Fraud & Abuse

Fraud and abuse enforcement in healthcare is aggressive, with severe penalties for violations—including fines, exclusion from federal healthcare programs, and even criminal liability. At Goodman Allen Donnelly, our attorneys provide proactive compliance guidance and strategic defense for healthcare providers, medical practices, and organizations facing fraud and abuse allegations.

Healthcare Fraud & Abuse Laws

We help clients navigate and comply with complex federal and state laws, including:

  • Stark Law (Physician Self-Referral Law) – Prohibiting improper financial relationships between physicians and healthcare entities
  • Anti-Kickback Statute (AKS) – Regulating referral-based remuneration in federally funded healthcare programs
  • False Claims Act (FCA) – Addressing improper billing and fraud allegations in Medicare, Medicaid, and other federal programs
  • Civil Monetary Penalties Law (CMPL) – Imposing fines for violations related to fraud, patient inducements, and overpayments
  • Exclusion Authorities & Compliance with OIG Guidelines

Compliance & Risk Prevention

A strong compliance program is the best defense against fraud and abuse allegations. Our team assists with:

  • Developing and implementing corporate compliance programs
  • Conducting internal audits and risk assessments
  • Training staff on compliance best practices
  • Advising on fair market value (FMV) and commercial reasonableness in physician compensation arrangements
  • Responding to government audits, subpoenas, and investigations

Fraud Defense & Investigations

If your practice is facing a government investigation, whistleblower complaint, or fraud enforcement action, our attorneys provide aggressive defense in:

  • Civil & Criminal Fraud Investigations – Representation before DOJ, HHS-OIG, and CMS
  • False Claims Act (FCA) & Whistleblower Defense – Handling qui tam lawsuits and government intervention cases
  • Medicare & Medicaid Audits & Appeals – Challenging overpayment claims and exclusions
  • Negotiating Settlements & Voluntary Disclosures – Mitigating liability through self-disclosure protocols

Why Choose Us?

Our deep experience in healthcare regulatory compliance and fraud defense allows us to protect healthcare providers from costly penalties and reputational damage. Whether you need compliance guidance, audit defense, or legal representation in a fraud case, Goodman Allen Donnelly is here to help.

Contact us today to discuss your compliance concerns or fraud defense strategy.

Contact Goodman Allen Donnelly