Facing Federal Healthcare Fraud Conspiracy Charges?

Federal healthcare fraud conspiracy involves an agreement between two or more people to defraud a healthcare benefit program, such as Medicare or Medicaid. These charges, typically brought under statutes like the federal healthcare fraud and anti-kickback laws, are aggressively prosecuted and can lead to decades in prison, massive fines, and the forfeiture of personal and business assets.

Recent federal cases highlight the severe consequences:

• PFIZER INC. - $2.3 BILLION SETTLEMENT (2009): Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. agreed to pay $2.3 billion, the largest health care fraud settlement in the history of the Department of Justice, to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products.
• 2025 NATIONAL HEALTH CARE FRAUD TAKEDOWN - $14.6 BILLION: The Justice Department announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General's Offices across the United States
• UNITED STATES V. FARRUKH ALI, 25 CR. 882 (ESW): Farrukh Jarar Ali, 41, of Pakistan, was charged by indictment with conspiracy to commit health care fraud and wire fraud, three counts of wire fraud, and money laundering in connection with an alleged $650 million scheme involving at least 41 substance abuse treatment clinics in Arizona.

What Can Federal Authorities Accuse You Of?

Healthcare Fraud & Conspiracy (18 U.S.C. §§ 1347, 1349): 

• The core offenses for knowingly executing a scheme to defraud a healthcare program. The conspiracy charge does not require proof of an overt act—the agreement itself is the crime.

Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)): 

• Prohibits knowingly and willfully paying, offering, soliciting, or receiving remuneration (e.g., kickbacks, bribes) to induce or reward patient referrals or the generation of business involving any item or service payable by federal healthcare programs.

Money Laundering (18 U.S.C. § 1956): 

• Engaging in financial transactions to conceal the proceeds of healthcare fraud.

False Statements Relating to Health Care Matters (18 U.S.C. § 1035): 

• Knowingly making false statements in connection with the delivery of or payment.

How We Fight Federal Healthcare Fraud Conspiracy Charges

Core defense strategies focus on dismantling the government's evidence and proving a lack of criminal intent:

• Lack of Fraudulent Intent: The cornerstone of a strong defense is demonstrating that you did not act "knowingly and willfully." We work to prove that any billing errors or questionable practices were mistakes made in good faith, not part of an intentional scheme to defraud.
• No Unlawful Agreement: For conspiracy charges, we challenge the prosecution's ability to prove that you knowingly entered into an agreement to commit fraud. We can argue you were an unwitting participant or that your actions were independent and legitimate.
• Good Faith and Legitimate Practice: We can argue that all services and prescriptions were based on professional medical judgment and were medically necessary for patient care, countering the government's claims that they were fraudulent.
• Reliance on Expert Advice: A strong defense can be built by showing you acted in good faith based on the advice of compliance experts, billing specialists, or legal counsel regarding complex healthcare regulations.

Possible Sentencing & Penalties in New York

Sentencing and penalties vary depending on the specific charge:

Healthcare Fraud (18 U.S.C. § 1347):

• Up to 10 years imprisonment per count, fines, and restitution. The sentence can increase to 20 years if the fraud results in serious bodily injury and life if it results in death.

Conspiracy (18 U.S.C. § 1349):

• Carries the same penalties as the underlying healthcare fraud offense.

Anti-Kickback Statute:

• Penalties include up to 10 years in prison and fines up to $100,000 per kickback.

Sentencing Guidelines - §2B1.1 (Fraud):

• Sentences are primarily driven by the total "loss amount" billed to the government. Enhancements apply for:‍
  
  • Loss Amount: The higher the fraudulent billing, the longer the sentence.‍
  • Vulnerable Victims: Targeting elderly or disabled patients increases penalties.‍
  • Abuse of Trust: A physician, nurse, or other medical professional using their position to commit fraud faces a sentencing enhancement.‍
  • Leadership Role: Organizers of the scheme receive significantly longer sentences.

You might be facing forfeiture and professional consequences too:

Criminal Forfeiture (18 U.S.C. § 982):

• The government will seek to forfeit any property and proceeds derived from the healthcare fraud scheme. This can include bank accounts, real estate, vehicles, and other assets.

Exclusion from Federal Healthcare Programs:

• A conviction often results in mandatory, long-term exclusion from participating in Medicare, Medicaid, and other federal health programs, effectively ending a medical career.

Examples and Related Cases

The Law Offices of Jason Goldman has handled various matters related to medicare fraud, medicaid fraud, and healthcare fraud in general. Most of our significant victories within this landscape has come well-before criminal prosecutions, during investigatory phases where we have successfully convinced regulatory agencies from bringing charges.

Oftentimes, healthcare fraud matters are initiated with wide-ranging, overbroad subpoenas requesting voluminous records from organizations and executives at insurance companies or medical facilities. In this capacity, our office recently represented a doctor who was being investigated by the attorney general’s office in New York, where we successfully conducted a parallel defense investigation, indexed records, and convinced prosecutors to decline further action upon an extensive review.

Your Defense Begins Now

If you are accused of conspiracy to commit healthcare fraud, seek counsel from a former prosecutor and preeminent criminal defense attorney who has dealt with these offenses on both sides of the aisle.

The sooner you put your case in the hands of an experienced defense lawyer, the more opportunity you will have to work toward a favorable outcome. Contact The Law Offices of Jason Goldman today.