Healthcare Fraud Enforcement in 2026
On June 23, 2026, the Department of Justice announced its 2026 National Health Care Fraud Takedown: 455 defendants charged across 56 federal districts, including 90 doctors and other licensed medical professionals, in cases alleging more than $6.5 billion in false claims. The cases centered on wound care and skin substitutes, telemedicine, durable medical equipment, genetic testing, opioid diversion, behavioral health, hospice, and cardiovascular testing. The Southern District of Florida remains one of the most active healthcare fraud districts in the country.
How Healthcare Fraud Investigations Start
- Data analytics. DOJ and HHS-OIG flag providers whose billing stands out from their peers.
- Contractor audits. A UPIC or other Medicare contractor audit, records request, or payment suspension (42 C.F.R. § 405.371) often comes first. An audit that looks administrative can be feeding a criminal referral.
- Whistleblowers. Employees, billers, and competitors file qui tam suits under the False Claims Act, which are sealed while the government investigates.
- Cooperators. Marketers, office managers, and co-owners who were approached first and agreed to help.
- Subpoenas and demands. HHS-OIG subpoenas, civil investigative demands, and grand jury subpoenas for records.
- Agent visits. HHS-OIG and FBI agents interviewing staff, patients, and referral sources, or the provider directly.
The Charges We Defend
Florida
- Medicaid provider fraud, Fla. Stat. § 409.920
- Patient brokering, Fla. Stat. § 817.505, which applies regardless of who pays
- Kickbacks, Fla. Stat. § 456.054
- Insurance fraud, Fla. Stat. § 817.234
Federal
- Health care fraud, 18 U.S.C. § 1347: up to 10 years per count, more if a patient is seriously injured
- Conspiracy to commit health care or wire fraud, 18 U.S.C. § 1349: same penalty as the underlying offense
- Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b): up to 10 years per count
- Eliminating Kickbacks in Recovery Act, 18 U.S.C. § 220: labs, recovery homes, and clinical treatment facilities, any payer
- False statements relating to health care matters, 18 U.S.C. § 1035
- Money laundering, 18 U.S.C. §§ 1956 and 1957, and aggravated identity theft, 18 U.S.C. § 1028A (a mandatory two years, consecutive)
Civil and administrative, running alongside
- False Claims Act liability with treble damages and per-claim penalties (31 U.S.C. § 3729)
- Exclusion from Medicare and Medicaid (42 U.S.C. § 1320a-7), license action, and DEA registration issues
Healthcare Fraud Cases We Handle
DME and orthotic brace fraud. Telemedicine and telehealth fraud. Genetic and cancer genomic testing. Anti-Kickback and Stark issues. Wound care and skin substitutes. Laboratory billing. Hospice and home health. Behavioral health, substance abuse treatment, and sober homes. Pharmacy and compounding fraud. Controlled substance prescribing.
AI-Generated Records and Health Care Fraud
AI scribes, templated notes, and AI summaries are lawful and increasingly common. The exposure is a chart that describes care that did not happen, or a note a provider signed without reading. In July 2026, four Minnesota defendants pleaded guilty to wire fraud after using ChatGPT to fabricate Medicaid records requested by insurers, and DOJ called AI use "a burgeoning trend" in health care fraud.
The most dangerous moment is the records request. Creating or completing records after a payer, contractor, or auditor asks for them can turn an overpayment dispute into a charge under 18 U.S.C. § 1519, which carries up to 20 years, and add an obstruction increase at sentencing. Preserve everything, including AI tool logs, and have counsel review records before anything is produced.
More: AI-Enabled Fraud Defense
How Healthcare Fraud Cases Are Defended
- Intent. Health care fraud requires proof that the defendant knowingly and willfully executed a scheme to defraud. Billing errors, reliance on coders and compliance staff, and good-faith clinical judgment are not crimes.
- Medical necessity. The government's reviewers often second-guess treating physicians from a file. Independent clinical review and the full patient record regularly tell a different story.
- Safe harbors and structure. Many payment arrangements fit an Anti-Kickback safe harbor or fall outside the statute entirely. The documents and the actual flow of money matter more than labels.
- Loss. The sentencing guidelines treat the amount billed as evidence of intended loss, which is why the loss number usually drives the sentence more than any other factor. We attack that number with data of our own.
- Timing. The strongest defense work happens before indictment, when the government is still deciding whom to charge and for what.
Who We Represent
Physicians and specialists. Nurse practitioners and physician assistants. Pharmacists and pharmacy owners. Clinic, lab, DME, hospice, and home health owners. Billing and coding companies. Marketers and management companies. Hospital and health system executives. Investors in healthcare businesses.
Healthcare Fraud Defense Nationwide
Healthcare fraud is prosecuted in every federal district, and the Strike Force model concentrates cases in a handful of them. AMC Defense Law represents providers and executives in Florida, New York, New Jersey, North Carolina, Texas, California, and other federal districts, appearing pro hac vice where required.
Who Handles Your Case
Aaron M. Cohen has defended federal healthcare fraud, Anti-Kickback, DME, telemedicine, and controlled substance cases for more than 30 years. Our team includes a federal investigations consultant who is a former FBI Supervisory Special Agent and a Certified Public Accountant licensed in Ohio and Florida, with a career investigating healthcare fraud and complex financial crime, and a sentencing strategist who works on mitigation and loss analysis from the start of the case.
