Our Approach

We Take a Comprehensive and Custom-Tailored Approach to Healthcare Compliance and Defense

When establishing or growing a healthcare practice, you need to know that you are doing everything that is necessary to avoid unnecessary risks. Healthcare providers and businesses involved in the healthcare industry face enormous compliance burdens, and failing to effectively address any aspect of compliance can lead to recoupments, fines, and other penalties.

Similarly, if you or your healthcare company has been accused of healthcare fraud or is under investigation, you know that you need effective legal defense. Without it, you could leave yourself exposed to serious liability.

Whether you need compliance or defense representation, you need a law firm that offers the skills and insights you need. But how can you tell which law firm is the right one for you?

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former Department of Justice

Brian J. Kuester

Former U.S. Attorney
Former DA

John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach

Former Special Agent (OIG)

Michael Koslow

Former Supervisory Special Agent (FBI)

Chris Quick

Former Special Agent (FBI & IRS-CI)

Ray Yuen

Former Supervisory Special Agent (FBI)

The healthcare compliance and defense lawyers at the national law firm Oberheiden P.C. know that the experience and the background of a law firm are not the only things that matter for potential clients. The approach that your lawyers will take is important to you, as well.

At Oberheiden P.C., our approach centers on providing experienced and tactful legal advice that is specifically tailored to your goals, interests, and concerns. We understand that not all healthcare providers’ circumstances are the same, and we know that their compliance programs and defense strategies must account for these differences. To ensure that we are not providing you with generalized compliance advice or defense strategies that fit “most” companies, or that have worked for other clients in the past but may not work for you, we take a “listen first” approach that focuses on understanding everything we can about your practice or business before developing a custom-tailored strategy that reflects your practice or business’s specific risks and needs.

Oberheiden P.C.’s Approach to Healthcare Compliance

Due to the risks of failing to effectively maintain compliance, healthcare providers and businesses involved in all aspects of the healthcare industry need to ensure that they are taking a comprehensive and custom-tailored approach to compliance management. To help our clients do what is necessary, we take an approach that involves:

1. Conducting a comprehensive needs assessment

2. Developing custom-tailored compliance policies and procedures

3. Assisting our clients with compliance program implementation

4. Conducting periodic internal healthcare compliance audits

5. Conducting internal investigations as necessary

6. Monitoring for necessary compliance program updates

7. Documenting compliance on an ongoing basis

By taking all of these steps, we are able to help our clients manage their federal healthcare compliance obligations with confidence. With our lawyers’ experience, we make compliance management as straightforward as possible, and we take all guesswork out of the equation.

1. Comprehensive Needs Assessment

With our “listed first” approach, our first step when developing a healthcare compliance program is to conduct a comprehensive needs assessment. Whether your practice or business currently has a compliance program or you are starting a new business and need to develop a compliance program from scratch, we will determine exactly what you need to avoid liability for billing errors, prescription errors, and other compliance failures. Then, we will provide compliance recommendations that address everything you need to address—and nothing you don’t.

2. Custom-Tailored Compliance Policies and Procedures

Conducting a comprehensive needs assessment allows us to develop compliance policies and procedures that are custom-tailored to your practice or business’s needs. When facing scrutiny from federal authorities, healthcare providers need to be able to show that they are addressing their compliance obligations effectively—and an off-the-shelf compliance package won’t cut it. With our custom-tailored approach, we help ensure not only that our clients are able to maintain compliance, but that they are able to satisfactorily demonstrate compliance to federal authorities when necessary.

3. Compliance Program Implementation

While developing custom-tailored compliance policies and procedures is an important step, it is insufficient on its own. Healthcare providers also need to implement these policies and procedures effectively. At Oberheiden P.C., we assist our clients with all aspects of compliance program implementation, from procuring necessary software contracts (and negotiating with software vendors) to providing training to their employees.

4. Internal Healthcare Compliance Audits

Even with effective implementation, issues can still arise from time to time. To uncover these issues before they lead to problems, we conduct internal healthcare compliance audits for our clients. Since we know our clients’ compliance programs inside and out, we are able to conduct these audits efficiently, and our lawyers’ comprehensive knowledge of all pertinent laws and regulations ensures that no issues go overlooked during the internal audit process.

5. Internal Investigations

Along with conducting periodic internal healthcare compliance audits, we also conduct internal investigations for our clients when necessary. Internal investigations are necessary when employees make mistakes that have the potential to expose the business to civil or criminal liability. After conducting these investigations, we help our clients determine and execute appropriate next steps as well.

