Are you looking for a federal health care fraud lawyer?

At StechLaw Criminal Defense, we are federal health care fraud lawyers with nearly 15 years of experience guiding clients through complex federal cases.

If you are a physician, pharmacist, or health care business owner facing a federal health care fraud investigation, an experienced defense lawyer can help protect your rights and respond to the government’s case. Our federal health care fraud lawyer at StechLaw Criminal Defense has defended professionals against financial crime allegations in federal court for nearly 15 years. Ben Stechschulte has tried over 60 cases to verdict and is board certified in criminal trial law by The Florida Bar. We offer a free and confidential consultation to review the allegations and explain your options.

Federal Health Care Fraud Lawyer

Federal health care fraud generally involves knowingly executing, or attempting to execute, a scheme to defraud a health care benefit program or to obtain money from one through false or fraudulent claims. The programs at the center of most cases are Medicare, Medicaid, and TRICARE, though private insurers are also covered. The government must prove that the claims were false and that the defendant acted knowingly and with intent to defraud. The people charged range from physicians and pharmacists to clinic owners, laboratories, billing companies, and marketers.

These matters are document intensive and often data driven. They are investigated by agencies such as the Department of Health and Human Services Office of Inspector General and the FBI, and they are prosecuted by the Department of Justice’s Health Care Fraud Unit and local United States Attorneys. A case can begin with an audit, a billing anomaly flagged by data analytics, or a subpoena for patient and billing records.

Types of Federal Health Care Fraud Cases We Handle

Health care fraud is charged under several federal statutes, and the scheme alleged shapes the evidence, the loss calculation, and the penalties. We represent providers, owners, and employees at every stage, from an initial audit through indictment and trial. The categories below reflect the allegations we see most often in federal court.

Billing for services not provided. These cases allege that a provider submitted claims for appointments, procedures, or supplies that never occurred. The government builds them from claims data, patient interviews, and scheduling records.
Upcoding. This involves billing for a more expensive service or procedure than the one actually performed. Prosecutors compare the codes submitted against the documentation in the patient file.
Unbundling. This category alleges that a provider billed separately for services that should have been billed together at a lower combined rate. The result is a higher total reimbursement than the rules allow.
Medically unnecessary services. These allegations involve procedures, tests, or equipment that the government contends were not needed for the patient’s care. Clinical judgment is frequently at the center of the dispute.
Kickbacks and referral schemes. These cases allege that money or something of value was paid or received in exchange for patient referrals or for ordering covered items and services. They often reach marketers, laboratories, and equipment suppliers as well as physicians.
Illegal prescribing and diversion. These matters involve prescribing controlled substances outside the usual course of practice or without a legitimate medical purpose. Pill mill allegations and opioid cases fall within this category.
Durable medical equipment schemes. This involves claims for braces, tests, or equipment that patients did not request, need, or receive. Telemarketing and telehealth referrals are common features of these cases.

Why Choose StechLaw Criminal Defense as my Federal Health Care Fraud Lawyer?

Trial Experience and Former Prosecutor Insight

Our founder, Ben Stechschulte, has tried over 60 cases to verdict during nearly 15 years defending clients in the Tampa Bay area. He served as a Hillsborough County prosecutor before entering private practice, so we understand how the government assembles billing evidence and works with cooperating witnesses. Ben is board certified in criminal trial law by The Florida Bar, a credential held by a small percentage of attorneys in the state. Super Lawyers named him a Rising Star in 2015, and he earned his law degree from Stetson University College of Law.

A Practice Built for Federal Cases

A health care fraud charge can affect your liberty, your finances, and your professional license at the same time. Our track record in criminal matters includes dismissals, reduced charges, and acquittals. We defend these cases as part of our federal fraud defense practice and our broader federal criminal defense work, which lets us handle related counts, forfeiture, and program exclusion together rather than in isolation.

What Is Important To Understand About Federal Health Care Fraud Cases?

