Why Health Care Providers Must Have a Corporate Compliance Program

Our Former Justice Department Prosecutors Provide Compliance Representation for Business Owners and Medical Providers Nationwide

Every health care business and every medical provider must make a fundamental choice for their practice: Do I risk being the next target of a federal investigation; or, do I effectively protect myself and eliminate the possibility of auditors or federal prosecutors accusing me of fraudulently billing Medicare, Medicaid, or another government health care benefit program?

In today’s world of aggressive health care fraud enforcement, not a day goes by without news of new arrests, take downs, and indictments targeting licensed practitioners, company executives, and other providers and organizations. While the government has traditionally focused its law enforcement efforts on fraud and abuse targeting Medicare, current indictments demonstrate how dramatically the spectrum of investigations has broadened. We have recently seen a significant influx of cases involving allegations of Medicare, Medicaid, Tricare, and Department of Labor (DOL) fraud against:

  • DME Companies
  • Addiction Treatment Centers
  • Toxicology Laboratories
  • PGX Laboratories
  • Telemedicine Businesses
  • MSO and Physician Joint Ventures
  • Pharmacies (Traditional & Compound Pharmacies)
  • Opioid Prescribers
  • Home Health & Hospice Agencies
  • Surgery Centers and Hospitals
  • Individual Physician Practices

While no two investigations are exactly alike, what all investigations have in common is that they can be prevented with an effective compliance program. By prioritizing compliance, health care businesses and medical providers can effectively shield themselves from accusations of fraud and abuse. At Oberheiden, P.C., our former U.S. Department of Justice (DOJ) health care prosecutors provide comprehensive compliance representation for health care-industry clients across the country.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Attorney-at-Law & Founder

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Lynette S. Byrd
Lynette S. Byrd

Former Federal Prosecutor

Partner

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Subodh Chandra
Subodh Chandra

Former Federal Prosecutor

Local Counsel

Elizabeth K. Stepp
Elizabeth K. Stepp

Partner

Roger Bach
Roger Bach
(Non-Lawyer)

Former Special Agent, OIG

Dennis A. Wichern
Dennis A. Wichern
(Non-Lawyer)

Former Special Agent-in-Charge

Chris Quick
Chris Quick
(Non-Lawyer)

Former Special Agent, FBI

Kevin M. Sheridan
Kevin M. Sheridan
(Non-Lawyer)

Retired Supervisory Special Agent, FBI

Ray Yuen
Ray Yuen
(Non-Lawyer)

Former Supervisory Special Agent, FBI

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz
(Non-Lawyer)

Former Supervisory Special Agent, FBI

Don’t Become the Next Target of a Health Care Fraud Audit or Investigation

Our compliance team offers health care clients the frontline experience of former Assistant U.S. Attorneys, former DOJ trial attorneys, and former federal investigators who have decades of experience in federal health care fraud matters. We know what the government is looking for, and we know what it takes to survive an audit. Led by founding attorney Dr. Nick Oberheiden, our team has represented hundreds of physicians and health care businesses across the United States with regard to both proactive compliance and federal health care fraud defense.

When you choose Oberheiden, P.C. for health care compliance, your compliance team will include:

  • Former DOJ health care fraud prosecutors
  • Former auditors and billing experts
  • Former federal agents (FBI, DEA, OIG, and IRS)
  • Proven tools and strategies for surviving audits and investigations
  • No junior lawyers, no paralegals, and direct access to our senior attorneys

If you are worried about being audited or investigated by federal authorities, then know there is effective medicine against such concerns. Call Dr. Nick Oberheiden and learn within minutes how your practice can be better protected, how you can avoid the ten biggest mistakes in your health care practice, and how you can establish a corporate structure that will signal to auditors and federal agents that their efforts are misguided. Our phones are answered 24/7, so call (214) 692-2171 now.

What Are the Advantages of Implementing a Comprehensive Health Care Compliance Program?

