Why Healthcare Providers Must Have a Corporate Compliance Program

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

Every healthcare 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 healthcare benefit program?

In today’s world of aggressive healthcare 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, healthcare 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) healthcare prosecutors provide comprehensive compliance representation for healthcare-industry clients across the country.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

John W. Sellers
John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena
Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (OIG)

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz

Former Supervisory Special Agent (FBI)

Chris Quick
Chris Quick

Former Special Agent (FBI & IRS-CI)

Kevin M. Sheridan
Kevin M. Sheridan

Former Special Agent (FBI)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Dennis A. Wichern
Dennis A. Wichern

Former Special Agent-in-Charge (DEA)

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

Our compliance team offers healthcare 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 healthcare 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 healthcare businesses across the United States with regard to both proactive compliance and federal healthcare fraud defense.

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

  • Former DOJ healthcare 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 healthcare 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 888-680-1745 now.

What Are the Advantages of Implementing a Comprehensive Healthcare Compliance Program?

“In thousands of healthcare cases, I have never once seen a clinic, a hospital, or any other healthcare business that was perfect. While most businesses are not expected to be perfect, healthcare 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 Healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare facilities.

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

Our compliance team has helped hundreds of healthcare providers successfully navigate the federal healthcare 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 healthcare auditors, as well as our experience defending healthcare providers in hundreds of criminal healthcare fraud investigations.

Our attorneys’ experience serving the Justice Department; our experience defending of hundreds of clients against healthcare fraud allegations; and our daily interactions with the FBI, the OIG, and the Justice Department in healthcare 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 healthcare 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 888-680-1745 now.

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