Healthcare Compliance Lawyer

Example 1: Healthcare Audit & ZPIC Audits

Years ago, an audit was a matter of routine, something every doctor could reasonably expect at some point during his/her career. Today, receiving a healthcare audit is much more meaningful. When a clinic or a physician receives a healthcare audit nowadays, a preliminary decision has already been made that something is suspicious. For example, a physician may receive a patient record request because a computer analysis has shown that this physician is an “outlier” and bills more services than peers in the same geographical location. Similarly, a Medicare clinic under ZPIC audit cannot simply assume that the request for information is entirely random. Again, today’s audits are prefiltered and targeted. If you are subject to an audit, you should, from day one, consult with the Oberheiden P.C. team to make sure that the government’s concerns are identified and addressed immediately so that there is no ongoing perception of fraud, no referral to the U.S. Attorney’s Office, and no license revocations. Act immediately, call us right away when you get an audit request. Many criminal indictments may be avoidable if the clinic owner or the physician acts appropriately at the early stage of receiving the request. Here is a small selection of our recent case representations.

• Comprehensive Compliance Analysis and Protection for Cardiologist in Defense of CMS Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Multi-Clinic Podiatrist in Defense of ZPIC Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Psychologist in Defense of Medicare Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Home Healthcare Agency in Defense of ZPIC Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Chiropractor in Defense of P-Stim Medicare Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Pediatric Dentist in Defense of Medicaid Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Pharmacy in Defense of DEA Inspection and Audit. Audit Passed, No Referral, No Recoupment.
• Comprehensive Compliance Analysis and Protection for Laboratory in Defense of OIG Medicare Audit. Audit Passed, No Referral, No Recoupment.
• Dozens of more examples. Call us to inquire!

Example 2: Grand Jury Subpoena, OIG Subpoena & CIDs

Part of the government’s investigative arsenal is to issue subpoenas. The three most common subpoenas are grand jury subpoenas, subpoenas issued by the Department of Health and Human Services (HHS-OIG), and the so-called Civil Investigative Demand (CID). All three subpoena forms have in common that they typically request the production of enumerated corporate and financial documents such as business contracts, patient files, and bank account information. Here is a small selection of our recent case representations.

• Whistleblower Defense of Dentist in OIG & FBI Investigation. Oberheiden P.C. Compliance Intervention and Defense: No Charges, No Liability.
• Whistleblower Defense of Toxicology Laboratory: FBI Kickback Investigation. Oberheiden P.C. Compliance Intervention and Defense: No Charges, No Liability.
• Whistleblower Defense of DNA Laboratory: Justice Department Declined to Continue the Case after Oberheiden PC Attorneys Conducted Internal Investigation that Addressed Government’s Concerns. No Charges, No Liability.
• Civil Investigative Demand of Pharmacy: Justice Department Looked into Billing Schemes and Medically Unnecessary Prescriptions. Oberheiden P.C. Internal Investigation and Compliance Defense Package. No Charges, No Liability.
• Civil Investigative Demand of Pharmacy: OIG Compound Fraud Investigation Was Resolved Through Oberheiden P.C. Compliance Assessment and Evaluation. No Charges, No Liability.
• Grand Jury Subpoena of Surgeon: Complex Surgery Kickback Scheme. Oberheiden PC Compliance and Defense Intervention. No Charges, No Liability.
• Grand Jury Subpoena of Billing Company: Federal Criminal Home Healthcare Investigation. Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• Grand Jury Subpoena of Healthcare Marketing Group: Oberheiden PC Kickback Analysis and Compliance Defense. No Charges, No Liability.
• Dozens of more examples. Call us to inquire!

