Workers’ Compensation Consultants for Audits and Investigations
If you bill the Office of Workers Compensation Program (OWCP) or any other U.S. Department of Labor (DOL) workers’ compensation program, you need to be wary of the risks involved in facing an audit or investigation. Our federal health care fraud defense lawyers and workers’ compensation consultants have the experience and insights you need to avoid practice-threatening penalties.
When you bill the U.S. Department of Labor (DOL) workers’ compensation program, you need to be wary of the risks involved in facing an audit or investigation. Our federal health care fraud defense lawyers and workers’ compensation programs, including those administered by the Office of Workers Compensation Program (OWCP), are subject to strict rules and regulations, and there are various federal laws that impose civil and criminal penalties for health care providers that over-bill the DOL.
This means one thing: For health care providers that bill DOL workers’ compensation programs, compliance is key. With an effective DOL compliance program, not only can you significantly reduce your risk of being targeted in a workers’ comp audit or Office of Inspector General (OIG) investigation; but, in the event that you are audited or investigated, you can clearly establish that you are not deserving of practice during an audit or investigation can be more challenging, but you could still have a number of effective compliance program in place, defending your practice during an audit or investigation can be more challenging, but you could still have a number of effective defense strategies available.
About Oberheiden, P.C. | Federal Health Care Fraud Defense Lawyers and Workers’ Comp Consultants for DOL Health Care Providers Nationwide
At Oberheiden, P.C., our practice is focused on representing health care providers that bill the DOL’s workers’ compensation programs and other federal health care benefit programs. In addition to representing providers with regard to proactive compliance, we also regularly advise clients regarding audits and investigations. Our lawyers and consultants, many of whom previously worked for the federal government investigating and prosecuting providers suspected of defrauding these programs, offer centuries of combined experience and a proven track record of helping providers avoid the substantial penalties that can result from DOL fraud liability.
While we represent health care providers that bill all federal health care benefits programs – and a significant portion of our practice is devoted to Medicare and Medicaid fraud defense – we routinely counsel providers who treat injured federal and private-sector employees under the four main DOL programs:
- Federal Employees’ Compensation Program (FECP)
- Energy Employees Occupational Illness Compensation Program (EEOICP)
- Longshore and Harbor Workers’ Compensation Program (LHWCP)
- Coal Mine Workers Compensation Program (Black Lung)
We know the regulations governing these programs like the backs of our hands; and, with our defense attorneys’ prior prosecutorial experience, we are able to offer efficient, strategic, and effective consulting services for clients that are either concerned about or actively facing a DOL workers’ compensation program audit or investigation.
How Our Lawyers and Consultants Help with Federal Workers’ Comp Audits and Investigations
As lawyers and consultants, we are able to provide comprehensive, full-service advice and representation for federal workers’ comp audits and investigations. This includes conducting internal audits to identify potential areas of exposure, interfacing with the DOL and federal prosecutors on behalf of our clients, executing defense strategies focused on avoiding federal charges, and assisting with the development and implementation of adequate DOL compliance policies and procedures. Depending upon your clinic’s or health care practice’s specific needs, we can provide you with services including:
1. Confidential and Attorney-Client Privileged Internal Compliance Audit
When facing a federal workers’ comp audit or investigation, you need to know what – if anything – the DOL is going to find. However, in the process of uncovering any potential violations, you also need to avoid generating records or disclosing information that might be subject to a warrant or subpoena. We can work with you and your key personnel to confidentially and discretely conduct an internal audit that avoids raising concerns among your employees and patients, and we can ensure that all communications, notes, and other records produced during the internal audit are protected by the attorney-client privilege.
