DOJ Is Now Using Data Analytics to Pick Health Care Fraud Targets. What South Florida Providers Need to Know.

The Justice Department just announced six health care fraud trial convictions in under three weeks. At least one of those cases started with no whistleblower and no patient complaint. It started with billing data. Federal prosecutors ran the numbers, found a provider who stood out as a statistical extreme, and built a case from there. One of the six trials was tried in Fort Lauderdale, and the largest scheme in the group, a billion-dollar telehealth fraud, came out of the Southern District of Florida. If you bill Medicare or Medicaid from a South Florida practice, this announcement tells you how the government now finds people like you.

The DOJ Health Care Fraud Unit now pairs trial prosecutors with data analysts who flag billing outliers before any witness comes forward.

Key takeaways

• The DOJ Health Care Fraud Unit secured six trial convictions in under three weeks in 2026, including a case tried in Fort Lauderdale.
• Core charges run through 18 U.S.C. 1347 (health care fraud) and 18 U.S.C. 1349 (conspiracy), each carrying up to ten years per count.
• Kickback exposure runs through 42 U.S.C. 1320a-7b, and altered or back-dated records can add obstruction counts under 18 U.S.C. 1519.
• Prosecutors now open cases from billing-data outliers, not just informants. This makes South Florida providers visible long before any complaint is filed.
• Pre-indictment defense, before a target letter hardens into an indictment, is where these cases are most often shaped.

What Actually Happened

The National Fraud Enforcement Division reported that its Health Care Fraud Unit won six jury trials between May 13 and June 1, 2026, with convictions in Fort Lauderdale, Los Angeles, Detroit, New York, and Nashville. The Department called the losses more than $1.1 billion across six distinct schemes, and described the unit as one of its most active white-collar trial components, with nine trials completed in 2026, every one of them a conviction. You can read the announcement on the Department of Justice press release.

Two details matter more than the headline number. First, the cases were not simple. They involved a telehealth platform that the government says industrialized Medicare fraud, a physician prosecuted off a data anomaly, home health and physical therapy kickback networks, and a pain clinic narcotics case. Second, and more important for anyone under investigation, the Department openly credited its Data Analytics Team with originating at least one prosecution. The case did not begin with a witness. It began with a spreadsheet showing one provider had been paid more by Medicare for a single procedure than any other provider in the country.

What the Government Is Actually Building

Read past the press release and a method shows through. The Health Care Fraud Unit runs an integrated team model that pairs trial prosecutors with data analysts, investigators, and paralegals from the opening of a file through verdict. That structure tells you where the risk now sits. The government is no longer waiting for a tip. It is mining claims data, flagging outliers, and deciding who to look at before anyone on the provider side knows a file exists.

For South Florida, this is not abstract. The Health Care Strike Force program has charged more than 6,200 defendants since 2007, and South Florida remains one of its busiest theaters. A federal investigation defense posture that assumes you will get advance warning is built on a premise the government has now abandoned. The billing data is the warning, and the provider is usually the last to see it.

By the time a target letter arrives, the government has already decided the case is worth its trial team's time. The analytics clock starts before the provider's does.

Exposure and Charges

Most of these prosecutions are built on a familiar set of statutes. Health care fraud is charged under 18 U.S.C. 1347, which carries up to ten years per count, up to twenty years if the scheme causes serious bodily injury, and up to life if it causes death. Conspiracy and attempt are charged under 18 U.S.C. 1349, which exposes a defendant to the same penalty as the underlying offense and does not require completion of the scheme.

Kickbacks are the second pillar. Paying or receiving anything of value to induce referrals of items billed to a federal program violates the Anti-Kickback Statute, 42 U.S.C. 1320a-7b. In the recent trials, the government described kickbacks routed through CashApp, PayPal, sham contracts, and shell companies. False statements in health care matters are charged under 18 U.S.C. 1035.

