A federal investigation can move quickly, leaving little time to prepare. When a qui tam (whistleblower) lawsuit or government inquiry targets your billing practices or financial records, you need a response strategy before the government builds its case. A False Claims Act (FCA) defense lawyer represents professionals and organizations when the government alleges fraudulent claims were submitted for federal funds.
An FCA allegation can pull in more than a single transaction. Regulatory reviews, parallel investigations, and licensing consequences can develop alongside the primary case. Bertolino LLP has defended Texas professionals for over 20 years, and we don’t send form letters.
A financial and health care compliance defense lawyer builds the defense from the actual record: contracts, billing data, and professional standards that governed your decisions.
What the False Claims Act Actually Covers
Congress passed the False Claims Act to address fraud against federal programs, and the statute carries significant civil and criminal consequences. Health care providers, defense contractors, research institutions, and financial professionals all face FCA scrutiny when federal funds are involved.
The government pursues these cases through two main paths. Federal agencies investigate directly, or a private party called a relator files a qui tam lawsuit on the government’s behalf and stands to receive a share of any recovery.
The statute covers more ground than most professionals expect. Inaccurate billing codes, incomplete program certifications, and payments tied to kickback arrangements can all create FCA liability.
The statute does not always require proof of specific intent to defraud, and certain documentation or billing errors can still lead to liability under that standard.
How an FCA Defense Attorney Approaches the Record
We start by building a complete picture of the file. Billing records, compliance policies, certification language, and communications related to the alleged conduct are reviewed before we assess where the government’s account falls short.
The statute requires that a false claim be submitted “knowingly,” and that standard opens specific defense opportunities. We examine how the organization’s protocols were written, how billing decisions were made, and what regulatory guidance was available at the time.
Qui tam cases frequently originate with a current or former employee who has access to partial information and a financial incentive to characterize it broadly. We test the factual foundation of those claims and challenge assertions that go beyond what the record supports.
Where FCA Allegations Surface in Texas
Federal health care programs expose Texas professionals to significant FCA liability. In Texas, qui tam cases frequently target Medicare and Medicaid billing. Those cases regularly involve upcoding, unbundling, and referral arrangements scrutinized under the Anti-Kickback Statute.
Texas professionals in federal contracting and grant-supported work face False Claims Act liability when program certifications are scrutinized. A contractor who certifies compliance with a requirement that wasn’t fully met can face a claim regardless of how well the underlying work was performed.
When an FCA matter involves a licensed professional, the Texas Medical Board, the Texas State Board of Public Accountancy, or another licensing authority may open a parallel review. Positions taken in the federal proceeding can affect that process, so a coordinated defense across both forums is important from the start.
Early Defense Priorities in FCA Cases
The first weeks of an FCA investigation set the trajectory of everything that follows. Early responses that don’t align with the record can create inconsistencies that compound as the case develops.
In those first weeks, we prioritize:
- Pulling and preserving billing records, compliance documentation, and communications tied to the alleged conduct.
- Reviewing government subpoenas and civil investigative demands before a response goes out.
- Identifying whether parallel criminal proceedings are a factor.
- Assessing any licensing or credentialing implications tied to the same conduct.
- Making sure internal communications and legal responses tell the same story across all proceedings.
The work done at this stage shapes how the rest of the case develops.
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When Settlements and Litigation Become the Question
The Department of Justice resolves most qui tam cases through settlement rather than trial. Those agreements can require corporate integrity agreements, program exclusions, and public disclosures. For licensed professionals, those terms can shape your career and professional standing for years beyond the case itself.
We review every proposed settlement term before you consider signing. The dollar amount is only part of what a settlement requires. Operational restrictions and licensing consequences can follow that agreement, affecting your practice for years.
When the record calls for litigation, we prepare for it. We work through testimony, challenge the government’s damages theory, and show that your conduct met the professional standards in place at the time.
Protecting Your License Alongside the Federal Case
A federal False Claims Act investigation doesn’t stay in federal court. A Texas licensing board receives reports, and professional standing becomes part of the broader dispute. A False Claims Act defense attorney who handles only the federal side leaves a gap in your protection.
Bertolino LLP approaches these cases with both proceedings in view. We protect the positions you take in federal litigation from being used against you in a licensing review, and we support your professional record through whatever scrutiny follows the federal matter.
You’ve worked too hard to lose your license now. A short conversation can clarify your exposure and identify the right first steps before the record takes shape without your input. Reach out to our Client Success Liaison today to schedule a complimentary consultation.
Call or text (512) 515-9518 or complete a Case Evaluation form