Example 3: Anti-Kickback Counseling

What constitutes a kickback is not always clear. In light of recent changes of healthcare laboratory laws (e.g., EKRA) and Travel Act prosecutions, it is pertinent to make sure that your clinic, your office, your healthcare contracts, and your business operations stay up to date and are in fact compliant. Whether you are a surgeon contemplating an investment in a surgery center, a healthcare marketing specialist, or the owner of a pharmacy/home healthcare agency, etc., the Anti-Kickback Statute may apply whenever referrals and compensation are involved. Get the trusted advice from former DOJ healthcare fraud prosecutors, former OIG/DEA/FBI healthcare fraud special agents, and experienced attorneys and counselors to make sure your marketing fees and your financial arrangements will not get you in trouble. The Oberheiden PC attorneys have handled hundreds of kickback investigations and offer their front-line experience to all Oberheiden P.C. compliance clients. Here is a small selection of our recent case representations.

• FBI/OIG Kickback Investigation for Surgeon: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• FBI/OIG Kickback Investigation of Pain Medicine Doctor: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• FBI/OIG Kickback Investigation against Internal Medicine Physician: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• FBI/OIG Kickback Investigation of Pharmacy: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• FBI/OIG Kickback Investigation of Compound Pharmacy: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• FBI/OIG Kickback Investigation of Chiropractor: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• OIG Subpoena Against Marketing Group: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• OIG Subpoena Against Dental Group: Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• Grand Jury Subpoena Against Healthcare Marketer. Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• Grand Jury Subpoena Against Physician. Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• CID Subpoena. Oberheiden P.C. Compliance Intervention: No Charges, No Liability.
• Dozens of more examples. Call us to inquire!

Example 4: DEA Diversion and Controlled Substances Investigations

Team Leader:

• Attorney Lynette S. Byrd

Oberheiden P.C. has defended healthcare providers of all specialties and pharmacies throughout the United States from Seattle to Miami and from Boston to San Diego under audit by the DEA. Over and over again have we saved our clients’ professional licenses, avoided criminal referrals, and made sure that their reputations did not falter. The success of our representations includes defenses against death penalty charges when DEA agents allege that our clients’ prescriptions caused or added to the death of a patient; similarly, with dozens of cases pending at any time, our compliance team has proven the effectiveness of our opioid protocols and diversion policies. If you are a nurse, a physician, or a pharmacy owner under DEA diversion investigation, please call us immediately. Former DEA Special Agent in Charge Dennis Wichern and his Oberheiden PC team are immediately available to offer you decades of DEA experience. Here is a small selection of our recent case representations.

• Pharmacy Executive Board (DEA Search Warrant): No Charges, Kept License.
• Pharmacy (DEA Inspection): No Charges.
• Pharmacy (Tricare Audit): No Charges.
• Pharmacy (Grand Jury Subpoena): No Charges.
• Pharmacy (Compound Fraud Case): No Charges.
• Pharmacy (CID Subpoena): No Charges.
• Pharmacy (Request to Surrender DEA License): No Charges/Kept DEA License.
• Representation of Various Dental Surgeons for Alleged DEA Violations. No Charges/Kept DEA License.
• Family Medicine Physician (DEA Criminal Opioid Investigation): No Charges.
• Internal Medicine Physician (DEA Criminal Opioid Investigation): No Charges.
• Pain Management Doctor (DEA Criminal Opioid Investigation): No Charges.
• Psychiatrist (DEA Criminal Opioid Investigation): No Charges.
• Nurse (DEA Diversion Investigation): No Charges, Kept License.
• Dozens of more examples. Call us to inquire!

Example 5: Dental Fraud Investigations

Team Leader:

• Dr. Nick Oberheiden

Dentists are more under attack by regulators and law enforcement agencies than ever before. The Department of Justice, the FBI, the OIG, the Medicaid Fraud Control Unit, and Attorney General offices nationwide have significantly expanded their scrutiny of dentists, dental surgeons, and pediatric dental specialists. Oberheiden P.C. has responded to these audits (e.g., by DentaQuest, Medicaid Fraud Control Unit — MFCU) with a robust and successful defense strategy centered around the elimination of criminal intent. The Oberheiden PC Dental Fraud Prevention and Compliance Package has become a trusted response to inquiries into excessive billing patterns, billing for services not provided, billing for medically unnecessary services, lack of operational compliance, allegations of federal False Claims Act violations and many other issues unique and particular to the operations of pediatric dental clinics, Medicaid dentists, and oral surgeons.

