You’ve Been Contacted by a Federal Agent for Healthcare Fraud—Now What?
If you’ve been contacted by a federal agent for healthcare fraud, the decisions you make now could determine the course of your life for years to come. Whether it’s a knock on your office door, a phone call from the FBI, or a grand jury subpoena landing in your inbox, federal involvement signals that you are either a target, subject, or witness in a serious criminal investigation.
And make no mistake—healthcare fraud investigations are among the most aggressively pursued white-collar crimes by the Department of Justice (DOJ), the FBI, and other federal agencies. Penalties can include prison time, hefty financial penalties, loss of professional licenses, and permanent damage to your reputation.
At Werksman Jackson & Quinn LLP, we defend physicians, billing managers, hospital executives, pharmacists, and business owners throughout California who are facing scrutiny from federal authorities.
It’s crucial to secure first-rate legal representation before you respond, talk, or hand over a single piece of information.
Understanding What’s Really Happening
When federal agents initiate contact, it may seem casual. They might just say they “have a few questions,” or they might downplay the nature of the investigation. Do not fall for it. Federal agents are trained interrogators. You are not.
Their job is not to help you—it’s to gather evidence. If they are contacting you in connection with a healthcare fraud investigation, it means they’ve already gathered information and are now looking to build or solidify a criminal case.
The most common types of fraud they investigate include:
- Billing for services not rendered
- Upcoding or unbundling procedures
- Kickback schemes
- Medicare or Medicaid reimbursement fraud
- Prescription or pharmacy fraud
- False certifications or documentation
Even if you don’t think you’ve done anything wrong, never assume you’re in the clear. You may be a target—or you could potentially become one.
Say Nothing Without Legal Counsel
If there’s one universal rule in white-collar criminal defense, it’s this: Don’t talk to federal agents without an attorney present.
You are not required to answer questions without legal representation, even if you’re approached unexpectedly. Politely but firmly say: “I understand you have questions, but I will not be speaking with anyone without legal counsel. Please provide your contact information, and my attorney will follow up.”
This is not obstruction. This is your constitutional right. Anything you say can—and will—be used against you, even seemingly harmless or honest answers. Agents are trained to look for inconsistencies, admissions, or evidence of intent.
Determine the Nature of the Contact
There are three general categories of individuals in a federal case:
- Witness: You have information relevant to the investigation but are not suspected of wrongdoing.
- Subject: You are under investigation and may have done something illegal, but no charges have been filed yet.
- Target: The government believes you committed a crime and is likely to bring forth charges.
You may not know which category you fall into unless the agents tell you (and they often won’t). However, the receipt of a grand jury subpoena, or more aggressive questioning, is often a sign you are either a subject or target.
A qualified defense attorney can determine your classification and respond appropriately—without compromising your legal position.
Do Not Destroy or Alter Any Records
If you’ve received a subpoena or suspect you’re under investigation, do not delete emails, alter charts, or “clean up” files. This may be viewed as obstruction of justice, which is a separate felony charge.
Even if you think a document looks bad, altering or hiding it will look worse.
Here’s what you’ll want to do instead:
- Preserve all records, emails, and notes as they exist.
- Identify the systems and employees with access to sensitive data.
- Avoid discussing the case with colleagues or staff.
Let your Los Angeles healthcare fraud defense attorney handle all communications and coordination regarding any documentation requests.
Retain a Criminal Defense Attorney Experienced in Federal Healthcare Fraud Cases
Federal healthcare fraud cases are not routine. They require a deep understanding of medical billing practices, regulatory compliance, and DOJ prosecutorial strategies. You need a team that has successfully defended high-profile, high-exposure clients—especially in cases where your life, liberty, and licensure are on the line.
At Werksman Jackson & Quinn LLP, our defense attorneys include former prosecutors, trial-tested litigators, and strategic negotiators who’ve taken on the DOJ and won. We are uniquely qualified to respond to:
- FBI contact advice and communication management
- Grand jury subpoena response and document production
- Interviews and proffer sessions with federal agents
- Indictment defense and motion practice
- Trial advocacy if your case goes to court
What an Aggressive Defense Strategy Looks Like
When a client comes to us after being contacted by a federal agent for healthcare fraud, we act immediately. Our approach is proactive, not reactive.
Key steps we take:
- Determine your status (witness, subject, or target)
- Engage with prosecutors before charges are filed
- Control document production to avoid over-disclosure
- Prepare for interviews or depositions so you’re never unprotected
- File pre-indictment motions when possible to stop the case before it escalates
Every move we make is calibrated to protect your freedom, your finances, and your professional reputation.
Do You Need a Lawyer If You Haven’t Been Charged?
Yes. In federal cases, the investigation phase can last months or even years. But that doesn’t mean it’s time to wait and see. The earlier you retain counsel, the more opportunity you have to resolve the issue before an indictment is ever filed.
It’s time to act if you’ve been contacted by an agent, received a grand jury subpoena, or believe your practice is being audited by the DOJ or HHS-OIG.
Talk to a Los Angeles Healthcare Fraud Defense Lawyer Today
Being caught in a healthcare fraud investigation is both stressful and life-altering. Without experienced legal guidance, what starts as a conversation could end in a criminal charge.
Werksman Jackson & Quinn LLP is one of California’s most respected criminal defense firms. We represent clients in Los Angeles and beyond who are facing the most serious accusations—including Medicare fraud, Stark Law violations, and federal conspiracy charges. We are discreet, strategic, and unrelenting.
Call (213) 688-0460 today to schedule an initial consultation with one of our knowledgeable and experienced criminal defense attorneys—completely free and completely confidential. Let us protect your rights, your reputation, and your future.
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