Skin Substitute Fraud Defense Attorney in Houston, TX
Act Before an Investigation Becomes a Case
- Put a former prosecutor in your corner
- We step in before charges are filed
- Small caseload by design
- Houston-based, nationwide reach
Why Clients Come to Us
We've stopped investigations from becoming charges.
Getting involved before prosecutors commit to a theory is where defense counsel does the most good.
We know the other side's playbook.
Paul Doyle spent seven years as a prosecutor and knows what the government must prove and where its theories are weakest.
We bring in experts early.
When the government's case rests on chart review and a loss calculation, the right expert at the right time can end an investigation before it becomes an indictment.
Why Wound Care Is
Under the Microscope
Skin substitutes, also called skin grafts, wound care grafts, or CTPs, are used to treat chronic wounds. For years Medicare paid for them based on what the product cost, so a more expensive graft brought a larger payment. Spending climbed fast.
The government responded on two fronts. Starting January 1, 2026, Medicare stopped paying for these products separately and set a flat rate of roughly $127.28 per square centimeter, no matter which graft you use. Meanwhile, wound care has been a featured target in the Justice Department's last two national health care fraud takedowns. In 2025, a Houston-area podiatrist was indicted over more than $90 million in skin substitute billing. The June 2026 takedown charged 455 people nationwide, including 11 wound care defendants across six federal districts.
The coverage picture has never been simple. Medicare contractors issued new skin substitute coverage rules, then withdrew them on December 24, 2025, days before they were to take effect. Prosecutors are now looking backward at decisions made under rules that were unclear, inconsistent between regions, and revised more than once, and asking juries to treat those decisions as fraud.
Allegations and How We Respond
These prosecutions rarely claim no patient was treated. They claim the treatment wasn't covered, wasn't necessary, or was driven by money. Knowing which theory you face is the first real step in your defense.
What they say
How we answer
01
"The wound wasn't ready, or the graft was too big."
Auditors flag grafts applied on a first visit, before about four weeks of standard wound care, or in amounts larger than the wound.
Breaking a coverage rule is a billing problem. To make it a felony, prosecutors must prove you knew the claim was false and meant to cheat the program. A qualified wound care expert can explain why chronic wounds fail conservative care.
02
"The money moved the wrong way."
Pay that rose with reimbursement, such as a cut of each paid claim, rep commissions, or medical director fees, is charged as a kickback.
Not every percentage arrangement is a kickback. There are safe harbors, legitimate employment relationships, and real fair-market-value deals. When the government calls a contract a sham, that's an argument it has to prove, not a fact.
03
"The invoices were inflated."
Prosecutors allege that invoices overstated product cost and the difference was split. Cases built on this theory almost always bring money laundering charges too.
We trace the money ourselves with forensic accountants, and we test whether the "shell company" label actually fits.
04
"Someone else did the work."
The graft was applied by unlicensed or unsupervised staff and billed under a provider's number.
Who did what, and under which supervision rules, is a factual question. The government's chart review isn't the last word. Wound history, clinical context, and contemporaneous records all matter.
05
"You followed bad advice."
The government says you should have known better than the guidance you were given.
Following bad advice is a defense. Relying on manufacturer training, distributor billing guidance, or your billing company goes directly to whether you intended to defraud anyone. Save every email and training deck you received.
One warning: Don't clean up, supplement, or reorganize records after an audit or subpoena arrives. A changed chart can bring its own obstruction charge and turn a survivable audit into an indictment.
Podiatrists
More podiatrists have been charged than any other group, because diabetic foot ulcers are the main covered condition. These investigations usually start with billing data rather than complaints. A busy wound practice can look like an outlier on a spreadsheet for good clinical reasons, and that's worth explaining early.
Physicians, NPs, and wound clinics
Mobile operations and practices serving nursing homes, hospice, and homebound patients draw the most attention. Whether a treatment was medically necessary depends on the patient, the contemporaneous record, and the coverage rules in effect. That takes a qualified expert, not a billing spreadsheet.