The Oberheiden P.C. compliance approach is tailored to the specific needs of its dentist clients and is compelling evidence that our clients truly want to do it right. Here are some recent examples of our representations of dentists.

• Whistleblower Defense of Dental Group: Oberheiden P.C. Compliance Intervention: No Charges. Attorney General and Justice Department Declined to Intervene. No Charges.
• Whistleblower Defense of Dental Group: Oberheiden P.C. Compliance Intervention: No Charges. Attorney General and Justice Department Declined to Intervene. No Charges.
• Whistleblower Defense of Dental Group: Oberheiden P.C. Compliance Intervention: No Charges. Attorney General and Justice Department Declined to Intervene. No Charges.
• Dentist Accused of Medicaid Fraud. OIG Criminal Investigation. Oberheiden P.C. Compliance Intervention: No Charges.
• Dentist Accused of Medicaid Fraud. FBI Criminal Investigation. Oberheiden P.C. Compliance Intervention: No Charges.
• Dentist Accused of Medicaid Fraud. OIG Criminal Investigation. Oberheiden P.C. Compliance Intervention: No Charges.
• Dentist Accused of Medicaid Fraud. FBI Criminal Investigation. Oberheiden P.C. Compliance Intervention: No Charges.
• Federal Search Warrant against Dental Clinic. Oberheiden P.C. Compliance Intervention: No Charges.
• Dozens of more examples. Call us to inquire!

Example 6: Home Health & Hospice Care (Form 485)

Home health and hospice agencies are notorious targets of FBI and OIG healthcare fraud investigations. With several hundreds of home health agencies in cities like Houston, Miami, and Los Angeles alone, investigators maintain high scrutiny in three areas of concern. The first one is medical necessity. Many DOJ indictments accuse physicians and home healthcare agencies of providing medically unneeded services. The core problem in virtually all of these cases is that many medical providers, nursing directors, and business owners simply do not understand Form 485 and thus routinely deviate from the rigid homebound criteria. Two, Medicare home health and hospice agencies must be careful how and through whom they recruit their patients. The government is critically examining compensation schemes structured as commissions, percentage, or “per referral” payments. Three, separate and in addition to marketing, a great number of individuals get federally indicted each year for allegedly paying or receiving illegal kickbacks in connection with Medicare patients. All three areas — and there are more — remain heavily enforced. If you own a home health agency or if you serve as a medical provider or supervisor, contact Oberheiden P.C. today and learn how our compliance package has successfully addressed civil and criminal investigations, avoided federal False Claims Act liability, and saved medical and nursing licenses across the United States. Here is a small selection of our recent case representations.

• Compliance Counseling and Comprehensive Training (Form 485) for Large Home Healthcare Network in Defense of ZPIC Audit. No Referral, No Recoupment.
• Compliance Counseling and Comprehensive Training (Form 485) for Hospice Care Agency in Defense of FBI/OIG Investigation. No Charges.
• Compliance Counseling and Comprehensive Training for Home Healthcare Agency in Defense of RAC Audit. Audit Passed, No Referral, No Recoupment.
• Compliance Counseling and Comprehensive Training for Home Healthcare Agency in Defense of Federal Kickback Investigation. No Referral, No Recoupment
• Compliance Counseling and Comprehensive Training for Home Healthcare Medical Provider in Defense of Federal Kickback Investigation. Audit Passed, No Referral, No Recoupment.
• Dozens of more examples. Call us to inquire!

Example 7: Medical Necessity Investigations

Compliance can make a big difference when it comes to questions of medical necessity. Typically, in a medical necessity case, the government will allege that a certain procedure, medication, or clinical service was not needed. The Oberheiden P.C. compliance approach routinely defeats such arguments by demonstrating through our expert consultants (e.g. nationally recognized medical experts, certified billers, coders, certified fraud examiners, investigators, and former law enforcement personnel) that our client did practice within the accepted standard, followed his/her independent professional judgment, did follow medical necessity considerations, and did not have any intent, incentive, or motive to violate ethical or legal regulations. Here is a small selection of our recent case representations.