6. Compliance Program Updates

Federal authorities regularly issue new regulations and amend existing regulations that impact how healthcare providers operate. Our healthcare lawyers monitor for these updates on behalf of our clients and let our clients know when compliance program updates are needed.

7. Ongoing Compliance Documentation

When facing external audits and investigations, healthcare providers can protect themselves by being prepared with clear documentation of compliance. In addition to developing custom-tailored compliance policies and procedures for our clients, we also assist our clients with documenting their compliance efforts on an ongoing basis so that they are fully prepared to withstand external scrutiny.

Oberheiden P.C.’s Approach to Healthcare Fraud Defense

At Oberheiden P.C., you can count on us to provide effective and experienced legal advice that is tailored to your situation, interests, and concerns. To that end, our approach involves seven things:

1. A thorough understanding of the legal landscape surrounding healthcare fraud
2. A “listen first” approach to crafting a defense strategy
3. Letting our extensive experience with prior clients guide your defense strategy without dictating it
4. Direct communication with the senior lawyers on your defense team
5. Getting involved as early as possible in your case
6. Taking an active posture in your defense
7. An appreciation for the collateral consequences of a healthcare fraud case

Together, these facets of our unique approach make our legal representation as effective as possible and provide you with a peace of mind that is often overlooked or undervalued by other law firms when you face serious allegations of fraud.

1. Our Understanding of Healthcare Fraud is Unmatched

As federal healthcare fraud defense lawyers with notable experience in representing both individual and corporate clients who have been accused or suspected of healthcare fraud, we have come face-to-face with all of the most common situations that come up in these cases, as well as many of the least common.

Some of the allegations that we have helped clients defend against have been for:

• Medicare fraud
• Pharmaceutical fraud
• Laboratory fraud
• Billing fraud
• Psychologist and psychiatrist fraud
• Hospice care fraud
• Home health agency (HHA) fraud
• Tricare fraud
• Drug diversion

These serious allegations do not just crop up out of nowhere, though. Over the course of our years of helping clients fight them off, we have found that they tend to escalate from audits like:

• Medicaid audits
• Comprehensive error rate testing (CERT) audits
• Medicare administrative contractor (MAC) audits
• Targeted probe and educate (TPE) audits
• Zone program integrity contractor (ZPIC) audits
• Recovery audit contractor (RAC) audits
• Qlarant investigations and audits

They also frequently result from evidence found through an investigation like:

• Drug diversion investigations
• One performed by the Food and Drug Administration (FDA) or the Department of Labor (DOL)
• A civil investigative demand (CID)
• A subpoena by the Office of Inspector General (OIG)
• A fraud investigation of a federally-qualified health center
• One for Medicare fraud
• Those performed by your medical board

Occasionally, healthcare fraud allegations stem from evidence uncovered through a lawsuit, often one for:

• Medical malpractice, including telemedicine malpractice
• Qui tam claims
• Wrongful death
• Sexual assault

We know how to handle these situations to insulate you and your healthcare company from legal liability.

2. We Listen First

One of the complaints that keeps coming up with regard to law firms and the legal representation of lawyers is that attorneys do not listen to their clients well enough.

At Oberheiden P.C., we hardly ever get this complaint because a fundamental element of our approach is to fully understand our client’s needs, desires, concerns, and situation before we craft a defensive strategy. We also realize that, as the situation progresses, your needs and concerns can evolve, as well. To account for that, we always provide our clients with an open line of communication to the senior lawyers that are on your case, and check in whenever there are big developments in your case that could change your attitude or goals.

3. Our Experience Helping Other Clients Guides, But Does Not Dictate, Your Defense

Lots of lawyers tout their experience in a given practice area of the law, and Oberheiden P.C. is no exception. Our attorneys are highly experienced with handling healthcare fraud defense cases and have a long track record of successes.

However, lots of other attorneys think that, because they have handled a case that is similar to your own, all they have to do is use the same defensive strategy that worked the last time in order to get a similar outcome. They get stuck in the past and fail to see how your case is different from the one they handled before. That hinders your success because the underlying circumstances, your goals, and particular concerns are your own.

At Oberheiden P.C., we prefer to use our past experiences and successes as lessons to be learned for future cases, not as blueprints for success. We know that your circumstances are unique and go to great pains to learn and understand them. We also know that what worked for someone before might not work so completely for you, now.

