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What to do in a Tricare Audit?

Categories: Criminal Law & Process

Federal Tricare Fraud Defense Attorneys - Oberheiden & McMurrey, LLP
Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
Direct: (214) 469-9009
Including Weekends

The federal government has dramatically increased the number of investigations against Tricare healthcare providers. The Tricare Pharmacy Program is administered by Express Scripts. Many Tricare providers such as physicians, pharmacies, compound pharmacies, and toxicology groups affected by these audits are confronted with an audit request for the first time and therefore may have questions for Tricare-experienced attorneys to avoid mistakes.

Significance of an Audit:

Many providers are currently being audited by Express Scripts due to rumors of collusion between healthcare marketing groups and compound pharmacies. While every audit is stressful, providers should not panic, nor should they respond to an audit too casually.

What Not to Do:

Depending on the particular circumstances of each case, some providers may feel uneasy about providing certified answers to Tricare audit questions without further thought. Put simply, not all questions are obvious to understand. Because of that ambiguity and the legal implications of the answers for future investigations, it is not advisable to simply answer a question in the hope that the answer is the “right” and “correct” one.

What to Do:

Instead of risking a mistake that can lead to follow up audits, in-person audits, or even governmental investigations, physicians should discuss and coordinate their answers with experienced Tricare attorneys. Doing so allows the physician and healthcare provider to complete the audit without having to worry about making a mistake.

Audit Question No 5 (Express Scripts):

Our experience has been that most audit questions center around records and documentation such as treatment protocols and patient records. One question, however, which is often the 5th question in Express Scripts’ standard audit protocol, asks physicians whether they have directly or indirectly benefited from their referrals made to compound pharmacies. This is a tricky question as the underlying purpose of that question is to inquire into violations of the federal anti-kickback and Stark Law statute. While no recommendations can be provided without knowing the details of the specific arrangement, physicians should use utmost caution before answering the question. Legal consultation may be appropriate.

Our Tricare Experience:

We are a healthcare fraud defense law 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 Tricare and other healthcare law proceedings.

Many of our attorneys have served the Department of Justice in critical healthcare law positions. Our governmental experience provides our clients valuable insights as to how, why, and when the government investigates healthcare fraud and what defense are generally accepted by federal decision-makers.

Our Tricare Clients:

Oberheiden & McMurrey, LLP is one of the preeminent law firms in the country when it comes to advising clients subject to a Tricare Audit or Tricare investigations. We have handled virtually every aspect of compound pharmacies. With several former federal healthcare prosecutors and experienced healthcare fraud defense attorneys on staff, clients from across the country hire our services to no longer worry about filling out Tricare audit questionnaires or being contacted by law enforcement. Among the many clients we have advised in Tricare matters are:

  • Compound Pharmacies (Across the U.S.)
  • CEO, Marketing Company
  • National Marketing Group
  • Regional Marketing Group
  • Physicians (TX, CO, CA, PA, NM and other states)
  • Toxicology Groups
  • DME Group

In terms of geographic regions, we receive calls from all parts of the United States such as Oregon, North Carolina, South Carolina, Texas, New Mexico, California, Colorado, New York, Arkansas, Alabama, and Mississippi, to name just a few.

Our Tricare Track Record:

  • Investigation against Healthcare Provider (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Provider (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.
  • Investigation against Healthcare Marketing Group (Tricare Fraud)
    Result: No civil or criminal liability, case dismissed.

Who We Are:

The attorneys of Oberheiden & McMurrey, LLP are former state and federal healthcare prosecutors and experienced healthcare fraud defense attorneys.

Nick Oberheiden

  • Managing Principal
  • Lead Defense Attorney in Healthcare Fraud Investigations
  • Significant OIG, FBI, DEA, DOL, and Tricare Fraud Experience

Lynette S. Byrd

  • Former Federal Prosecutor
  • Civil and Criminal Healthcare Investigations
  • Department of Justice, Texas

Free & Confidential Consultations:

Physicians and healthcare providers with questions regarding an Express Script audit or government investigation should speak with the experienced attorneys of Oberheiden & McMurrey, LLP. Former federal healthcare prosecutors and nationally recognized healthcare defense attorneys will answer your questions in a free and confidential consultation, also on weekends.

Oberheiden & McMurrey, LLP
National Criminal Defense
Former Federal Prosecutors and Experienced Defense Attorneys
(800) 810-0259
(214) 469-9009
www.federal-lawyer.com

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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