“First Do No Harm” Considerations for Healthcare Providers in Light of Historic Healthcare Fraud Enforcement Announcement by the U.S. Department of Justice

On Monday, the Department of Justice Criminal Division, led by Matthew R. Galeotti, announced its largest healthcare fraud enforcement charging individuals and entities across the globe in allegedly $14.6 billion criminal and civil healthcare violations. [1] This enforcement action was done in partnership with the Centers for Medicare & Medicaid Services that is led by Administrator Dr. Mehmet Oz (“Dr. Oz”). Defendants run the gamut from licensed medical professionals—doctors, nurse practitioners, and pharmacists—to business executives and insurance providers. [2] The Acting Drug Enforcement Agency Administrator, Robert Murphy, stated the government is “targeting the entire ecosystem of fraud” because “health care fraud isn’t just theft – it’s trafficking in trust.” [3]

This latest enforcement action is expected to cause shockwaves throughout the healthcare industry, leaving industry operators weary on how to best protect themselves in the wake of these large-scale and ever-growing investigations.  When considering the white collar, tax, regulatory and bankruptcy implications in light of this historic enforcement action, it is recommended to follow these “Juris Doctor’s Orders.”

Doctor’s Orders – Be Careful with the Frequency and Accuracy of CPT Code Usage.

CPT Data are Breadcrumbs for Federal Investigators.

As every healthcare provider knows CPT (“Current Procedural Terminology”) codes are critical when conducting a patient assessment.  However, these codes are also breadcrumbs for federal criminal and civil investigators.  Whether it is an FBI Special Agent, or a data analyst at a United States Attorney’s office, CPT codes are often the starting point for healthcare fraud investigations.

Doctor’s Orders – Be cautious that CPT Data Mining Can Lead Investigators into your Bank Records.

Healthcare Data Can Lead Investigators Straight to Bank Accounts.

CPT code analysis can often lead investigators to identify suspicious medical billing practices.  Imagine the following – a data analyst working at the Maryland U.S. Attorney’s Office carefully reviews all the CPT codes for a basic blood draw test.  The analyst then identifies that one medical practice in Chevy Chase, Maryland that has three times the number of submitted CPT codes, and as a result bills paid by the federal government, when compared to similar practices throughout Maryland.  In turn agents from the DEA, HHS’ Office of Inspector General and the FBI will potentially subpoena financial records to see how much that Chevy Chase medical practice collected financially.

Doctor’s Orders – when responding to criminal subpoenas and/or civil demand requests BE THOUGHTFUL as these can be the building blocks for criminal prosecution and civil enforcement. 

Criminal and Civil Investigators Work Hand-in-Hand. 

The breath and scope of federal investigators and prosecutors is remarkable.  There are 94 U.S. Attorneys throughout the United States that partner with the DOJ Healthcare Fraud Section and various State Attorneys General.  Every city and state are covered by their investigative range.  The offices make up some of the best and brightest legal minds in investigating and prosecuting fraud, waste and abuse.  Federal criminal and civil enforcement often go hand-in-hand with criminal enforcement actions potentially resulting in federal prison sentences, forfeiture of money and property, restitution and fines, as well as civil regulators bringing significant civil enforcement actions.   False Claims Act litigation brought by healthcare insiders also presents an avenue where those in a medical practice might “blow the whistle” otherwise known as a “Qui tam” action and share with federal prosecutors’ evidence of fraud, waste and abuse.  Moreover, when Head of the Criminal Division Matthew R. Galeotti announced this historic enforcement action, he emphasized that international borders often do not limit the government’s reach. [4] In this recent takedown alone, four of the defendants were apprehended in Estonia and seven defendants were arrested at U.S. airports and on the U.S. border with Mexico. [5] The long arm of the law remains extensive.

Doctor’s Orders – Be deliberate about your taxes, failure to file will allow prosecutors to argue this is consciousness of guilt

Your Taxes Matter.

Federal prosecutors have the ability to obtain your tax returns as part of their investigations through what is known as an ex parte tax order and there is no immediate obligation to share with you that they are analyzing your returns for potential tax evasion.  Why does this matter?  Imagine the example of a Maryland healthcare practitioner whose practice has a number of charges demonstrating potentially fraudulent CPT codes.  FBI agents may interview the patients involved to see if they actually received the tests, while also potentially seeking an ex parte order for the doctor’s tax records in order to review claimed income or evidence the doctor did not report this income on their tax returns.

A Cautionary Tale from Al Capone.  

Once one of America’s most notorious mobsters caught the attention of federal investigators, they stopped at nothing to charge Mr. Capone.  However, an often-overlooked lesson is that federal law enforcement could not catch Al Capone orchestrating an act of violence or illegal bootlegging, but instead it was his taxes that brought him under federal indictment. [6] As strange as it might seem Al Capone’s story underscores that once federal investigators have you on their radar your tax liabilities could be an aspect of their case.  

Doctor’s Orders – Be mindful that bankruptcy can be a powerful and important legal tool but using it as a shield from criminal and civil investigators is often a prescription for trouble.

Bankruptcy is Not Always a Solution. 

While some healthcare practitioners believe that they can simply close their practice and start fresh in another state, declaring bankruptcy does not deter federal investigators.  In fact, false statements within a bankruptcy filing can result in additional potential charges, including bankruptcy fraud.  Your financial lenders also do not look favorably on your bankruptcy filing and/or defaulting on a loan.  For example, the Small Business Administration is a tremendous resource for loans to support small businesses, but if you default on these loans, you can be limited in obtaining future loans from the SBA.  

DOJ’s historical health care fraud announcement only begins the process for criminal and civil enforcement throughout the United States.  Whether it’s civil enforcement actions under the False Claims Act, the Anti-Kickback Act, or other civil fraud enforcement, prosecutors will use these tools as part of their enforcement toolbox to combat fraud, waste, and abuse.  Criminal prosecutions also bring potentially disastrous outcomes including incarceration, loss of a medical license, and the financial and administrative consequences for defrauding government funded healthcare programs such as Medicare and Medicaid.  Meeting this historical moment in health care fraud enforcement requires vigilance, diligence, and preparation as the DOJ has made clear combatting health care fraud is a top priority. Going forward, it is more imperative than ever to heed the Hippocratic Oath’s command to “first do no harm” in this “new era of aggressive prosecution and data driven intervention.” [7]

Cole Schotz’s team of White Collar, Tax, and Bankruptcy attorneys are monitoring the evolving intersection between health care enforcement, white collar, tax and bankruptcy, as well as civil enforcement and criminal prosecution implications. From Florida to D.C., New York and New Jersey to Delaware, Texas to Maryland, Cole Schotz is here to help you address the impacts of this historic healthcare fraud enforcement action. We are well poised to help you navigate these changing legal strategies and industry-specific issues.  Please reach out to the authors and your Cole Schotz relationship partner with any questions. Results may vary depending on your particular facts and legal circumstances.

A special thanks to Summer Associate Claire Cooper for her contributions to this alert.

“First do no harm” is among the promises doctors make in swearing the Hippocratic Oath.

[1] Press Release, National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud (June 30, 2025), https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146.

[2] Id.

[3] Id.

[4] Id.

[5] Id.

[6] Nat’l Archives and Recs. Admin., https://www.archives.gov/exhibits/american_originals/capone.html (last updated May 22, 1997).

[7] Matthew R. Galeotti, Head of Dep’t of Just. Crim. Div., Press Conference to Announce the results of the 2025 National Health Care Fraud Takedown, at 7:05 (June 20, 2025), https://www.justice.gov/opa/video/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146.