Hillsborough County Healthcare Fraud Attorney
Healthcare fraud investigations do not announce themselves. A federal agent’s visit, a subpoena for billing records, a notice from the Department of Health and Human Services Office of Inspector General, or a quiet termination from a Medicare provider agreement, these are often the first signals that something serious is underway. By the time most people realize they are under scrutiny, investigators may have spent months reviewing claims data, interviewing staff, and building a paper trail. Omar Abdelghany of OA Law Firm has defended clients in Hillsborough County against federal and state criminal charges, including Hillsborough County healthcare fraud cases, and he handles every matter personally from the initial consultation through resolution.
What Federal and Florida Prosecutors Actually Target in Healthcare Fraud Cases
Healthcare fraud prosecutions in this region tend to concentrate in a few areas that reflect the character of Tampa Bay’s healthcare economy. Hillsborough County is home to a substantial concentration of medical providers, home health agencies, durable medical equipment suppliers, compounding pharmacies, substance abuse treatment centers, and behavioral health practices. That density means federal investigators and Florida’s Medicaid Fraud Control Unit have no shortage of targets, and enforcement activity in this corridor has been consistent over the years.
The schemes prosecutors pursue most often involve billing for services never rendered, upcoding, which means billing a more expensive procedure or service than was actually delivered, unbundling charges that should be submitted together to inflate reimbursements, using patient referrals that violate the Anti-Kickback Statute, prescribing controlled substances outside the bounds of legitimate medical practice, and submitting claims under the identities of providers who did not actually furnish the services billed. In substance abuse and mental health billing, investigators frequently focus on whether documented group therapy sessions actually occurred and whether licensed clinicians were present. In home health, scrutiny often falls on whether patients met the homebound criteria and whether physicians actually reviewed the plans of care they signed.
What all of these categories share is that they involve federal programs, Medicare, Medicaid, TRICARE, or federal employees’ benefits, which means charges typically come through the U.S. Department of Justice and are prosecuted in federal court. For Hillsborough County defendants, that means the Middle District of Florida in Tampa, where Omar is licensed to practice.
The Criminal Charges That Accompany a Healthcare Fraud Investigation
A healthcare fraud prosecution rarely involves a single charge. Federal prosecutors routinely layer multiple statutes on top of one another, and the combination of charges determines both sentencing exposure and the strategy for defending the case. The primary criminal statute is 18 U.S.C. 1347, the healthcare fraud statute, which prohibits executing or attempting to execute a scheme to defraud a healthcare benefit program. A single count carries up to ten years in federal prison, with higher maximums if patients were harmed or if a death resulted.
Beyond the core fraud count, prosecutors frequently add wire fraud charges under 18 U.S.C. 1343, false statements charges under 18 U.S.C. 1001, and Anti-Kickback Statute violations under 42 U.S.C. 1320a-7b. When multiple individuals are involved, a conspiracy count under 18 U.S.C. 1349 is almost always included, and that conspiracy charge can expose someone to the same penalties as the underlying substantive offense even if they did not personally submit a single fraudulent claim. Money laundering counts under 18 U.S.C. 1956 appear regularly when proceeds were moved through separate accounts or entities, and they add another layer of mandatory minimums and forfeiture exposure.
The civil side runs parallel to the criminal case. The False Claims Act allows the government, and private relators in qui tam actions, to pursue civil penalties of more than ten thousand dollars per false claim, plus treble damages. For a practice that submitted thousands of claims over several years, civil liability under the False Claims Act can exceed the criminal fines by a wide margin. Healthcare providers also face mandatory exclusion from Medicare and Medicaid upon conviction, which is effectively a career-ending consequence for anyone whose livelihood depends on treating program beneficiaries.
How a Defense Attorney Approaches These Cases in Practice
The most important work in a healthcare fraud defense often happens before any charges are filed. If a client receives a target letter, a grand jury subpoena, or a request for a voluntary interview with federal agents, the response in those early stages can shape the entire trajectory of the case. Agreeing to speak with investigators without counsel, producing documents without understanding what they reveal, or taking steps to alter records after receiving a subpoena can all create independent legal exposure that did not exist before.
