On August 7, 2026, Epstein Becker Green attorneys Thomas J. Jaworski and Caitlin Carlton joined podiatrists from across the country at the American Podiatric Medical Association’s (APMA) 2026 Annual Scientific Meeting for a discussion on a subject that has become increasingly difficult for providers to ignore: federal health care fraud enforcement.
Their presentation, “When the Department of Justice Knocks: What Podiatrists Need to Know About Medicare and Medicaid Fraud Investigations,” focused on how these investigations begin, where the government is focusing its attention today, and what podiatrists can do now to reduce the risk of becoming the next enforcement headline. This post recaps the highlights on each of these topics.
How Investigations Actually Start
By the time the Department of Justice (DOJ) “knocks,” an investigation is often well underway. Claims data, utilization patterns, audits, and administrative requests can all trigger government scrutiny long before a provider realizes it is under review. Once a subpoena, target letter, or search warrant arrives, the investigation may already be substantially developed and the provider’s window to respond significantly narrowed.
As a result, early contact from the government matters and should not be ignored. A records request, audit, or education letter may appear routine, but how a practice responds—and whether it continues the questioned conduct—can shape what happens next.
Where Enforcement is Actually Focused Right Now
From skin substitutes to compounded medications, recent cases reveal a consistent throughline: the government is rarely asking only whether a service was billed. It is also asking whether the treatment was medically necessary, whether the documentation supports it, whether improper financial incentives influenced clinical decisions, and how the provider responded once concerns were raised.
For podiatrists, that makes compliance less about reacting to a particular headline and more about recognizing the warning signs that recur across cases. Unusual billing patterns, high utilization, weak documentation, questionable financial relationships, and continued billing after an audit or warning can all heighten scrutiny. Practices that identify and address those issues early are generally in a stronger position than those confronting them for the first time after the government has already begun asking questions.
What Practices Can Do Now
An ounce of prevention is worth a pound of cure. For podiatry practices, the discussion at APMA highlighted several practical areas of focus.
- Understand Your Billing Patterns. Medicare and Medicaid claims data can be analyzed to identify unusual utilization, coding, and billing patterns. Practices should understand how their own data may appear in that context. Although outlier status does not itself establish wrongdoing, it can be enough to trigger additional scrutiny.
- Maintain a Meaningful Compliance Process. Regular review of billing practices, medical necessity, documentation, and financial relationships can help surface issues before they become more difficult to address. Particular attention may be warranted where reimbursement incentives intersect with clinical decision-making or where a recurring billing practice affects a significant volume of claims.
- Treat Government Contact as a Signal to Reassess. Audits, records requests, education letters, subpoenas, and other inquiries should be evaluated promptly and in context. Once a concern has been identified, the practice’s response—and whether the questioned conduct continues—can materially affect how the government characterizes the conduct going forward.
The earlier a practice identifies and addresses potential concerns, the better positioned it is to assess the scope of the issue, take appropriate corrective action, and avoid allowing a discrete compliance concern to develop into a broader enforcement matter.
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