Health care fraud in Virginia carries severe federal penalties under 18 U.S.C. § 1347, including up to 10 years in prison per count. Law Offices Of SRIS, P.C. has 4,739+ documented results firm-wide across VA, MD, NJ, NY, and DC. Contact us 24/7.
Health care fraud is defined under federal law at 18 U.S.C. § 1347 as knowingly and willfully executing a scheme to defraud a health care benefit program. This includes billing for services not rendered, upcoding, and kickback schemes. The statute applies to both public programs like Medicare/Medicaid and private insurance plans. Virginia also prosecutes related fraud under state law, including Va. Code § 18.2-178 (larceny by false pretenses) for schemes targeting state-funded health programs. A Health Care Fraud lawyer Virginia must understand both federal and state frameworks to build an effective defense.
Last verified: April 2026 | Federal courts in Virginia (EDVA/WDVA) | 18 U.S.C. § 1347 (official U.S. Code)
For Virginia-specific health care fraud statutes, see Va. Code § 18.2-178 (Virginia General Assembly). For federal court procedures in Virginia, visit the Eastern District of Virginia federal court website.
In federal court, health care fraud cases typically begin with a grand jury indictment. The government often uses data analytics to identify billing patterns before filing charges. Your medical billing fraud defense lawyer Virginia should examine the government’s coding methodology early.
- Step 1: Secure legal representation immediately upon receiving a subpoena or target letter.
- Step 2: Preserve all billing records, medical documentation, and communication with payors.
- Step 3: Your attorney will analyze the government’s theory — false billing, kickbacks, or medically unnecessary services.
- Step 4: Negotiate pre-indictment resolution or prepare for grand jury proceedings.
- Step 5: If indicted, file pretrial motions challenging the sufficiency of evidence or statute interpretation.
- Step 6: Prepare for trial or negotiate a favorable plea agreement with sentencing advocacy.
In Virginia federal courts, health care fraud carries substantial penalties under 18 U.S.C. § 1347 and related sentencing guidelines.
| Offense | Classification | Incarceration | Fine | License Impact | Additional Consequences |
|---|---|---|---|---|---|
| Health Care Fraud (18 U.S.C. § 1347) | Federal Felony | Up to 10 years per count | Up to $250,000 (individual) or $500,000 (organization) | Medicare/Medicaid exclusion (mandatory 5+ years) | Restitution, forfeiture, supervised release 1-3 years |
| False Claims Act Violations (31 U.S.C. § 3729) | Civil/Qui Tam | N/A (civil) | $5,500-$11,000 per claim + treble damages | Medicare/Medicaid exclusion | Debarment from federal programs |
| Kickback Violations (42 U.S.C. § 1320a-7b) | Federal Felony | Up to 5 years per count | Up to $25,000 per violation | Medicare/Medicaid exclusion | Restitution, forfeiture |
Results may vary. Prior results do not guarantee a similar outcome.
Law Offices Of SRIS, P.C. was founded in 1997 by former prosecutor Mr. Sris. The firm has over 120 years of combined legal experience and has handled 4,739+ documented case results with a 93%+ favorable outcome rate firm-wide across VA, MD, NJ, NY, and DC. Our team includes attorneys with federal criminal defense experience, including former prosecutors who understand government investigation tactics. As a healthcare scheme charge lawyer Virginia, we bring deep knowledge of both federal and state health care fraud statutes.
Bryan Block, Defense Attorney at Law Offices Of SRIS, P.C. — Licensed in VA. Former Virginia State Trooper (15 years). View Bryan Block’s Profile
Matthew Greene, Senior Defense Attorney at Law Offices Of SRIS, P.C. — Licensed in VA. 30+ years criminal defense. Death penalty certified (formerly). View Matthew Greene’s Profile
Firm-wide across VA, MD, NJ, NY, and DC: 4,739+ documented results with 93%+ favorable outcome rate. Our attorneys have handled complex federal health care fraud cases involving Medicare billing, kickback allegations, and False Claims Act investigations.
Results may vary. Prior results do not guarantee a similar outcome.
Our Fairfax location is approximately 30 minutes from the EDVA courthouse in Alexandria, accessible via I-66 and I-395. If you need a Health Care Fraud lawyer Virginia near Fairfax, we serve clients throughout Northern Virginia.
Neighborhoods served: Fairfax, Arlington, Reston, Herndon, McLean, Vienna, Tysons, Centreville, Chantilly, Burke, Springfield, Annandale, Falls Church, Manassas, Woodbridge, Leesburg, Ashburn, Warrenton, Stafford, Fredericksburg.
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Q: Do I need a Health Care Fraud lawyer Virginia for a federal investigation?
Yes. Federal health care fraud investigations often lead to indictment. Early legal intervention can prevent charges or reduce exposure. Contact a Health Care Fraud lawyer Virginia immediately upon receiving a subpoena or target letter.
Q: What is the difference between civil and criminal health care fraud?
Civil fraud under the False Claims Act involves fines and exclusion from federal programs. Criminal fraud under 18 U.S.C. § 1347 carries prison time. A medical billing fraud defense lawyer Virginia can help distinguish between the two.
Q: Can I lose my medical license for health care fraud?
Yes. A conviction can result in mandatory Medicare/Medicaid exclusion and state medical board discipline. A healthcare scheme charge lawyer Virginia can work to protect your professional license during the defense.
Q: How long does a federal health care fraud case take in Virginia?
Federal cases typically take 6-18 months from indictment to resolution. Complex cases involving multiple defendants or extensive document review can take 2-3 years. Your Health Care Fraud lawyer Virginia will provide a timeline estimate based on your specific facts.
Q: What should I do if I receive a subpoena for medical records?
Do not destroy or alter any documents. Contact a Health Care Fraud lawyer Virginia immediately. Your attorney will advise on compliance with the subpoena while protecting your Fifth Amendment rights against self-incrimination.
Last verified: April 2026. Information current as of April 2026. Laws change — contact Law Offices Of SRIS, P.C. at (888) 437-7747 for current guidance.