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Oberheiden Attorneys

What Compound Pharmacies Should Do In A DOL Or Tricare Investigation

Categories: Compliance

Federal Compound Pharmacy Fraud Defense Attorneys - Oberheiden & McMurrey, LLP
Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
Direct: (214) 469-9009
1-800-810-0259
Open on Weekends

Almost no week goes by without publication of a new investigation against compound pharmacies. The focus of these investigations is the relationship between pharmacy executives, physicians, and marketing groups with respect to referrals of federally funded patients; in particular, the investigations focus on Tricare and patients paid for by the Department of Labor. Because liability for wrongdoing may includes severe civil penalties and even imprisonment, it is of critical importance to work with lawyers that have a proven track record of defending Tricare and DOL charges.

Multi-Level Investigations

Our experience in compound cases has been that the government pursues a multi-level investigative approach. On the one hand, physicians referring Department of Labor patients or Tricare patients for compound scripts receive audit requests from Express Scripts or other pharmacy programs. Part of the audit is an inquiry as to whether the audited physician has received any direct or indirect benefits from referring federal scripts. The request may cause physicians to disclose their relationship with marketing groups or compound pharmacies. Federal agents of the FBI and the DEA then approach marketers, distributors, and current or former pharmacy staff for interviews to learn about the compound pharmacies’ operations, business model, referral sources, and cash distribution concept. The purpose of the audit and investigation is ultimately to prosecute physicians, marketers, and compound pharmacy executives for illegal kickback schemes and healthcare fraud pursuant to 18 U.S.C. Sect. 1347 and similar federal criminal statutes.

Experience Required

The attorneys of Oberheiden & McMurrey, LLP have been on the forefront of building strong corporate and regulatory concepts for pharmacies and compound pharmacies. Similarly, when such concepts were not followed initially and investigations are announced, we have developed safety measures in anticipated or pending investigations to significantly reduce our clients’ exposure. Our experience in Tricare, DOL, and Medicare audits, specifically in the area of pharmacies and compound pharmacies, is profound and includes not just successful case resolutions but also decades of prosecuting these cases as former federal healthcare prosecutors. That said, as former prosecutors in critical governmental positions, we know exactly how the government builds these cases and what needs be done to efficiently defend affected clients. It is no surprise that physicians, healthcare executives, and healthcare businesses such as pharmacies, compound pharmacies, toxicology groups, hospitals, and physician syndications request our services to benefit from our experience and reputation.

Emergency Defense Package

Clients that engage us appreciate the high pace and honest passion with which we advise and defend our clients. We know that in order to avoid exposure for our clients, things need to happen quickly. Over the years, we have developed protocols that have proven to be successful to take on a case without wasting time. Among the many elements of our strategies and protocols is the “Emergency Defense Package” that has been featured by media stations across the country.

The “Emergency Defense Package” allows us to implement tools that can significantly and instantly catapult a client’s missing or ineffective regulatory and compliance paperwork to a business that is in full line and compliance with OIG and Department of Justice promoted training materials and business records.

In addition to concepts, training, and paperwork, we work closely with top professionals that are standing by to assist clients with their experience, credibility, and reputation:

  • Certified Fraud Examiners, CFE
  • Certified Public Accountants, CPA
  • Billing & Coding Professionals
  • Compliance Officers
  • Former DEA Agents
  • Former Pharmacy Board Enforcement Officers
  • Former FBI Supervisory Special Agents

Our Services

We are a healthcare fraud defense firm. Our attorneys are profoundly familiar with all nuances of healthcare law and have developed proven defense strategies to assist physicians, pharmacies, and marketing groups during Medicare, Tricare, DOL, and other healthcare law proceedings.

Many of our attorneys have served the Department of Justice in critical healthcare law positions. Lynette S. Byrd is a former federal prosecutor, who has handled False Claims Act, anti-kickback, Medicare Fraud, Tricare Fraud, DOL Fraud, and Stark Law violations as a Department of Justice attorney as well as subsequently at Oberheiden & McMurrey, LLP. This governmental experience provides our clients valuable insights as to how, why, and when the government conducts audits and what defenses are generally accepted by federal decision-makers.

Our Service Regions

Because finding attorneys familiar with all nuances of healthcare regulations, profound government experience, and outstanding defense strategies is difficult, clients approach us from literally all parts of the United States including:

  • San Francisco, CA
  • Los Angeles, CA
  • San Diego, CA
  • Portland, OR
  • Albuquerque, NM
  • New York, NY
  • Newark, NJ
  • Denver, CO
  • Colorado Springs, CO
  • Cheyenne, WY
  • Dallas, TX
  • Tyler, TX
  • San Antonio, TX
  • Houston, TX
  • Washington, DC
  • And many

Cases We Have Handled

Oberheiden & McMurrey, LLP is one of the preeminent law firms when it comes to building strategic and effective defenses for clients in expected or pending healthcare investigations. With several former federal healthcare prosecutors and experienced healthcare fraud defense attorneys on staff, clients from across the country hire our services to avoid or mitigate law enforcement encounters. Among the many clients we have advised in Tricare and DOL matters are:

  • Compound Pharmacies
  • CEO, Marketing Company
  • National Marketing Group
  • Regional Marketing Group
  • Individual Marketers
  • Physicians (TX, CO, CA, NM, NY, NJ, etc.)
  • Attorneys
  • Toxicology Groups
  • DME Groups

Recent Case Outcomes

  • Tricare Fraud Investigation against Laboratory (Department of Defense)
    Result: No civil or criminal liability, case dismissed.
  • Tricare Fraud Investigation against Laboratory (Department of Justice)
    Result: No civil or criminal liability, case dismissed.
  • Tricare Fraud Investigation against Laboratory (Department of Defense)
    Result: No civil or criminal liability, case dismissed.
  • Tricare Fraud Investigation against Marketing Group (Department of Defense)
    Result: No civil or criminal liability, case dismissed.
  • Tricare Fraud Investigation against Laboratory (Department of Defense)
    Result: No civil or criminal liability, case dismissed.
  • Medicaid Fraud Investigation against fmr. CEO (Attorney General)
    Result: No civil or criminal liability, case dismissed.
  • Medicare Fraud Investigation against Laboratory (OIG)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (OIG)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (S. Attorney’s Office)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against DME Company ( Health & Human Services)
    Result: No civil or criminal liability, case dismissed.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.

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