Charges, Penalties, and Defense Strategies for Federal Health Care Fraud Cases

The government pursues health care fraud through the federal fraud statutes, the false claims laws, and the laws against kickbacks. A single billing scheme can produce several counts, and prosecutors frequently add wire fraud, money laundering, and conspiracy charges when claims and proceeds move electronically. Because most prosecutions involve Medicare and Medicaid, the penalties for Medicare fraud are a central concern from the earliest stage of a case.

Prison and financial exposure. Convictions can bring significant prison terms, fines, and orders of restitution, and the recommended sentence climbs as the alleged loss grows.
Program exclusion. Beyond any criminal sentence, a conviction can lead to exclusion from Medicare, Medicaid, and other federal programs, along with action against a professional license, which for many providers ends a career.
Forfeiture. The government often seeks to forfeit funds and property it links to the alleged scheme.
Intent defenses. Many cases depend on whether a billing error was a mistake or a knowing act, and honest errors and reasonable coding disagreements are not crimes.
Medical necessity and reliance. Where clinical judgment or reliance on billing staff is at issue, the defense examines the records, the applicable rules, and who actually made each decision. The federal sentencing guidelines tie the offense level to the loss figure, so contesting the loss amount is often central.

Federal health care fraud charges generally carry a five-year statute of limitations.

What Are Important Aspects of a Federal Health Care Fraud Case?

A few issues tend to determine how a health care fraud case develops, and each rewards early attention.

The intent question usually turns on documents, billing patterns, and what the provider knew, rather than on direct proof.
The loss amount drives both the charging decision and the sentence, so its calculation is contested closely.
Compliance policies, audits, and prior warnings can either help the defense or strengthen the government’s case.
The matter may involve one provider or a wider network of clinics, marketers, and suppliers charged together.
The point at which counsel becomes involved can shape whether the case is resolved before charges are filed.

What Is The Federal Health Care Fraud Case Timeline?

Federal cases follow a longer and more formal path than state prosecutions, and most health care fraud matters move through similar stages.

The process often opens with an audit, a civil investigative demand, or a subpoena, and many clients first realize they are under federal investigation at that point.
The government may issue a target letter once it identifies a person it intends to charge.
A grand jury reviews the evidence and decides whether to return an indictment.
During pretrial litigation, the defense examines the claims data and records and can file motions challenging the search, the evidence, or the loss theory.
The case resolves through declination, dismissal, a negotiated plea, or trial, with sentencing to follow any conviction.

What Should You Bring to Your Federal Health Care Fraud Consultation?

Bringing the right records helps us assess the exposure and the defenses quickly.

Any subpoena, civil investigative demand, target letter, or charging document you have received.
Billing records, claims data, and the patient files tied to the claims at issue.
Correspondence with Medicare or Medicaid contractors, auditors, or private payers.
Your practice’s compliance policies and any prior audit results.

During the consultation, we will review these materials, explain the likely charges and exposure, and lay out the next steps. The meeting is free and confidential.

What Are Important Florida Legal Resources for Federal Health Care Fraud Cases?

Federal health care fraud is investigated and prosecuted by several agencies, and the resources below explain how these cases work and where to find reliable information. They are general references and do not replace advice about your specific situation.

The HHS Inspector General investigates fraud against federal health programs and publishes enforcement actions and consumer alerts.
CMS explains how Medicare and Medicaid fraud, waste, and abuse are identified and reported.
The U.S. Attorney’s Office for the Middle District of Florida prosecutes federal cases in the district and posts announcements about charges and convictions.

Reach Out to StechLaw Criminal Defense to Schedule a Consultation

If you are under investigation or facing federal health care fraud charges, we are ready to review the allegations and explain your options. The initial consultation is free and confidential. Contact us to arrange a time to speak with a defense attorney who understands how these cases are investigated, charged, and defended. We handle federal cases across the Middle District of Florida.