Conducting an internal audit during (or in anticipation of) a federal workers’ comp audit or OIG investigation is important for a number of reasons. These reasons include:
- Federal auditors and agents will not always tell you what they are investigating; and, as a result, you need to do your own legwork to determine what allegations you may need to defend against;
- By identifying any DOL billing violations before the government, you can develop a proactive strategy for responding to the audit or investigation;
- As a health care provider that bills the DOL, you may have an obligation to affirmatively disclose billing violations, but you cannot do this confidently until you know exactly what you need to disclose; and,
- By identifying any workers’ comp code errors or other billing mistakes, you can proactively update your policies and procedures to demonstrate to the DOL that you are serious about compliance with the federal workers’ comp rules.
2. Intervention and Proactive Defense of the DOL’s Audit or Investigation
When facing a federal workers’ comp audit or investigation, one option is to let the DOL conduct its inquiry at its own pace and according to its own standards and protocols. Another option is to intervene in the audit or investigation, take control of the process, and actively steer the inquiry toward a favorable outcome. At Oberheiden, P.C., we believe firmly in the latter approach, as it has protected the vast majority of our clients not just from facing criminal penalties, but from federal charges even being filed. With our defense lawyers’ and former prosecutors’ insights, and with our federal workers’ comp consultants’ experience, we are able to swiftly and strategically intervene in DOL audits and investigations and begin working promptly toward a positive outcome.
3. Assertion of DOL Billing Fraud Defenses and Legal Protections
In order to avoid federal charges during a workers’ comp audit or investigation, you need to convince the DOL and the U.S. Department of Justice (DOJ) that it is not necessary or in the government’s interests to move forward with prosecution. While the government has the burden of proof in court, during an audit or investigation, it is up to you to present a compelling case as to why prosecution is unwarranted. Once our lawyers and consultants assess the facts of your case, we may be able to assert a variety of defense strategies on behalf of your clinic or practice, including:
- Compliance with all workers’ comp rules and regulations
- Protection under the Anti-Kickback Statute safe harbors
- Unconstitutional search or seizure
- Unconstitutional interrogation or “fruit of the poisonous tree”
- Lack of evidence to justify federal prosecution
4. Demonstrating Lack of Knowledge or Intent
In federal health care fraud cases, including those involving allegations of fraud under DOL workers’ compensation programs, a key element of the government’s case is intent. If prosecutors can present a case that you intentionally overbilled the DOL, then they can pursue prison time and other criminal penalties. If evidence of intent is lacking, or if you can use your compliance program to affirmatively demonstrate that you fully intended to comply with the federal workers’ comp rules, then prosecution is unwarranted. In addition to the defenses listed above, if it is not possible to argue that you are 100% innocent (i.e. if billing errors have clearly been made), then our lawyers and consultants can use their experience to argue that the evidence does not support an inference of intent.
Lack of knowledge or intent can also be a key defense strategy in cases where a provider’s alleged liability is based upon the conduct of a third party – such as a third-party billing company, marketer, or ancillary service provider. If federal prosecutors are trying to implicate your clinic or practice in a DOL fraud conspiracy, then demonstrating not only that you did not intend to violate the law, but that you were not even aware that a violation occurred, can be hugely effective for resolving an audit or investigation without negative ramifications.
5. Taking Corrective Action to Prevent Future Federal Workers’ Comp Violations
As we mentioned above, one of the reasons for conducting an internal audit once you have been contacted by the DOL (or if you have reason to believe that the DOL may be contacting you soon) is so that you can correct any ongoing issues or systemic compliance deficiencies. However, overtly taking corrective action can also signal to the DOL that you are aware that a problem exists. In addition to dealing with the DOL on your behalf, our lawyers and consultants can also assist you with making any necessary changes to your clinic’s or practice’s billing policies and procedures without increasing your risk of prosecution for past violations.
Get Started with a Free Initial Consultation at Oberheiden, P.C.
If you would like to speak with a member of our federal workers’ compensation fraud consulting and defense team, we encourage you to contact us promptly. To schedule a free and confidential consultation as soon as possible, call (214) 692-2171 or tell us how to reach you online no