Over the last decade, Florida, Texas, Louisiana, and several other southern states have been the
center of gravity for federal healthcare fraud enforcement. These regions have seen countless cases
involving durable medical equipment (DME), pharmacy billing, pain cream marketing, and kickback
arrangements that evolved into large, multi-district prosecutions.
From my experience working in these districts, I have seen how deep the infrastructure of enforcement
runs. Federal prosecutors and investigators in those regions have built models that the rest of the
country now studies and emulates. They have shaped how cases are charged, how sentencing
recommendations are constructed, and how courts evaluate cooperation and accountability.
The Shift North
What is interesting now is seeing those same patterns appear in districts that were not traditionally
known for healthcare-related cases. Boston, for instance, has long been recognized for its focus on
securities fraud and public corruption. Lately, it has begun to see more activity in healthcare
fraud—particularly around DME and physician kickback structures that mirror cases once limited to
southern districts.
That development does not mean Boston is suddenly the next Florida or Texas, but it does show that
healthcare fraud enforcement is no longer regional. The same investigative frameworks that took shape
years ago in the South are now being applied wherever prosecutors believe similar conduct exists.
Why Sentencing and Mitigation Work Matter
One consistent reality across these districts is how sentencing proceeds once a case reaches that
stage. In the southern regions where I have worked with defendants, the system moves fast. The
investigations are often large, the plea negotiations complex, and the sentencing exposure can be
significant because of enhancements for loss amounts, leadership roles, or kickback allegations.
That is why mitigation work is essential. The best results I have seen always come from preparation
that begins early: gathering personal history, addressing accountability, and creating a truthful,
well-documented narrative of what led to the offense and what has changed since. Judges want to see
who the person is beyond the case file, and that perspective does not come together at the last minute.
Mitigation is part structure, part storytelling. It requires organization, reflection, and clarity—but most
importantly, it must be real.
A Broader Pattern Emerging
What we are watching now is a nationalization of healthcare fraud enforcement. What began in the
South has expanded outward. The DME and telemedicine models, the kickback enforcement
strategies, and the sentencing practices developed in Florida, Texas, and Louisiana are now
influencing how cases are handled across the country.
That does not mean every case will look the same, but the tone has been set. Prosecutors are more
coordinated, judges are referencing prior southern cases, and the system as a whole has less tolerance
for what used to be considered gray areas in medical marketing or referral relationships.
Understanding how those trends developed—and how to navigate them when facing a federal
case—has become critical for anyone involved in the healthcare space.