Here is a reality that surprises most healthcare providers and compliance officers: when federal agents finally knock on the door or when criminal charges are formally announced the investigation has often been underway for months or years. The 2025 National Healthcare Fraud Takedown charged 324 defendants across 50 federal districts. The schemes behind those charges […]

Most healthcare organizations don’t learn they are under investigation until federal agents appear at the door. Investigations are deliberately kept covertsometimes for months or yearswhile agencies build a case that, by the time it surfaces, is already formidable. In 2025, DOJ Fraud Section prosecutors charged 265 defendants with aggregate estimated fraud losses exceeding $16 billionmore […]

You work in healthcare, and you’ve seen something that doesn’t add up. Procedures billed that weren’t performed. Diagnosis codes that don’t match the patient in front of you. A billing department that seems to know exactly which codes generate the highest reimbursements regardless of what actually happened in the exam room. You know it’s wrong. […]

Ask most business owners or compliance professionals to describe healthcare fraud, and they’ll picture a dramatic criminal scheme: stolen identities, phantom clinics, shell companies laundering Medicare payments. What they rarely picture is a physician’s billing department quietly adjusting procedure codesday after day, patient after patientto inflate reimbursements by a few hundred dollars per claim. That’s […]

Your doctor ordered a lab test at your last visit. You didn’t think much of itthey’re the expert. What you may not have known is that the lab paid your doctor an illegal kickback to order that test, the test wasn’t medically necessary, and your insurance was billed for something you didn’t need. You were […]