Instead, we like to think of our past successes as potential avenues for your own success, or as lessons or tools that we can use to help you get the outcome you want; not as the only way to get there.

4. You Communicate Directly with the Senior Lawyers on Your Case

All of this requires exceptional communication between our firm and our clients. Realizing how much of our approach relies on clear and consistent communication, we at Oberheiden P.C. made an unconventional decision: We decided to only hire the senior attorneys who would oversee your case to our firm. No associate or junior lawyers. Not even any paralegals or legal secretaries. When you call Oberheiden P.C., you get one of the senior lawyers who is on your case and who can answer your questions.

We made this decision for several reasons.

First, it eliminates any potential communication issues within our firm. When you call and speak with a secretary, what you tell them gets relayed up the ladder, often to a paralegal, then to a junior associate, and finally to the senior lawyer who is ultimately responsible for your case. Every step in this process presents the opportunity for your concerns to get muted, skewed, or lost entirely. By giving you direct access to the senior lawyer on your case, we eliminate that possibility.

Second, we understand that being accused of healthcare fraud is a traumatizing experience. Having your credibility questioned can be emotional. The last thing that you need during this trying time is to have your law firm add to the stress that you are under. One of the most common ways for them to do this is to treat your concerns as secondary or make it seem like your lawyers are not listening to you. Defending against an allegation of healthcare fraud is harrowing enough. How your law firm treats you should not make it worse.

5. We Get Involved as Early as Possible

A key part of our defense strategy is to get involved in your case as soon as possible. This is especially important for healthcare fraud suspects, rather than defendants. If you think that you or your healthcare company are even being suspected of fraudulent activity, you should get legal representation as soon as you can. Many people overlook the necessity of effective legal defense at this preliminary stage.

In the best cases, it can quash any rumors or misinformation that is pointing law enforcement in your direction. This can prevent an audit from escalating at all, protecting your company from legal liability and even the inconvenience of an intrusive investigation.

Even in the worst cases, our approach to early legal action can set the stage for the best defense possible as your case unfolds.

6. We Take an Active Role in Your Defense

Throughout your defense, but especially in the early days, our approach is generally to take an active role on your behalf. This does not just mean taking all of the necessary steps to ensure that your rights are protected during the investigation. It also means, when necessary and wise, opening a dialogue with law enforcement and showing them how weak of a case they have against you.

When we get involved in your case at its very beginning, this approach can be very effective. Many clients think that there is nothing better than an acquittal at trial. But that is not true. The best outcome is when your lawyers can stop an investigation in its tracks by persuading prosecutors and law enforcement agents that there is nothing to see and that it is not worth looking. This protects you and your company from liability, and it saves you lots of time, stress, and effort.

7. We Appreciate the Collateral Aspects of a Healthcare Fraud Allegation

Finally, our experience in handling countless healthcare fraud defense cases in the past has given us a deep appreciation for how these allegations can lead to other legal issues or intersect with other allegations. Not only can healthcare fraud charges begin with a civil lawsuit filed by a private party, but the charges themselves can trickle down and morph into other problems. A big part of our approach is to foresee what those other problems can be and then adjust our defensive strategy to mitigate them or avoid them entirely.

A good example is a criminal charge for healthcare fraud. Many general defense lawyers think that a go-to defensive strategy is to show that you did not have the necessary intent to defraud. This is a fairly easy defense to raise and tends to be hard for prosecutors to overcome. However, they often do not realize that criminal charges for fraud can also be pursued as a civil action by law enforcement agencies. Those civil actions, while they do not carry the potential for jail time, still have crippling financial sanctions. They also do not need the requisite intent for a criminal case: You can be civilly liable for fraud even for accidental or unknowing conduct. Successfully defending a criminal case of healthcare fraud with the lack of intent defense tacitly admits to a civil case of healthcare fraud, exposing you and your company to significant liability.

A big part of our approach in defending healthcare fraud cases is to look ahead and see what the repercussions of our defensive strategy can be.

Speak with a Healthcare Lawyer at Oberheiden P.C.

If you have questions about compliance, if you have been accused of committing healthcare fraud, or if you think that you might be, or are, facing an audit that could potentially uncover evidence of fraud, we encourage you to contact us promptly for more information. Call the healthcare compliance and defense lawyers at Oberheiden P.C. at (888) 680-1745 or contact us online today.