Once involved, Omar’s first task is understanding exactly what the government appears to have. That means reviewing the subpoena or target letter carefully, analyzing the billing records and documentation practices that are likely to be at issue, and identifying whether the conduct in question was the result of intentional fraud, negligent billing practices, or a misunderstanding of complex Medicare and Medicaid billing rules. That distinction matters enormously. The healthcare fraud statute requires proof of knowing and willful conduct. Billing errors, even systematic ones, do not automatically become criminal fraud, and the government must establish that a defendant acted with the intent to deceive, not simply that claims were submitted incorrectly.
On the evidentiary side, healthcare fraud cases are built largely on claims data, electronic health records, and cooperating witnesses, often former employees, billing contractors, or co-defendants who have already entered into cooperation agreements. Understanding what cooperators told investigators, whether their accounts are consistent with the documentary record, and whether their own conduct gives rise to credibility challenges is central to constructing a defense. Constitutional challenges to searches of provider records, challenges to the scope of a grand jury subpoena, and suppression motions based on Fourth Amendment violations are all available tools depending on how the investigation was conducted.
Questions Clients Typically Have Before Retaining Counsel
I received a Civil Investigative Demand from the Department of Justice. Does that mean I am being criminally investigated?
Not necessarily. Civil Investigative Demands are tools used in civil False Claims Act investigations, but a civil investigation can evolve into a criminal referral, and the documents you produce in a civil inquiry can be used in a criminal proceeding. It is worth having counsel review any government demand before you respond.
My billing company submitted the claims, not me. Can I still be charged?
Potentially, yes. Federal prosecutors frequently argue that a provider who signed orders, plans of care, or certifications knew or should have known that the billing was improper, even if a third-party biller handled the actual submissions. Signing medical documentation without verifying its accuracy is an area of significant legal risk.
If I repay the government, will the criminal case go away?
Repayment resolves civil liability under some circumstances, but it does not prevent criminal prosecution. The Department of Justice can and does bring criminal charges even after a provider has entered into a civil settlement. These are separate proceedings with separate standards and different legal consequences.
What happens to my medical license if I am convicted of healthcare fraud?
A conviction triggers mandatory exclusion from Medicare and Medicaid, and the Florida Department of Health reviews criminal convictions in disciplinary proceedings that can result in suspension or revocation of a professional license. The licensing consequences often outlast the criminal sentence in their practical impact on a provider’s career.
Is it possible to resolve a federal healthcare fraud case without going to trial?
Many cases are resolved through negotiated plea agreements, but the terms of those agreements, including the charges that remain, the sentencing guidelines calculation, and the extent of forfeiture and restitution, depend heavily on what defense counsel can establish about the weakness in the government’s evidence and the circumstances of the defendant’s conduct. Entering a plea without thorough preparation rarely produces the best available outcome.
Can family members who work in the practice be charged?
Yes. Co-owners, office managers, and administrative staff have all been charged as co-conspirators in healthcare fraud cases when prosecutors believe they were aware of or participated in the billing scheme. Anyone who received a subpoena or has been identified as a subject of an investigation should obtain independent counsel.
How long do healthcare fraud investigations typically last before charges are filed?
Federal investigations in this space can run for several years before charges are filed. The statute of limitations for most federal healthcare fraud offenses is five years, and investigators use that window to build the most comprehensive case they can before approaching the grand jury. This is one reason why receiving a subpoena years after the conduct in question does not mean the matter has been dropped.
Facing a Federal Healthcare Fraud Investigation in the Tampa Area
OA Law Firm handles federal criminal defense in the Middle District of Florida, and Omar Abdelghany is licensed in federal court to represent clients facing healthcare fraud charges in Hillsborough County and across the Tampa Bay region. He handles all matters personally, communicates directly with clients throughout the process, and focuses entirely on criminal defense. If you have received any form of contact from federal investigators or received legal process connected to a healthcare fraud inquiry, contact our office to speak directly with Omar about your situation. A Hillsborough County healthcare fraud attorney who has worked through the federal system can evaluate your exposure and your options before the government’s investigation reaches its next stage.
