Hospital Lawyers
Our Lawyers Represent Hospitals in All Areas of Healthcare Compliance and Defense
Hospital Compliance and Defense Team Lead
Former DOJ Attorney
Contact LynetteHospitals face legal risks in all aspects of their operations. To manage these legal risks effectively, they must give due consideration to compliance, and they must be prepared to launch a strategic defense when necessary. Compliance failures can lead to scrutiny from Medicare and Medicaid auditors, the U.S. Department of Health and Human Services (DHHS), and even the U.S. Drug Enforcement Administration (DEA). When facing scrutiny, engaging an experienced hospital lawyer promptly is critical for avoiding steep penalties.
Each hospital lawyer at Oberheiden P.C. has significant experience in both compliance and defense. We work with hospitals and other healthcare providers across the country to help them manage compliance, demonstrate compliance during audits and investigations, and address compliance failures when necessary. Federal auditors and investigators expect strict compliance—we ensure that our clients have the knowledge, tools, and resources they need to meet these expectations on an ongoing basis.
About the Hospital Lawyers at Oberheiden P.C.
Our hospital lawyers have deep backgrounds in healthcare law. While some of our lawyers, including Dr. Nick Oberheiden, Founding Attorney, have spent their entire careers in private practice representing hospitals and other clients, many of our lawyers also have prior experience working for the federal government. In this capacity, they led investigations and prosecutions targeting hospitals and other entities suspected of billing fraud, prescription drug fraud, and other civil and criminal violations. This includes Lynette Byrd, our Healthcare Team Lead, who prosecuted healthcare fraud at the U.S. Department of Justice (DOJ) before entering private practice.
When you choose Oberheiden P.C., you will work with a team of lawyers who have the knowledge and insights needed to represent your hospital in all areas of federal compliance and defense. Our team approach promotes both comprehensiveness and efficiency in our representation—and it ensures that every client we represent receives the full benefit of our team’s collective experience on both sides of federal healthcare compliance and enforcement matters.
Our Legal Services for Hospitals in the U.S.
In today’s world, hospitals need experienced legal representation. While an in-house compliance team is important, it is not enough on its own. Hospitals must rely on experienced legal counsel to guide their compliance efforts on a day-to-day basis, and they must have access to a team of lawyers who are prepared to respond to audits, investigations, complaints, and other legal risks immediately if necessary.
Our legal services for hospitals in the U.S. include:
Hospital Compliance Services
We provide comprehensive and custom-tailored compliance services for hospitals. To begin, a hospital lawyer at Oberheiden P.C. will work closely with you and your team to clearly identify the full scope of your hospital’s compliance obligations. This is an extremely important step in the process, as any oversights have the potential to leave your organization exposed.
With our experience in all areas of healthcare compliance, we can help you clearly understand all of the statutory and regulatory requirements and restrictions that apply. Then, we can begin working with you to develop a custom-tailored hospital compliance program. While individual hospitals’ obligations vary, generally speaking, a comprehensive hospital compliance program will need to address areas including (but not limited to):
- Medicare, Medicaid, Tricare, and DOL billing compliance
- Private insurance, PPO, and HMO billing compliance
- Prescription drug compliance
- Data privacy compliance
- Healthcare marketing compliance
- Telehealth and telemedicine compliance
- Anti-Kickback Statute and Stark Law compliance
Within these areas, among others, hospitals must ensure that they have adequate policies and procedures to ensure compliance in all aspects of their operations. Then, they must ensure adequate implementation on an organization-wide basis. To meet the DHHS’s expectations, hospitals must have dedicated compliance officers and compliance teams, provide adequate training to all relevant personnel, and ensure that their teams have the resources they need to maintain—and document—compliance in all areas.
Documentation is a critical aspect of hospital compliance. Not only must hospitals maintain compliance, but they must also be prepared to demonstrate compliance when necessary. This requires extensive documentation. A hospital lawyer at Oberheiden P.C. can advise you regarding the documentation your personnel should be generating and storing in order to support its defense efforts in the event of a federal audit, investigation, or lawsuit.
Hospital Defense Services
Federal audits, investigations, and lawsuits present substantial risks for hospitals. In some cases, they can present risks for hospital administrators, directors, and executives as well. As a result, a proactive and strategic defense is key, and hospitals must be able to rely on their counsel to guide them forward effectively.
We defend hospitals in all federal matters. If your hospital is facing scrutiny or facing a lawsuit, we can get to work immediately building and executing an effective defense. Our hospital defense lawyers have a strong track record in federal defense matters—a record which includes resolving the substantial majority of our clients’ investigations under the False Claims Act (i.e., investigations targeting alleged Medicare and Medicaid fraud) without charges being filed.
