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5 Reasons Doctors Are Criminally Indicted
Physicians and other medical professionals hold positions of immense trust. When the law is broken, even unintentionally, that trust can quickly become a legal liability. Criminal charges against doctors are on the rise in the United States, and the consequences can be devastating: prison time, license suspension, and irreversible harm to a hard-earned reputation.
At Gimbel, Reilly, Guerin & Brown, LLP, our Milwaukee, WI criminal defense attorneys represent medical professionals throughout Wisconsin who have been accused of many types of crimes. We understand the unique pressures doctors face and how legal issues intersect with clinical practice. Below are five of the most common reasons doctors are criminally indicted and what can be done to fight back.
Prescription Fraud and Drug Offenses
Federal and state authorities aggressively pursue cases involving the illegal prescribing or distribution of controlled substances. Doctors may be charged under statutes such as the Controlled Substances Act (CSA) or state-level drug laws for writing prescriptions that are deemed medically unnecessary, especially for opioids, benzodiazepines, and stimulants.
Federal charges often include conspiracy, wire fraud, and distribution of narcotics, especially if the alleged conduct led to overdose or death. Convictions can result in years of imprisonment and permanent loss of DEA registration.
However, not every error or deviation from best practices is a crime. Sometimes, what the government labels as criminal behavior is simply a matter of poor recordkeeping or administrative oversight. A strong legal defense begins with a thorough review of medical records, patient communications, and prescribing protocols to challenge the government’s narrative.
Medicare or Medicaid Fraud
Billing fraud is another major reason doctors come under criminal investigation. The Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), and state agencies regularly audit providers for irregularities, such as:
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Billing for services not provided
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Upcoding or inflating billing codes to receive higher reimbursement
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Submitting claims for medically unnecessary procedures
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Unbundling, or billing separately for services that should be combined
In some cases, doctors are unaware that their billing staff or outsourced providers are making these errors. Unfortunately, that does not always shield them from criminal liability. Prosecutors often use fraud statutes to pursue these cases.
When defending a doctor in a billing fraud case, the goal is to distinguish negligence or administrative mistakes from intentional deception. Documentation, audit trails, and financial records are key to building a solid defense.
Kickback and Stark Law Violations
Many doctors are approached by laboratories, pharmaceutical reps, or other providers offering incentives in exchange for referrals. Under the federal Anti-Kickback Statute (AKS) and the Stark Law, these arrangements may be criminally prosecuted if they are found to influence medical judgment inappropriately.
Even if a doctor believes they were simply participating in a legitimate business opportunity, prosecutors may allege that the arrangement was designed to increase profit at the expense of patient care.
Defending against these charges often requires dissecting contracts and financial records. When applicable, presenting expert testimony on standard practices can also help undermine the prosecution’s case.
Sexual Assault or Inappropriate Contact with Patients
Allegations of sexual misconduct are among the most personally and professionally damaging accusations a doctor can face. In many cases, what begins as a medical exam or therapeutic interaction may later be portrayed as an assault, especially when a patient misunderstands or misinterprets the doctor’s actions.
Doctors may also face civil lawsuits or administrative licensing complaints based on the same allegations. These cases are often emotionally charged and receive significant media attention, even before the facts are fully established.
A strong defense requires early and thorough investigation, including identification of witnesses, office protocols, and patient records. It is also essential to understand how professional boundaries are taught and enforced in medical training and to contextualize any disputed behavior within clinical norms.
Insurance Fraud and False Documentation
Doctors can face criminal charges for falsifying records, forging signatures, or submitting fraudulent claims to insurers. These cases are sometimes linked to personal financial gain, but just as often, they arise from attempts to help a patient receive coverage for necessary treatment. Examples include altering diagnostic codes to justify a procedure, creating backdated or false records, or submitting claims under another provider’s name.
While insurance fraud charges may seem less serious than drug or assault cases, they are felonies – sometimes even federal felonies – and can lead to substantial prison sentences. They can also result in immediate suspension of medical licensure and expulsion from insurance networks.
When defending against fraud charges, the focus often turns to the intent behind the documentation. If the doctor acted in good faith or delegated tasks to others, that may significantly change the legal outcome.
Doctors Need an Experienced, Discreet Criminal Defense Team
Criminal cases involving medical professionals are not like other criminal matters. Prosecutors often work closely with federal agencies, including the DEA, FBI, and Department of Health and Human Services, and these investigations are typically lengthy and complex. Doctors facing indictment risk not only their freedom, but also permanent licensure loss, exclusion from federal programs, civil fines, restitution, and irreparable career damage.
At our firm, we provide aggressive, strategic representation for doctors, surgeons, dentists, pharmacists, and other healthcare providers. Our defense team collaborates with experts in health care law, billing compliance, and clinical practice standards to challenge every aspect of the government’s case.
Early Legal Intervention Is Critical
If you suspect you are under investigation — or if you have received a subpoena, target letter, or notice of complaint — do not wait. Talking to investigators or responding without legal guidance can make your situation worse.
GRGB’s white collar criminal defense team will begin by conducting a detailed review of your case, identifying your exposure, and crafting a legal strategy tailored to your goals. Whether we negotiate with prosecutors, challenge evidence, or take your case to trial, we fight to protect your career, your name, and your future.
Contact a Milwaukee, WI Criminal Defense Attorney for Physicians
If you are a physician or medical professional facing criminal charges in Wisconsin, contact a Milwaukee, WI criminal defense attorney at Gimbel, Reilly, Guerin & Brown, LLP today. Our experienced team defends doctors accused of fraud, drug offenses, assault, and other serious charges. We understand what is at stake and we are here to help you protect everything you have worked so hard for. Call 414-271-1440 now to schedule a consultation.
