WRITTEN BY Zachary Newland, Founding Partner. Last Updated July 21, 2026

Colorado Healthcare Fraud Defense Lawyer

On This Page

• Federal Healthcare Fraud Investigations in Colorado
• Key Federal Statutes Used in Colorado Healthcare Fraud Cases
• How Colorado Healthcare Fraud Investigations Begin and Proceed
• Responding to a DOJ or HHS-OIG Subpoena in Colorado
• Why Colorado Healthcare Providers Choose Evergreen Attorneys
• How Evergreen Attorneys Defends Colorado Healthcare Fraud Cases
• Frequently Asked Questions

Colorado healthcare providers, practice owners, and billing professionals face an aggressive federal enforcement environment. The U.S. District Court for the District of Colorado is the venue for federal healthcare fraud prosecutions brought by the Department of Justice and supported by the HHS Office of Inspector General.

Medicare and Medicaid billing disputes that might once have been treated as administrative matters are now routinely investigated as potential criminal conduct under 18 U.S.C. § 1347, the False Claims Act, the Anti-Kickback Statute, and related federal laws. A single investigation can threaten your medical license, your practice, your personal assets, and your freedom.

If federal agents have contacted you or you have received a federal document, contact Evergreen Attorneys at (303) 948-1489 before responding or producing information. Be proactive and get in touch today.

Federal Healthcare Fraud Investigations in Colorado

Federal healthcare fraud enforcement in Colorado is driven by the DOJ Criminal Division Health Care Fraud Unit, the U.S. Attorney’s Office for the District of Colorado, the HHS Office of Inspector General, the FBI, and, in certain cases, the DEA. These agencies coordinate strike-force operations and long-term investigations targeting billing patterns, referral arrangements, and prescribing practices across the state.

Colorado providers are particularly exposed because the state’s mix of urban medical centers, rural health systems, and federally qualified health centers creates a large volume of Medicare and Medicaid claims. When federal data analytics flag statistical outliers in billing, the investigation that follows may involve civil investigative demands, grand jury subpoenas, search warrants, and undercover operations before a provider is even aware of the scrutiny.

Increasingly, prosecutors are using large data-sets and algorithmic decisions to decide who to investigate and what charges to file.

Key Federal Statutes Used in Colorado Healthcare Fraud Cases

Federal healthcare fraud investigations in Colorado rarely rely on a single statute. Prosecutors layer multiple charges to maximize pressure and broaden the range of available penalties. Understanding how these laws differ and interact is essential to mounting an effective defense.

18 U.S.C. § 1347: Health Care Fraud

This is the primary federal criminal healthcare fraud statute. It prohibits knowingly and willfully executing or attempting to execute a scheme to defraud any health care benefit program or to obtain money or property from such a program through false pretenses. Each count can carry up to 10 years of imprisonment, with enhanced penalties if the offense results in serious bodily injury. In Colorado, this statute is used to charge billing schemes involving Medicare, Medicaid, TRICARE, and private plans administered through federal programs.

31 U.S.C. §§ 3729-3733: The False Claims Act

The False Claims Act is a civil statute that imposes liability for knowingly submitting or causing the submission of false or fraudulent claims for payment to the United States. It carries treble damages and per-claim civil penalties. It can be enforced through DOJ civil actions or qui tam whistleblower suits. Although it does not carry prison time on its own, FCA exposure often runs parallel to criminal healthcare fraud charges. DOJ may pursue both tracks simultaneously, and a civil FCA settlement does not necessarily resolve criminal liability.

42 U.S.C. § 1320a-7b(b): The Anti-Kickback Statute

The Anti-Kickback Statute makes it a crime to knowingly and willfully offer, pay, solicit, or receive remuneration to induce or reward referrals of items or services reimbursable by federal healthcare programs. In United States v. McClatchey, 217 F.3d 823 (10th Cir. 2000), the Tenth Circuit analyzed hospital-physician relationships and explained that remuneration intended to induce referrals of federal-program patients can trigger criminal liability even when payments are styled as compensation or consulting fees. Violations can result in felony convictions, incarceration, fines, and exclusion from federal healthcare programs.

42 U.S.C. § 1395nn: Stark Law

Stark Law is a civil physician self-referral statute that prohibits physicians from referring Medicare patients for certain designated health services to an entity with which the physician or an immediate family member has a financial relationship, unless a specific exception applies. Unlike the Anti-Kickback Statute, Stark Law does not require proof of intent; it is a strict-liability regime. Violations are enforced through civil penalties, repayment obligations, and potential False Claims Act exposure rather than imprisonment.

Colorado providers must structure ownership interests, compensation arrangements, and referral relationships to satisfy both Stark exceptions and Anti-Kickback safe harbors.

Additional Statutes Frequently Charged

Federal prosecutors in Colorado commonly add charges under 18 U.S.C. § 1035 (false statements relating to health care matters), 18 U.S.C. § 1343 (wire fraud, used when alleged schemes involve electronic claim submissions), and 18 U.S.C. § 371 (conspiracy).