“In thousands of health care cases, I have never once seen a clinic, a hospital, or any other health care business that was perfect. While most businesses are not expected to be perfect, health care is different. Mistakes can be interpreted as criminal intent, particularly when they are systemic and left uncorrected. A compliance program can mitigate this risk significantly, if not eliminate it entirely. If you are serious about protecting your business or practice, you need to devote adequate time and resource to compliance.” – Attorney Dr. Nick Oberheiden

What are the Elements of a Comprehensive Health Care Compliance Program?

Where does the need for a corporate compliance program come from? Why is Health Insurance Portability and Accountability Act (HIPAA) compliance not enough? Can an effective compliance program avoid scrutiny and eliminate accusations of criminal intent? Can an effective compliance program prevent unfavorable outcomes in ZPIC and commercial audits?

The Department of Health and Human Services (DHHS), the Office of Inspector General (DOJ, and the Justice Department expect every health care service provider to be compliant. In this context, to be “compliant” means to strictly follow all of the myriad rules and laws that apply to Medicare, Medicaid, Tricare, and DOL participants.

Unfortunately, many providers mistakenly believe that having HIPAA policies in place is sufficient to protect them from federal penalties. While addressing the burdens of HIPAA is certainly one aspect of a compliance program, in context it actually plays a fairly small role in shielding providers from federal scrutiny. In order to be sufficiently comprehensive, an effective compliance program must address all of the laws and regulations that the DOJ, OIG, and FBI use to criminally investigate and prosecute health care business owners and practitioners for  fraud.

For example, the Office of Inspector General’s Office minimally recommends the following components for an effective voluntary compliance program:

  • Conducting internal monitoring and auditing;
  • Implementing compliance and practice standards;
  • Designating a compliance officer or contact;
  • Conducting appropriate training and education;
  • Responding appropriately to detected offenses and developing corrective action;
  • Developing open lines of communication; and,
  • Enforcing disciplinary standards through well-publicized guidelines.

The OIG has also stated that, “[t]he goal of voluntary compliance programs is to provide a tool to strengthen the efforts of health care providers to prevent and reduce improper conduct;” and, “[t]hese programs can also benefit physician practices by helping to streamline business operations.” (OIG Workplan, 2012).  However, as with most things that the government creates, while its compliance tips and explanations are well-meaning, over time they have grown to thousands of pages of extraordinarily-complex rules and regulations, and the infrastructure recommendations are simply too difficult to implement for everyday practicing clinicians and health care facilities.

Why Should Providers and Business Owners Choose Oberheiden, P.C. for Health Care Compliance?

Our compliance team has helped hundreds of health care providers successfully navigate the federal health care compliance landscape. In order to assist our clients in putting compliance programs into practice, instead of just summarizing the relevant laws and regulations, we explain to our clients and their staff in detail why these rules exist, how to follow them, and what happens in cases of non-compliance. Our recommendations and insights come directly from our service as former Assistant U.S. Attorneys, federal prosecutors, federal agents, and health care auditors, as well as our experience defending health care providers in hundreds of criminal health care fraud investigations.

Our attorneys’ experience serving the Justice Department; our experience defending of hundreds of clients against health care fraud allegations; and our daily interactions with the FBI, the OIG, and the Justice Department in health care matters are extremely powerful resources that we are able to use strategically to our clients’ advantage. Whereas ineffective compliance programs can actually increase providers’ risk of prosecution in some cases, our programs are designed to prevent investigations – and to allow for prompt and favorable outcomes when they arise. If you have concerns about compliance and would like more information, we encourage you to contact us for a complimentary initial consultation.

Contact Us 24/7 to Speak with Attorney Dr. Nick Oberheiden in Confidence

Not sure about compliance? Want to find out how to adopt an effective compliance program and protect your business or practice against costly mistakes? Call attorney Dr. Nick Oberheiden today to discuss your needs in confidence. Learn how Dr. Oberheiden and his team have helped hundreds of health care clients avoid criminal charges, resolve audits without liability, and fend off federal charges carrying the potential for millions of dollars in financial penalties and decades of federal imprisonment.

We offer compliance packages of varying sizes that we can custom-tailor to your business’s or practice’s unique needs. A simple call or text connects you directly with Dr. Oberheiden. Let’s get you protected. Dial (214) 692-2171 now.

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