The third pillar is what people do once they realize they are under investigation, and it is where defendants hurt themselves most. In one of the recent cases, the government says the provider fabricated and back-dated patient consent forms and medical records after a grand jury subpoena arrived, then handed the altered documents to agents. That conduct is charged separately under 18 U.S.C. 1519 and treated as obstruction. It often carries more practical weight at sentencing than the underlying fraud, because it removes any argument that the conduct was a billing mistake.

Two more exposures follow almost every case. Where controlled substances are involved, the government adds distribution counts under 21 U.S.C. 841. And running alongside the criminal case is civil liability under the False Claims Act, 31 U.S.C. 3729, which allows treble damages and per-claim penalties. A provider can resolve the criminal case and still face a civil judgment that ends the practice.

When federal agents arrive, they usually have months of billing analysis behind them. The first 24 hours of the provider's response shape the rest of the case.

The Mistakes People Make Early

The data-driven model changes the timeline, but the early mistakes are the same ones defense lawyers have watched for years.

Talking to federal agents without counsel is first. Agents who appear at a clinic are not there to clear you. They are there to lock in statements they can use.

Second is producing documents in response to a subpoena without a litigation hold and a strategy. That is how clean cases turn into obstruction cases.

Third is the assumption that silence from the government means safety. Under the new model, the quiet period is when the analytics team and the prosecutors are building. No contact does not mean no file.

Fourth, and most costly, is waiting for an indictment before hiring a white collar defense attorney. By then the charging decision is largely made and the leverage is gone.

A Defense Approach That Fits the New Model

If the government is starting cases from data, the defense has to start early too. The most valuable work in a health care fraud case happens before charges, during the pre-indictment window. That is when a federal criminal defense attorney can test the government's theory, present billing context the analytics did not capture, and in some cases persuade prosecutors that an outlier has an innocent explanation.

Statistical anomalies have explanations. A solo specialist will out-bill a group of generalists. A practice that treats a rare condition will look nothing like its peers. Those points land far better before an indictment than after.

Where exposure is real, the early decision is cooperation versus litigation, and it should be made with full information, not fear. That means understanding what the government already has, what it still needs to prove, and what a realistic guideline range looks like. It also means controlling the documentary record from day one, because the cases that collapse are usually the ones where someone altered a file.

Statistical outliers have explanations. A solo specialist or rare-disease practice looks nothing like its peers. Those points land far better before an indictment than after.

Why Timing Matters Now

The reason to act early is structural. Charging decisions in these cases are made over months, and the window to influence them closes once the grand jury returns an indictment. With the analytics-first model, the government's clock often starts before the provider's does. By the time a target letter arrives, the government has already decided you are worth its trial team's time.

South Florida providers should treat the billing data itself as the early-warning system the government will not give them. If your practice is an outlier on any high-volume code, assume that someone can see it. The right response is not to wait and hope. It is to get ahead of the explanation while the decision is still open.

Aaron M. Cohen handles federal health care fraud defense from Boca Raton, representing South Florida providers at the pre-indictment stage and through trial.

Facing a Federal Health Care Fraud Investigation in Florida?

The most important decisions in these cases are made before charges are ever filed. AMC Defense Law represents physicians, clinic owners, and health care businesses in federal investigations and prosecutions in South Florida and nationwide. If you have received a target letter, a grand jury subpoena, or a visit from federal agents, a confidential consultation early can change the trajectory of the case.

Aaron M. Cohen is the founder of AMC Defense Law, a federal and state criminal defense firm based in Florida. The firm represents clients in federal investigations and prosecutions involving health care fraud, white-collar crime, financial crimes, and complex federal litigation, in Florida and nationwide.

If you or your loved ones have been arrested or are under investigation, call Aaron M. Cohen, 24 hours a day, to get help.

This article is provided for general informational purposes only and does not constitute legal advice. Reading it does not create an attorney-client relationship. Every case is different, and outcomes depend on specific facts and applicable law. If you are under investigation or facing charges, consult a qualified attorney about your particular situation.