• Criminal Opioid Investigation (21 U.S.C. 841): Oberheiden P.C. Avoided Criminal Charges through Our Proven Opioid Protocol and Compliance Work. No Charges.
• Criminal Opioid Investigation (21 U.S.C. 841): Oberheiden P.C. Avoided Criminal Charges through Our Proven Opioid Protocol and Compliance Work. No Charges.
• Civil Opioid Investigation: Oberheiden P.C. Avoided Criminal Charges through Our Proven Opioid Protocol and Compliance Work. No Charges.
• Medicare Fraud Investigations: Oberheiden P.C. Avoided Criminal Charges through Our Proven Opioid Protocol and Compliance Work. No Charges.
• Medicaid Fraud Investigations: Oberheiden P.C. Avoided Criminal Charges through Our Proven Opioid Protocol and Compliance Work. No Charges.
• Defense of Allegedly Unnecessary Medical Procedures, Surgeries, Tests, and Services of Dozens and Dozens of Physicians, Dentists, Psychologists, Chiropractors, and Healthcare Business Owners across the entire United States through a Comprehensive Billing and Coding Review, Internal Investigation and Corrective Measures. No Charges.
• Dozens of more examples. Call us to inquire!

Example 8: Healthcare Marketing & Consulting Agreements

Whether you are a healthcare executive, marketing specialist, the owner of a home healthcare agency, or otherwise tied to the generation of leads in the healthcare industry, no business can survive without referrals and marketing. What is unique about healthcare marketing is that it can matter quite a lot how such marketing is conducted or paid for. Payments that are entirely appropriate in other industries (e.g. real estate commissions) may constitute federal felonies in the healthcare industry. A number of recent legislative and enforcement changes (e.g. EKRA, national healthcare fraud takedowns, Travel Act prosecutions) have further complicated the demarcation line between lawful marketing and illegal kickbacks for master distributors, contractors, and even employees. Flaws in marketing and services agreements are common; at times, with draconian consequences. If you have questions: (i) about bona fide employee issues, (ii) whether you can be (or actually are a) 1099 Independent Contractor, (iii) on how to structure MSOs and MSAs, and (iv) about whether other forms of consulting agreements that you may be a part of are in compliance with existing laws, you should call the Oberheiden P.C. Healthcare Law Compliance Team immediately. We routinely advise our clients on:

• W-2 and 1099 Marketing Contracts
• Personal Services Contracts
• Billing and Coding Contracts
• MSO Arrangements
• Medical Directorship Contracts
• PPMs, Physician Ownership Models
• Call Now for a Free & Confidential Consultation!

Example 9: Cardiologists and Internal Medicine Physicians (Medicare Billing Fraud)

Being a physician can be tough. They are expected to be perfect doctors always getting the right diagnosis and fixing the patient’s problem while at the same time they are expected to be perfect business people making only correct decisions when it comes to hiring staff and billers for which these physicians are responsible (civilly and even criminally). Quickly, this dual responsibility between clinical orders and business decisions can become a challenge. Each year, a vast number of physicians of all specialties are federally indicted because they allegedly ordered too many tests, did not perform the services billed for, up-coded, were tricked into a bad referral or physician-business joint venture, or are accused of some other variation of healthcare fraud. From our experience of over 1,000 healthcare fraud investigations, a lion’s share of these license revocations and criminal and civil liabilities are preventable. If you are a physician, a dentist, a psychiatrist, or other healthcare provider, please do not assume that you are in compliance just because you pay your staff to do things right. At the end of the analysis, the provider is the one exposed and responsible. Get in touch with the best healthcare fraud prevention lawyers you can find so that you can truly and comfortably say, I really did everything I could to do things right.

