April 8, 2026
Healthcare fraud is one of the federal government’s highest enforcement priorities, and the Southern District of Texas — which covers Houston and the surrounding region — is one of the most active districts in the country for federal healthcare fraud prosecutions. If you are a physician, nurse practitioner, hospital administrator, medical biller, pharmacy owner, or any other healthcare professional facing a federal healthcare fraud investigation, you are up against some of the most sophisticated and well-resourced prosecutors in the country.
You need an attorney who has been on that side of the table — and knows exactly how to fight back.
Monica Cooper Napier spent five years as a trial attorney with the United States Department of Justice’s Criminal Division, Fraud Section. During that time, she led multi-agency investigative teams — including FBI agents and HHS Office of Inspector General special agents — in investigating and prosecuting complex healthcare fraud cases throughout Texas and across the country. She trained federal prosecutors on trial presentation and the investigation of healthcare fraud offenses. In 2025, she received the DOJ’s prestigious “Powerhouse Prosecutor” award and was recognized for her role in the largest national healthcare fraud takedown case in history, which involved a staggering $10 billion in intended losses to Medicare. She also received a DOJ award for the largest loss amount in a plea agreement — $330 million.
Now, Monica brings that same knowledge and skill to defending healthcare professionals and businesses facing the full weight of the federal government.
Common Federal Healthcare Fraud Offenses
Federal healthcare fraud prosecutions in Texas typically involve one or more of the following:
Healthcare Fraud (18 U.S.C. §1347)
The core healthcare fraud statute makes it a federal crime to knowingly execute or attempt to execute a scheme to defraud a healthcare benefit program — including Medicare, Medicaid, TRICARE, or private insurers. This statute carries a maximum sentence of 10 years per count (20 years if serious bodily injury results, and life or death if death results).
False Claims Act Violations
The False Claims Act imposes civil and criminal liability for presenting fraudulent claims to the federal government. In healthcare, this includes billing for services not rendered, billing for a higher level of service than provided (upcoding), billing for medically unnecessary services, and unbundling procedures to inflate reimbursements.
Anti-Kickback Statute (42 U.S.C. § 1320a-7b)
The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals of federal healthcare program business. Common violations include paying physicians for referring patients to a particular pharmacy, lab, or facility; paying for speaking engagements that are really just referral fees in disguise; and kickback arrangements between medical device companies and prescribers.
Stark Law Violations
The Stark Law (Physician Self-Referral Law) prohibits physicians from referring patients to entities for certain healthcare services if the physician — or an immediate family member — has a financial relationship with that entity, unless a specific exception applies.
Money Laundering
Healthcare fraud proceeds are often charged in combination with money laundering counts under 18 U.S.C. § 1956, which can dramatically increase the overall sentencing exposure.
Conspiracy
Federal healthcare fraud cases almost always include conspiracy charges (18 U.S.C.§1349 or § 371), which allow the government to hold all participants in a fraudulent scheme jointly responsible — even if an individual participant’s direct role was limited.
How Federal Healthcare Fraud Investigations
Begin Federal healthcare fraud investigations are typically initiated by one of the following:
- Whistleblower complaints (qui tam actions under the False Claims Act) filed by current or former employees, business partners, or competitors
- CMS data analytics — the Centers for Medicare & Medicaid Services uses sophisticated data analysis to flag unusual billing patterns that deviate from peer norms
- Referrals from HHS OIG — the Office of Inspector General monitors Medicare and Medicaid claims data and refers suspicious patterns to the DOJ
- Tips from law enforcement or other agencies
By the time federal agents execute search warrants or make arrests, they have typically been investigating for a year or more. The government’s case is often already well-developed. This is why it is so critical to retain experienced federal defense counsel the moment you suspect you are under investigation — not after you’ve been indicted.
What to Do If Federal Agents Contact You
If FBI agents, HHS OIG investigators, or other federal law enforcement personnel contact you — whether it’s a knock at the door, a phone call, or a request for an interview — here is what you must do:
- Remain calm and do not answer questions. You have the right to remain silent. Exercise it.
- Do not consent to a search of your home, office, or vehicle without a warrant. If agents present a warrant, do not physically resist, but clearly state that you do not consent to the search.
- Do not destroy, delete, or alter any documents or electronic records. Even if you believe certain documents are incriminating, destroying them can result in federal obstruction of justice charges — which are often more serious than the underlying alleged fraud.
- Contact a federal criminal defense attorney immediately. Do not wait. Do not think you can explain your way out of the situation by cooperating without counsel. Federal agents are skilled interrogators, and anything you say — even innocent statements — can be used against you.
- If you receive a grand jury subpoena — whether as a witness, subject, or target — you are entitled to legal counsel. Contact an attorney before responding to the subpoena.
Defense Strategies in Federal Healthcare Fraud Cases
Lack of Intent
Federal healthcare fraud statutes require proof that the defendant knowingly and willfully engaged in fraudulent conduct. Medical billing is extraordinarily complex, and many alleged violations stem from mistakes, misunderstandings of billing codes, or reliance on incorrect advice from compliance staff. Establishing that billing errors were unintentional — rather than fraudulent — is a powerful defense.
Challenging the Government’s Expert Analysis
The government’s financial and medical experts will attempt to characterize billing patterns as fraudulent. We retain independent medical experts and forensic accountants to challenge these interpretations, demonstrate that billing practices were within accepted norms, or provide alternative explanations for the data.
Establishing Medical Necessity
If the government claims that services were medically unnecessary, we work with medical experts to review patient charts and establish that the treatment provided was, in fact, clinically appropriate.
Challenging the Sufficiency of the Evidence
In complex cases with enormous volumes of documents, the government does not always meet its burden of proof on every count. We carefully analyze every charge and challenge the sufficiency of the evidence on a count-by-count basis.
Pre-Indictment Negotiation and Declination
In some cases, Monica Cooper Napier’s deep familiarity with how federal prosecutors evaluate healthcare fraud cases allows her to present a compelling case for declination — persuading the government that charges are not warranted — or to negotiate significantly more favorable terms before a formal indictment is issued. This is far more difficult, and often impossible, to accomplish after indictment.
The Stakes Could Not Be Higher
A federal healthcare fraud conviction doesn’t just mean prison time. It can mean the permanent loss of your medical license, exclusion from all federal healthcare programs (ending your ability to practice medicine or run a healthcare business), devastating civil monetary penalties, asset forfeiture, and reputational destruction. For physicians and healthcare executives who have spent decades building their careers, the stakes truly could not be higher.
If you or your practice is under federal healthcare fraud investigation in Texas, contact The Napier Law Firm immediately for a free, confidential consultation. Monica Cooper Napier’s unique background as a former DOJ Fraud Section prosecutor gives you the insider advantage you need.