How Colorado Healthcare Fraud Investigations Begin and Proceed

Federal healthcare fraud investigations in Colorado typically start long before a provider receives formal notice. Understanding the investigative arc helps providers recognize warning signs and act before the situation becomes unmanageable.

Data analytics and billing audits. Federal agencies use sophisticated data analytics to identify statistical outliers in Medicare and Medicaid billing. A practice that bills certain procedure codes at rates significantly above regional averages, or that shows unusual patterns in referral relationships, may trigger automated scrutiny from the HHS-OIG or a Medicare Administrative Contractor.

Whistleblower (qui tam) complaints. Many Colorado healthcare fraud investigations begin when a current or former employee, competitor, or business associate files a qui tam complaint under the False Claims Act. The complaint is filed under seal, and DOJ investigates before deciding whether to intervene. Providers may be under investigation for months or years without knowing a whistleblower complaint exists.

Civil investigative demands and subpoenas. Once an investigation is active, the provider may receive a civil investigative demand from DOJ or a subpoena from the HHS-OIG or a federal grand jury. A CID typically seeks documents and written responses related to billing practices, referral arrangements, or specific patient records. A grand jury subpoena signals that the investigation has a criminal track.

Search warrants and agent interviews. In more advanced investigations, federal agents may execute search warrants at a practice, clinic, or provider’s home. They may also attempt unannounced interviews with providers, staff, or associates. Statements made during these encounters can be used in later proceedings, and 18 U.S.C. § 1001 makes it a separate federal crime to make a materially false statement to a federal agent.

Parallel proceedings. Colorado healthcare fraud matters frequently involve parallel civil and criminal tracks. DOJ may pursue FCA remedies while the U.S. Attorney’s Office considers criminal charges under 18 U.S.C. § 1347 or the Anti-Kickback Statute. Defense strategy must account for both tracks, because concessions or disclosures in the civil proceeding can affect the criminal case.

Responding to a DOJ or HHS-OIG Subpoena in Colorado

Receiving a subpoena or civil investigative demand from the Department of Justice, the HHS Office of Inspector General, or a federal grand jury is not a routine compliance matter. It signals active federal scrutiny of your billing, referral, or prescribing practices. How you respond in the first days and weeks will shape the trajectory of the entire matter.

1. Do not ignore the subpoena. Federal subpoenas carry enforceable deadlines, and noncompliance can result in contempt proceedings.
2. Do not destroy, alter, or selectively produce records. Document destruction after receipt of a federal subpoena can result in separate obstruction charges under 18 U.S.C. § 1519.
3. Do not speak with investigators without counsel present. Anything you say to a federal agent can be used against you, and inaccurate statements, even unintentional ones, can become the basis of a false-statements charge under 18 U.S.C. § 1001.
4. Retain a federal healthcare fraud defense lawyer immediately. Experienced counsel will conduct a privileged internal review of the requested records, assess potential criminal and civil exposure, negotiate the scope and timing of production, and develop a response strategy that protects your Fifth Amendment and Fourth Amendment rights.
5. Preserve all communications with the investigating agency and document the chain of custody for records produced.

Early intervention by experienced federal defense counsel can influence whether the matter remains civil, proceeds to criminal charges, or is resolved through negotiation before formal charges are filed. Providers who respond without counsel, or who delay engaging counsel, often find that early missteps narrow their options later in the process. For additional guidance, see responding to a Colorado healthcare fraud investigation.

Why Colorado Healthcare Providers Choose Evergreen Attorneys

Evergreen Attorneys is a federal criminal defense firm that handles healthcare fraud investigations, prosecutions, and related enforcement actions at every stage of the federal process. The firm’s founding partner, Zachary Newland, has appeared as counsel of record in more than 120 federal cases since 2016, including federal fraud crimes including healthcare fraud and False Claims Act cases, DOJ and HHS-OIG investigations, and matters involving the Anti-Kickback Statute and Stark Law.

Evergreen Attorneys won 9-0 in the U.S. Supreme Court in United States v. Hemani in June 2026. That result reflects the firm’s capacity to handle the most consequential federal defense matters at the highest level of the federal court system, a capability that directly benefits Colorado healthcare providers facing serious federal exposure.

The firm provides only partner-level representation. Colorado healthcare providers who engage Evergreen Attorneys work directly with experienced federal defense attorneys, not associates or contract lawyers, from the first contact through resolution.

How Evergreen Attorneys Defends Colorado Healthcare Fraud Cases

Evergreen Attorneys represents Colorado healthcare providers, practice owners, medical directors, billing companies, and other individuals at every phase of federal healthcare fraud enforcement. The firm’s approach is built around the specific procedural demands of the U.S. District Court for the District of Colorado and the Tenth Circuit.

