Health Care Fraud Defense and Compliance Counseling

The McGonigle, P.C. team of former federal prosecutors and regulators represents health care providers and their officers and directors in government investigations, and criminal and civil litigation concerning health care fraud allegations, the federal anti-kickback statute, and physician self-referral ("Stark Act") violations. We also counsel clients concerning cybersecurity threats, data breach responses, or other patient privacy or Health IT matters, and False Claims Act matters. 

Our team includes five former prosecutors from the U.S. Department of Justice, including the former Senior Litigation Counsel and Health Care Fraud Coordinator in the Fraud and Public Corruption Section and a former Assistant U.S. Attorney who successfully prosecuted the largest health care fraud case in District of Columbia history. 

We have significant experience handling billing and reimbursement issues, data security and patient privacy issues, and alleged kickback schemes. During our time as federal prosecutors, we prosecuted these very kinds of cases, resulting in significant jail time for individuals and large monetary fines for entities. We employ our experiences as prosecutors to aggressively defend our clients by highlighting the legal and factual weaknesses of the Governments’ cases. We use our knowledge of the Government’s tactics and institutional needs to craft case resolutions. 

Where possible, the Group seeks to assist our clients proactively in avoiding the problems that lead to governmental investigations, formal proceedings and disputes, and to position our clients to achieve the best possible result when adversarial proceedings become necessary. We therefore routinely support our clients through counseling, training, and the development of comprehensive compliance programs to address and meet current and future governmental and regulatory requirements and expectations. We are well-versed in responding to government subpoenas and information requests, assisting clients with voluntary disclosures to government agencies, and negotiating corporate integrity agreements. 

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Looking Forward

We believe that health care fraud will continue to be one of the most active sectors of the U.S. Department of Justice’s overall fraud enforcement programs. Federal and state regulators will continue to aggressively pursue fraud and abuse in False Claims Act matters, anti-kickback violations and patient privacy issues. We saw in September 2020 that the DOJ had one of the largest takedowns in history that targeted, among others, fraud and abuse in the telemedicine and prescription drug industries. We anticipate that as a result of the COVID-19 pandemic, under the Biden Administration, the DOJ and HHS will increase their focus on fraud and abuse in telehealth services that had expanded greatly in response to the coronavirus crisis. Providers and other individuals and entities who provide telehealth supplies and/or services are encouraged to consult their legal counsel to ensure that their policies and procedures will not trigger regulatory or law enforcement scrutiny.