The Napier Law Firm, PLLC – Houston Health Care Fraud Defense Attorneys with Federal Trial Experience
Medicare fraud—commonly referred to as healthcare fraud—involves intentionally submitting false or misleading claims to obtain payments from federal healthcare programs such as Medicare or Medicaid. This type of fraud is prosecuted aggressively by both state and federal authorities, as it results in billions of dollars in financial losses to the government each year.
Because the Medicare system operates largely on the “honor system,” where providers are trusted to bill accurately and ethically, it becomes an attractive target for bad actors. However, not every billing discrepancy is intentional. Innocent errors, outdated billing practices, or flawed third-party submissions can trigger investigations or charges.
Who Gets Caught in the Crosshairs?
At The Napier Law Firm, we understand that overzealous investigations can wrongly target well-meaning professionals. We have represented clients throughout Texas—including in Houston, The Woodlands, Fort Bend County, and Montgomery County—who found themselves suddenly facing accusations of healthcare fraud despite their best efforts to comply with complex billing laws.
Health care fraud allegations can be catastrophic—not only financially, but professionally and personally. With aggressive investigations led by federal agencies such as the FBI, HHS-OIG, and the Department of Justice, billing irregularities can trigger full-blown investigations and lead to criminal charges. Prosecution often targets individual providers, billing companies, pharmacy owners, and executives.
Our Houston-based legal team defends:
- Physicians and physician group practices
- Pharmacists and pharmacy owners
- Dentists, nurses, and physical therapists
- Durable medical equipment (DME) suppliers
- Home health care providers
- Ambulance company operators
- Mental health professionals and clinic owners
While serving as a trial attorney for the DOJ, Monica Cooper Napier was part of the Fraud Section’s health care strike force in Texas. Monica now uses that insider knowledge to ensure her clients receive a thorough and informed defense. At The Napier Law Firm, we apply a proactive, trial-tested approach to protect your license, liberty, and livelihood.
Why Health Care Fraud Requires Specialized Defense
At The Napier Law Firm, we are uniquely equipped to represent Houston providers, clinics, and medical professionals accused of federal health care fraud offenses.
Unlike many criminal offenses, health care fraud cases often hinge on nuanced regulations and in-depth analysis of whether evidence exists to establish criminal intent. They require detailed knowledge of health care law, CMS billing practices, and federal fraud statutes. At the Napier Law Firm, we deliver focused, experienced, and trial-tested defense strategies to help providers, clinics, and administrators navigate investigations, indictments, and criminal trials.
Common Allegations in Medicare Fraud Cases
Federal and state authorities often pursue healthcare providers for alleged fraudulent practices such as:
- Phantom Billing – Charging for services or equipment never provided
- Billing for Unnecessary Procedures – Submitting claims for tests or services that weren’t medically necessary
- Double Billing or Upcoding – Using billing codes for higher-cost services than what was actually provided
- Kickbacks or Referrals – Offering payments or gifts in exchange for Medicare patient referrals
- False Records—Falsification of medical records or documentation
- Identity Theft—Misuse of patient or provider identification numbers
In some cases, patients are complicit—agreeing to provide their Medicare number in exchange for cash, knowing that fraudulent charges will be submitted in their name.
What Are “Upcoding” and “Unbundling”?
Two of the most aggressively prosecuted billing practices in healthcare fraud investigations are:
- Upcoding – This occurs when a provider uses a billing code for a more expensive service or procedure than was actually performed in order to receive a higher reimbursement.
- Unbundling – This involves separating a group of related services (often referred to as a “panel”) into individual charges, inflating the total claim. It is especially common in lab testing and clinical diagnostic settings.
Both practices are treated seriously under federal law and may lead to civil penalties or criminal charges if investigators determine the intent was fraudulent.
The Government’s Aggressive Crackdown on Medicare Fraud: What You Need to Know
In June 2025, federal prosecutors launched the largest healthcare fraud takedown in U.S. history—charging over 300 individuals with allegedly participating in schemes that led to more than $14.6 billion in false Medicare claims. This multi-agency effort targeted a wide range of professionals, including doctors, pharmacists, DME providers, and clinic operators. Investigators alleged fraudulent billing practices for medical devices, amniotic allograft skin substitutes, home health services, telemedicine consults, and lab testing.