When you contact us, we will arrange for you to speak with a hospital lawyer in confidence as soon as possible. Based on this initial consultation, we will determine your (and our) next steps. We take the same proactive, comprehensive, and cost-conscious approach to every defense matter we handle. This includes (but is not limited to):
- MAC, RAC, and UPIC billing audits
- DHHS, DEA, and DOJ healthcare fraud investigations
- Issuance of search warrants, subpoenas, and target letters
- Civil healthcare fraud enforcement actions
- Criminal healthcare fraud indictments and trials
- Federal lawsuits involving cybersecurity breaches, healthcare fraud, and other allegations
- Matters involving the Centers for Medicare and Medicaid Services (CMS), Internal Revenue Service (IRS), and other federal authorities
Similar to hospital compliance, when defending against allegations of billing fraud or other violations, a comprehensive approach is key. Asserting a successful defense involves understanding all of the allegations at issue and addressing each of these allegations individually. With our experience in all areas of federal healthcare law, we are able to work quickly to build and execute effective defense strategies, and we are able to substantially limit (if not eliminate) our clients’ exposure in most cases.
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
Lynette S. Byrd
Former DOJ Trial Attorney
Partner
Brian J. Kuester
Former U.S. Attorney
Hon. Kevin McCarthy
55th Speaker, U.S. House of Representatives (ret.)
Government Consultant
Mike Pompeo
Of Counsel
Former U.S. Secretary of State
John W. Sellers
Former Senior DOJ Trial Attorney
Linda Julin McNamara
Federal Appeals Attorney
Nicholas B. Johnson
Former Prosecutor
Roger Bach
Former Special Agent (DOJ)
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Ray Yuen
Former Supervisory Special Agent (FBI)
FAQs: What Administrators, Directors, and Executives Need to Know About Hospital Compliance and Defense
How Important Is It for Hospitals to Have an Effective Compliance Program?
Having an effective compliance program is critical for hospitals. This is true for all hospitals—regardless of their size and geographic location. The DHHS and other federal authorities expect hospitals to prioritize compliance, as compliance is viewed as protecting both patients and taxpayers. Non-compliance can raise a variety of red flags, and it can lead to scrutiny from a variety of auditors and agencies.
What Are the Key Elements of Hospital Compliance?
There are several key elements of hospital compliance. The DHHS’s Office of Inspector General (OIG) has published a document titled Compliance Program Guidance for Hospitals that lists seven key elements of an effective hospital compliance program. While not comprehensive, this list sheds light on the types of obligations hospitals must meet in order to mitigate their risk effectively: (i) written documentation, (ii) designation of a Chief Compliance Officer, (iii) education and training, (iv) a reporting hotline, (v) internal enforcement, (vi) internal compliance audits, and (vii) investigations and remediation.
What Are the Risks of Non-Compliance for Hospitals?
The risks of non-compliance for hospitals are substantial. Depending on the nature of (and reason for) a compliance failure, civil or criminal penalties could be on the table. This is true for all types of non-compliance, including billing and coding violations, Controlled Substances Act (CSA) violations, and data privacy violations, among others. In both civil and criminal enforcement actions, hospitals can face substantial financial penalties, while criminal enforcement actions can expose administrators, directors, and executives to the possibility of federal prison time.
When Can Hospitals Face Federal Billing Audits and Healthcare Fraud Investigations?
Hospitals can face federal billing audits and healthcare fraud investigations at any time. Medicare and Medicaid auditors (i.e., RACs, MACs, and UPICs) audit hospitals and other providers systematically without triggering events. Investigations can result from audits, whistleblower complaints, automated billing reviews, and a variety of other triggers. While understanding why your hospital is facing scrutiny is important, the most important thing is that you engage experienced defense counsel as soon as possible.
When Should I Engage a Hospital Lawyer for Defense?
You should engage a hospital lawyer for defense if you have any concerns about the potential outcomes of an audit, investigation, or lawsuit. Engaging defense counsel early will generally afford the greatest opportunity for a pre-charge or pre-trial resolution. If you have been contacted by auditors or investigators, or if you have been served with a search warrant, subpoena, or complaint, we encourage you to contact us immediately for a complimentary initial consultation.
Speak with a Senior Hospital Lawyer at Oberheiden P.C.
If you would like to know more about our compliance or defense services for hospitals in the U.S., we invite you to get in touch. To arrange a complimentary initial consultation with a senior hospital lawyer at Oberheiden P.C., please call 888-680-1745 or get in touch online today.
