Health Care Fraud Conspiracy Charges: Why You Don’t Have to “Do the Crime” to Do the Time

Federal White Collar & Health Care Fraud Defense Attorney

If you’re a doctor, medical clinic owner, billing manager, or other health care professional facing federal fraud charges, you may be shocked to learn that you could be facing conspiracy charges—even if you never submitted a false claim, accepted illegal kickbacks, or profited from the scheme.

Federal law is broad and aggressive when it comes to conspiracy charges. In health care fraud cases, you don’t need to have been the person submitting fraudulent claims to find yourself under investigation. Just participating in or enabling the fraudulent scheme—even unknowingly—can expose you to the same penalties as the person who orchestrated it.

If you’re facing federal conspiracy charges, you’re looking at prison time, financial penalties, and professional consequences that could devastate your career and livelihood. But you don’t have to face it alone—Almonte Law is here to help. Robert Almonte, federal defense attorney and federal health care fraud defense attorney, is here to fight for you.

What Is a Health Care Fraud Conspiracy Charge?

Under 18 U.S.C. § 1349, conspiracy to commit health care fraud occurs when:

1. Two or more people agree to defraud a health care benefit program (like Medicare, Medicaid, or Tricare); and
2. At least one of the conspirators commits an act to further the fraud—such as submitting claims, signing off on certifications, or providing referrals.

The Key to Conspiracy Charges in Health Care Fraud Cases

What makes conspiracy charges dangerous is that the government doesn’t need to prove you committed fraud yourself. All they need to show is that:

• You agreed to be a part of the fraudulent scheme (even indirectly); and
• You took one overt action—like authorizing paperwork or reviewing patient charts—that could be interpreted as supporting the fraud.

That means if you signed off on forms or authorized patient care plans without fully understanding the situation, you could be charged—and the penalties can be severe.

Common Health Care Fraud Conspiracy Scenarios

Health care fraud conspiracy charges often arise from common practices in the medical field that could unintentionally put you at risk. These include:

• Medicare billing fraud for services not rendered or upcoded services
• Kickback schemes involving illegal payments for patient referrals
• Durable medical equipment (DME) fraud
• Unnecessary diagnostic tests or home health services billed to Medicare
• Telemedicine fraud, particularly regarding Medicare Advantage plans
• PPP and EIDL loan fraud tied to health care businesses during the COVID-19 pandemic

For example, a physician might be charged with conspiracy for signing a certification form for a home health service, even if they didn’t provide the service themselves and weren’t directly compensated for the fraud.

Example: The Unwitting Doctor Caught in a Fraud Scheme

A hypothetical: Dr. L, a primary care physician, signs off on home health orders for patients under the assumption that the clinic handling the patients is following proper procedures. The clinic is billing Medicare for services that were never rendered.

Despite not personally profiting from the fraud, Dr. L is charged with conspiracy to commit health care fraud because she took part in the fraudulent process by signing off on the orders. Can this happen? Yes. Is it fair? No. Can you fight it? Yes, with federal defense attorney and former healthcare fraud prosecutor, Robert Almonte.

Consequences: Dr. L faces the same federal penalties—including prison, restitution, and professional sanctions—as those who orchestrated the fraudulent scheme.

How the Government Builds Health Care Fraud Conspiracy Cases

Federal prosecutors often rely on circumstantial evidence to build their case. It is important to note that federal investigations are far reaching with unlimited resources. Common evidence includes:

• Emails and text messages that suggest coordination between professionals
• Billing records showing patterns of false claims
• Patient charts, certifications, and medical records with discrepancies
• Cooperating witnesses who may have been involved in the fraud and are offering testimony to reduce their sentences
• Financial records that show shared profits or financial interests

The government doesn’t need a signed agreement or direct evidence that you personally profited. In many cases, simply participating in a scheme—or failing to question red flags—is enough for them to charge you with conspiracy.

Why Health Care Fraud Conspiracy Is So Dangerous for Professionals

Health care fraud conspiracy charges carry severe consequences, particularly for those in the medical field. Even if you didn’t personally benefit from the fraud, you could still face the following penalties:

• Up to 10-20 years in prison, depending on the severity of the fraud
• Massive restitution payments to cover fraudulent claims paid by Medicare, Medicaid, or private insurers. Beyond restitution, you could be subjected to penalties under the False Claims Act.
• Professional consequences, including medical license revocation or suspension
• Loss of DEA registration (for prescribing drugs)
• Exclusion from federal health care programs, which could end your career as a health care provider
• Public record of your conviction, damaging your professional reputation

How Almonte Law, Federal Defense Attorney, Defends Health Care Professionals Facing Conspiracy Charges

At Almonte Law, we specialize in defending health care professionals facing conspiracy charges. With experience as a former federal health care fraud prosecutor, we know how these cases are built and how to dismantle them.

Our defense strategies include:

Challenging the Existence of a Conspiracy

We examine whether you truly agreed to participate in the fraudulent scheme and whether your actions were legally justified.

Establishing Lack of Criminal Intent

We focus on demonstrating that you did not knowingly participate in any fraud, and that you acted in good faith, relying on other professionals to handle administrative or billing matters.

Minimizing Your Role and Responsibility

In health care fraud cases, your role in the conspiracy affects the outcome. We work to show that your involvement was limited, reducing your potential penalties.

Attacking the Credibility of Government Witnesses

Many conspiracy cases rely on testimony from cooperating insiders—individuals who have entered plea deals in exchange for reduced sentences. We scrutinize their credibility and motivations to reduce their impact on your case.

Don’t Wait Until It’s Too Late—Get Help Now

Health care fraud conspiracy cases are high-stakes, with the potential to destroy your career and lead to years of imprisonment. If you’ve been indicted, received a target letter, or are under investigation, you need experienced federal defense counsel to protect your future.

Call Almonte Law Today for a Confidential Consultation

At Almonte Law, we provide dedicated, aggressive defense for health care professionals across the country. Our former prosecutor experience and comprehensive knowledge of federal fraud law can make all the difference in the outcome of your case.

• Call Now: 210-866-3233
• Schedule Your Confidential Consultation Online
• Serving Health Care Professionals in San Antonio and throughout Texas in Federal Fraud Defense

Don’t let an unintended mistake lead to a lifetime of consequences. Let us defend your rights. When the stakes are high, call federal defense attorney Robert Almonte immediately.