Distributors, manufacturers,
and sales reps
You never saw a patient, but you can still be charged. The kickback laws reach anyone who pays for referrals, and commissions tied to reimbursement have been charged directly.
Owners, executives, and investors
If you designed the pay structure, signed the distributor deals, or ran the billing, you have exposure whether or not you made a clinical decision. Prosecutors also go after forfeiture based on everything that came in, not what you kept.
How These Cases Start
- An audit letter requesting records for a sample of graft claims
- Claims held for review, or payments suspended
- An overpayment demand extrapolated from a handful of charts
- A Civil Investigative Demand
- A grand jury subpoena for your records or your biller's
- Agents calling your staff, referral sources, or distributor
- Agents at your office or home, or a warrant freezing your accounts
- A target letter
An audit isn't automatically a criminal case, but audits are where criminal cases come from. Several agencies can be working at the same time, including the U.S. Attorney's Office, HHS-OIG, the FBI, CMS, and Medicare contractors. You may know about only one of them. Everything you hand over becomes evidence if things escalate.
| Charge | Maximum penalty |
|---|---|
| Health care fraud | Up to 10 years per count |
| Conspiracy to commit health care fraud | Same penalty as the underlying charge |
| Illegal kickbacks | Up to 10 years per count |
| Money laundering | Up to 20 years |
| Exclusion | From Medicare, Medicaid, and TRICARE, which usually triggers action against your license |
What's at Stake
One number drives more of the outcome than any other: the loss amount the government puts on the case. It sets the sentencing range, and it is frequently wrong. Extrapolated audit findings, using what was billed instead of what was paid, and counting claims that were medically appropriate but sloppily documented all push that figure higher than it should be. Attacking that number is often some of the most valuable work in the defense.
Why Texas Providers
Face Added Risk
Two of the wound care cases in the Justice Department's June 2026 national takedown were brought in Texas, one in Houston and one in Dallas. Prosecutors here have handled these cases before, and they know the billing data and the coverage rules. Texas Medicare claims run through Novitas Solutions, and coverage decisions are made regionally. A product Novitas won't cover may be covered somewhere else, so a practice with clinics in more than one Medicare jurisdiction can be compliant in Texas and out of compliance elsewhere for the exact same graft. Sorting out which rule applied to which claim on which date is slow work, and it's often where the government's loss figure turns out to be inflated.
Your license is a separate fight. Podiatrists answer to the Texas Department of Licensing and Regulation, physicians to the Texas Medical Board, and nurse practitioners to the Texas Board of Nursing. Those proceedings run on their own deadlines, and what you say in one can be used in the others. We manage them together from day one.
I got an audit letter, not a subpoena. Do I need a defense lawyer?
- Audits are where criminal cases come from. What you produce becomes evidence, and what you say to auditors can be used against you later. Bringing in counsel now costs a fraction of defending an indictment later.
Can I be charged if I followed my distributor's billing guidance?
- You can be charged. But relying in good faith on guidance you were given goes to whether you intended to defraud anyone, which is what the government has to prove. Keep every communication yourself, and don't count on the distributor to keep copies.
I'm a sales rep, not a provider. Am I exposed?
- Yes. The kickback laws reach people who pay for referrals, not just people who bill. Reimbursement-linked commissions have been charged directly.
The government says the loss is in the millions. Is that final?
- No, and it is often one of the most contestable parts of the case. Extrapolation from small samples, counting billed instead of paid amounts, and sweeping in legitimate claims all inflate it.
My billing happened before the 2026 changes. Does that help?
- That may help you. Conduct gets measured against the rules that were actually in effect, and the earlier landscape was unclear in ways that cut against the government's argument that you knew you were doing something wrong.
Can you represent me if I'm not in Texas?
- Yes. We handle federal health care fraud investigations nationwide.
Not finding the answer you're looking for? We're always available to talk through your situation.
Cases described on this page reflect government allegations. Every defendant is presumed innocent unless proven guilty. Past results do not guarantee a similar outcome.
