Healthcare Fraud Healthcare Fraud We prosecute healthcare fraud and whistleblower claims.

Healthcare Fraud

The federal and state civil and criminal laws governing healthcare provide powerful weapons to combat fraud. At AM&R, we have substantial experience litigating healthcare fraud claims on behalf of a wide range of individuals and organizations, including in the following areas (among others):

  • Insurance Fraud
  • Patient Fraud
  • Medical Billing Fraud
  • CPT Coding Fraud
  • HIPAA Fraud Claims
  • Civil RICO Litigation
  • Medical Privacy Litigation
  • Medical Partnership Disputes

Representative Health Care Fraud Experience

Prosecuted RICO, fraud, and deceptive trade practice claims, including action on behalf of auto insurance carriers seeking in excess of $35 million in damages against physicians, surgery centers, and medical practice managers relating to certain spinal procedures performed on personal injury claimants. See State Farm Mut. Auto. Ins. Co. v. Kugler et al, 2011 WL 4389915 (S.D. Fla. Sept 21, 2011).

Defended Professional Employer Organization (PEO) against whistleblower claims asserted by the manager of a medical practice (under a co-employment theory) alleging that the medical practice had engaged in systematic insurance fraud, intentionally concealed medical malpractice, and engaged in a wide range of other illegal conduct.

Represented auto insurance carriers in Multiple Claims Investigation Unit (MCIU) and Special Investigation Unit (SIU) investigations regarding complex insurance fraud schemes, unlawful medical billing practices, and illegal clinic ownership claims.

Represented a wide range of medical practices in healthcare-related litigation, including the representation of radiologists, oral surgeons, and other medical professionals in connection with practice management litigation, noncompete actions, medical practice buy out disputes, and internal investigations.

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