Oberheiden P.C. has a long history of experience in healthcare compliance. Here is a small selection of our recent case representations.

• Cardiology Group (Stress Test Billing Fraud): FBI Investigated Our Client for Allegedly Excessive Testing. Oberheiden PC Intervened and Avoided Criminal Charges for all Physicians. No Charges.
• Established Comprehensive Compliance Program for Group of Cardiologists in An Effort to Defend against federal False Claims Act Investigation and Liability. No Charges.
• Oberheiden PC Compliance Program to Assist Dentist with Severe Billing Fraud Problems in Effort to Avoid Criminal Charges in Pending Investigation. No Charges.
• Representation and Counseling of Internal Medicine Physician Group in Medicare Fraud Investigation. Oberheiden PC Billing and Compliance Defense. No Charges.
• Call Now for a Free & Confidential Consultation!

Example 10: Mental Health Provider (Billing Audit)

Psychologists, psychiatrists, LPCs, and many other professional mental health providers routinely choose Oberheiden P.C. to receive guidance when it comes to responding to audits, resolving billing problems, or navigating through healthcare compliance challenges. The consultants and attorneys at Oberheiden P.C. have protected professionals from all across the country through difficult times, as the following examples show. Notably, every single mental healthcare client of Oberheiden P.C. has avoided charges and maintained their professional license — our compliance packages work! Here is a small selection of our recent case representations.

• Medicare Audit of Psychologist with 82% error rate, missing charts, missing notes: Oberheiden P.C. Compliance Intervention: No Charges, Passed the Audit.
• Medicare Audit of Psychologist: Missing Notes, Missing Charts, Billing Issues. Oberheiden P.C. Compliance Defense. No Charges, Passed the Audit.
• Private Insurance Audit of LPC. Five Years of Missing Files. Oberheiden P.C. Compliance Intervention: No Charges, Passed the Audit.
• Dozens of more examples. Call us to inquire!

Example 11: Federal Workers Comp Clinics

Few things in healthcare are as esoteric and complex as running a federal or state workers compensation clinic. Unknown to many, the rules governing state or federal compensation healthcare programs are fundamentally different when compared to the regulatory requirements of billing private insurance payors or Medicare. As a consequence, many DOL clinics struggle with complying with the ever-changing maze of rules and regulations. In an environment as heavily and aggressively enforced as federal and state workers compensation programs, you, as a business owner or employed physician, can simply not afford being part of billing errors, submission of false claims, or violations of Union Labor Laws and bribery. The DOL advisors at Oberheiden P.C. include former Justice Department prosecutors previously in charge of DOL healthcare prosecutions, attorneys that supervised U.S. Postal Inspection, and OIG workers compensation investigations, true DOL and state workers compensation billing and collection experts, as well as lawyers with profound DOL compliance expertise. Oberheiden P.C. has advised and defended federal worker’s compensation clinics and its owners across the United States. Here is a small selection of our recent case representations.

• Federal Criminal Defense of DOL Clinic (DOL Billing Fraud): Oberheiden P.C. Compliance Intervention: No Charges.
• Federal Criminal Defense of DOL Clinic (Kickbacks, Public Corruption): Oberheiden P.C. Compliance Intervention: No Charges.
• DOL Clinic (Kickbacks & Bribery Investigation): Oberheiden P.C. Compliance Intervention: No Charges.
• Compliance Advice to DOL Federal Workers Compensation Physical Therapy and Rehabilitation Clinic (Texas): Prevented Federal False Claims Act
• Compliance Advice to DOL Federal Workers Compensation Physical Therapy and Rehabilitation Clinic (Illinois): Prevented Federal False Claims Act
• Compliance Advice to DOL Federal Workers Compensation Physical Therapy and Rehabilitation Clinic (Ohio): Prevented federal False Claims Act
• Compliance Advice to DOL Federal Workers Compensation Physical Therapy and Rehabilitation Clinic (Florida): Prevented federal False Claims Act
• Dozens of more examples. Call us to inquire!