• Pre-indictment investigation and subpoena response. The firm manages privileged internal reviews, negotiates with DOJ and HHS-OIG on subpoena scope and timing, and develops strategies to resolve investigations before charges are filed.
• Grand jury defense and target letter response. When a client receives a target letter or learns of grand jury proceedings, Evergreen Attorneys evaluates the strength of the government’s evidence, advises on grand jury testimony and Fifth Amendment protections, and negotiates with prosecutors to seek declination or reduced charges.
• Trial defense in the District of Colorado. If the government proceeds to indictment, the firm prepares and tries cases in federal court. This includes challenging the sufficiency of the government’s proof on intent, materiality, and causation under 18 U.S.C. § 1347 and related statutes.
• Parallel civil and criminal defense. The firm coordinates defense strategy across simultaneous FCA civil actions and criminal prosecutions, protecting against inadvertent admissions in one track that could be used in the other.
• Sentencing advocacy. For clients who face sentencing, the firm presents detailed mitigation evidence, challenges loss calculations under the advisory Sentencing Guidelines, and advocates for the lowest defensible sentence.

For a broader view of the firm’s federal white collar crime defense in Colorado or additional Colorado federal health care fraud overview resources, those pages provide further detail on the firm’s capabilities and approach.

Frequently Asked Questions

What is federal healthcare fraud under 18 U.S.C. § 1347 in Colorado?

Federal healthcare fraud under 18 U.S.C. § 1347 occurs when someone knowingly and willfully executes or attempts to execute a scheme to defraud any health care benefit program, or to obtain money or property from such a program by false or fraudulent pretenses. In Colorado, this statute is used to prosecute alleged billing schemes involving Medicare, Medicaid, TRICARE, or private plans administered through federal programs. The government must prove intent to defraud and material falsehoods in the claims or documentation submitted. Cases can involve individual providers, practice owners, billing companies, or larger health systems, and they are charged in the U.S. District Court for the District of Colorado.

How is the False Claims Act different from criminal healthcare fraud charges?

The False Claims Act, codified at 31 U.S.C. §§ 3729-3733, is primarily a civil statute that imposes liability for knowingly submitting or causing the submission of false or fraudulent claims for payment to the United States. It is enforced through civil lawsuits by the Department of Justice or qui tam whistleblowers and carries treble damages and per-claim civil penalties rather than prison sentences.

Criminal healthcare fraud under 18 U.S.C. § 1347, by contrast, can result in imprisonment, probation, and criminal fines, and may be combined with charges like conspiracy or wire fraud. In many Colorado investigations, DOJ pursues both civil FCA remedies and parallel criminal healthcare fraud charges, so defense counsel must manage exposure in both tracks simultaneously.

What is the difference between the Anti-Kickback Statute and Stark Law for Colorado healthcare providers?

The Anti-Kickback Statute at 42 U.S.C. § 1320a-7b(b) is a criminal law that prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce or reward referrals of services reimbursable by federal healthcare programs. Violations can lead to felony convictions, incarceration, fines, and program exclusion.

Stark Law, codified at 42 U.S.C. § 1395nn, is a civil physician self-referral statute that restricts physicians from referring Medicare patients for designated health services to entities with which they have certain financial relationships unless an exception applies. Stark violations typically involve civil penalties, repayment obligations, and potential False Claims Act exposure rather than imprisonment. Colorado healthcare providers must structure compensation, ownership interests, and referral relationships to comply with both regimes, which have overlapping but distinct elements and exceptions.

What should I do if my Colorado medical practice receives a DOJ or HHS-OIG subpoena?

Treat a subpoena or civil investigative demand from the Department of Justice or the HHS Office of Inspector General as a sign of active federal scrutiny. Do not ignore the subpoena, do not destroy or alter records, and do not contact investigators without counsel. Retain a federal healthcare fraud defense lawyer in Colorado, conduct a privileged internal review of the requested records, and coordinate a timely and complete response strategy that protects your constitutional rights. Early intervention by experienced federal counsel can influence whether the matter remains civil, turns criminal, or is resolved without formal charges.

When should a Colorado healthcare provider retain federal criminal defense counsel?

The best time to retain federal defense counsel is at the first sign of federal interest: receipt of a subpoena, civil investigative demand, or target letter; contact from federal agents; notification that a qui tam complaint has been filed; or an internal discovery of billing irregularities that could trigger federal scrutiny.

Waiting until an indictment is returned eliminates many of the most effective defense strategies, including pre-charge negotiation, voluntary disclosure, and efforts to narrow the scope of the investigation. Early engagement allows counsel to protect the attorney-client privilege, coordinate with compliance professionals, and position the provider for the best available outcome.

If you are facing a federal healthcare fraud investigation, subpoena, or prosecution in Colorado, contact Evergreen Attorneys by email at [email protected] or by phone at (303) 948-1489 for a confidential consultation and case evaluation.