one of the most complex administrative systems in the United States. Physicians, clinics, hospitals, and other healthcare providers must navigate thousands of diagnostic and procedural codes while complying with constantly evolving Medicare, Medi-Cal, and private insurance regulations. In this environment, coding mistakes are not uncommon. But when regulators or prosecutors believe… Read More »
Why Whistleblower Retaliation Claims Can Complicate Fraud Defense
Healthcare fraud investigations are rarely straightforward. In many cases, they are driven not only by data analytics and audits, but also by insiders such as employees, former employees, or business partners who come forward with allegations of wrongdoing. These individuals are often referred to as whistleblowers, and when they claim they were retaliated against… Read More »
Do Miranda Rights Apply to Healthcare Fraud Investigations?
Healthcare fraud prosecutions rarely begin with flashing lights or dramatic arrests. More often, they start quietly, with audit letters, document requests, or phone calls from investigators. By the time a healthcare provider realizes the seriousness of the situation, federal agents may already have spent months or even years building a case. One of the… Read More »
Data Analytics and Billing Spikes Lead to Federal Healthcare Fraud Investigations in California
Dr. Mehmet Oz’s recent letter to Governor Newsom in January has put the state in the position where it must now step up investigations and prosecutions of healthcare fraud. In the letter, Dr. Oz emphasized explosive growth in certain Medi-Cal billing categories. Behind that language lies a critical reality for healthcare providers: modern healthcare… Read More »
CMS Puts California on Notice
What Dr. Oz’s Letter to Governor Newsom Means for Healthcare Providers In a highly publicized letter to Governor Gavin Newsom, the Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz signaled intensified federal scrutiny of California’s Medi-Cal system. The letter, directed to state leadership but clearly intended for a broader audience, alleges… Read More »
Federal Crackdown on Healthcare Fraud: What Providers Need to Know
Late in 2025 and early 2026, federal officials made headlines for an unusually public push to target alleged healthcare fraud in California, invoking prosecutions in Minnesota as part of a broader narrative about government enforcement priorities. At a January 2026 press briefing in Los Angeles, CMS Administrator Dr. Mehmet Oz and First Assistant U.S…. Read More »