Federal agencies involved included the U.S. Department of Justice (DOJ), Department of Health and Human Services – Office of Inspector General (HHS-OIG), FBI, DEA, and state Medicaid fraud units
These sweeping prosecutions reflect a clear reality: federal task forces are casting wide nets and moving fast, sometimes before defendants even know they’re under investigation.
The following have become specific areas of focus for federal and state task forces:
- Amniotic allograft skin substitute services and wound care services
- Partial Hospitalization Programs (PHPs)
- Ambulance transport for non-emergency services
- Telemedicine billing and consults
- Home health and hospice services
- DME billing schemes
- Mental health and substance abuse treatment clinics
- Lab Testing schemes
At The Napier Law Firm, we defend professionals in each of these categories and understand the nuances in billing regulations that often lead to misunderstandings or compliance disputes—not criminal conduct.
Potential Penalties
Federal sentencing in health care fraud cases can be severe, including:
– Up to 10 years in prison per count of health care fraud
– Up to 20 years if serious bodily injury results
– Civil monetary penalties and treble damages
– Mandatory restitution to federal programs or insurance companies
– Professional license suspension or revocation
– Exclusion from Medicare, Medicaid, and other federal programs
– Seizure and forfeiture of business assets or accounts
– Damage to professional reputation and future employability
What This Means If You’re a Healthcare Provider or Executive
If you’re a licensed healthcare professional—especially in industries like wound care services, telemedicine, durable medical equipment (DME), hospice, or home health—you may now be operating in an environment of heightened scrutiny.
These investigations often rely heavily on:
- Billing audits and data analytics
- Whistleblower complaints (qui tam lawsuits)
- Aggressive asset seizures and pretrial suspensions
Even providers with no intent to commit fraud can be swept up in investigations over coding issues, third-party billing services, or unclear Medicare regulations.
You Don’t Have to Face This Alone
At The Napier Law Firm, we understand the fear and confusion that come with a federal investigation. With experience with doctors, nurses, pharmacists, and healthcare executives in Houston and across Texas, we know how to:
- Respond to federal subpoenas or target letters
- Review claims data and compliance systems
- Challenge weak or misleading evidence
- Fight for dismissal, reduction of charges, or trial acquittal
Now Is the Time to Act
If you’ve been contacted by federal agents or believe you may be under investigation for healthcare fraud, do not speak to investigators without legal counsel. Prosecutors are building cases quickly—often using massive data sets and coordinated federal-state task forces.
Let our experienced defense team help you protect your license, reputation, and freedom.
How We Build a Strong Defense
1. Immediate Action and Case Evaluation: Early involvement allows us to engage with prosecutors and control the flow of information.
2. Review of Billing Records and Claims Data: We identify patterns or mistakes and explain the absence of intent to defraud.
3. Negotiation: Armed with our findings, we engage with prosecutors to show them why charges should not be brought, or only lesser charges should be brought.
4. Motion Practice: Suppress unlawfully obtained evidence, challenge overbroad subpoenas, and exclude prejudicial or irrelevant material.
5. Trial Preparation: Develop themes that show honest intent, lack of knowledge, or delegated billing responsibility.
6. Mitigation and Sentencing Advocacy: Where appropriate, we pursue non-prosecution agreements, civil resolutions, or reduced sentences.
Why Choose The Napier Law Firm
– Experienced Criminal Defense Representation
– Proven experience with federal investigations and criminal trials
– Former prosecutors with inside knowledge of how cases are built
– Clear, strategic, and responsive communication every step of the way
Take Action Immediately – Speak with a Houston Health Care Fraud Defense Attorney Today
If you’ve received a subpoena, target letter, or search warrant in Houston or anywhere in the Southern or Eastern Districts of Texas, contact our firm immediately. The Napier Law Firm provides skilled representation to health care clients facing audits, investigations, and federal charges.