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Defense Strategies Healthcare Fraud

Fox Rothschild LLP

The Presumption of Innocence Podcast: Episode 53 - Diagnosis: Innocent – A Doctor’s Journey to Acquittal

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For six and a half years, Dr. Muhamad Aly Rifai, a physician from Easton, PA, lived in fear and anxiety that life as he knew it was over. A leader in telehealth psychiatric services since the early 2000s, Dr. Rifai was...more

Oberheiden P.C.

A Guide to Qui Tam Lawsuits for Whistleblowers

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One avenue for whistleblowers to take to report fraud against the government is to file a qui tam lawsuit under the federal False Claims Act. These lawsuits are complex because they have not two, but three parties to them –...more

Oberheiden P.C.

A Handy Guide for Healthcare Whistleblowers

Oberheiden P.C. on

The healthcare industry relies heavily on whistleblowers to bring fraudulent conduct and other forms of waste and abuse to the attention of regulators, law enforcement, and the public in general. If you have found signs of...more

American Conference Institute (ACI)

[Event] 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement - January 23rd - 24th, New York, NY

Hosted by American Conference Institute, the 11th Annual Advanced Forum on False Claims and Qui Tam Enforcement returns for another exciting year for lively discussions on FCA enforcement including the ramifications of two...more

Oberheiden P.C.

Ten Things You Should Do NOW if Your Medical License is at Risk

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As a doctor or other licensed medical professional, the prospect of losing your license to practice medicine can be overwhelming. But, to protect your license—and your career—to the fullest extent possible, you need to act...more

Oberheiden P.C.

Ten Things You Should Know if Your Clinical Laboratory is Under Investigation

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Similar to other types of healthcare entities, clinical laboratories have been facing enhanced scrutiny from federal authorities over the past couple of years. While this is due in part to fraud concerns related to COVID-19...more

Oberheiden P.C.

5 Keys to Effective Texas Medical Board Investigation Defense

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As a licensed physician in Texas, facing a Texas Medical Board (TMB) investigation can present significant risks. Depending on the allegations underlying the investigation, your medical license could be in jeopardy—and you...more

Oberheiden P.C.

Recent DOJ Consumer Protection Branch Cases Highlight the Branch’s Enforcement Priorities

Oberheiden P.C. on

The U.S. Department of Justice’s (DOJ) Consumer Protection Branch works with other branches and federal law enforcement agencies to investigate and prosecute civil and criminal violations of the nation’s consumer protection...more

Oberheiden P.C.

5 Keys to Successful Qlarant Audit Defense Strategies for Healthcare Providers

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Facing a Qlarant audit is a serious matter for healthcare providers and other entities that bill Medicare or Medicaid. While the Qlarant Foundation is a non-profit entity, Qlarant Integrity Solutions is a profit-driven entity...more

Oberheiden P.C.

10 Steps to Take When Accused of Healthcare Fraud in Detroit

Oberheiden P.C. on

Medical professionals, patients, and others can commit healthcare fraud by deceiving the healthcare system, such as providing medically unnecessary services, in order to get unauthorized benefits or payments. Facing...more

Oberheiden P.C.

5 Key Healthcare Audit Defense Strategies

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Nearly all healthcare providers will face an audit (if not multiple audits) during their careers. Federal agencies such as the U.S. Department of Health and Human Services (HHS) routinely audit healthcare providers for...more

Oberheiden P.C.

A Step-by-Step Guide to Dealing with Detroit Healthcare Fraud Charges

Oberheiden P.C. on

Over recent years, the federal government has shown an increased interest in bringing healthcare fraud prosecutions. In fact, in 2020 alone, the federal government opened 1,148 new criminal healthcare fraud investigations,...more

Oberheiden P.C.

6 Frequently Asked Questions with Lab Defense Attorney Nick Oberheiden

Oberheiden P.C. on

Clinical laboratories have come under increased scrutiny in the past few years, especially those that deal with COVID-19 testing or drug testing. These federal investigations can be surprising and confusing for lab...more

Oberheiden P.C.

Tips and Insights for Clinical Lab Compliance in 2025

Oberheiden P.C. on

The COVID-19 pandemic increased the business opportunities available to clinical labs, including molecular and respiratory labs. As the nation—and the world—struggled to develop adequate testing infrastructure, the federal...more

Oberheiden P.C.

Federal Government Targets Providers Administering Amniotic Injections

Oberheiden P.C. on

The federal government has recently made clear its intention to go after healthcare providers who provide amniotic injections to certain Medicare and Medicaid recipients. Over recent years, the federal government has...more

Oberheiden P.C.

Key Elements of an OIG Compliance Program That Respiratory and Clinical Labs Need to Know

Oberheiden P.C. on

Clinical laboratories such as respiratory and clinical labs that bill Medicare, Department of Health and Human Services (“DHHS”) programs, and other federal programs are subject to oversight by the Office of Inspector General...more

Oberheiden P.C.

Indicted on Healthcare Fraud Charges? 5 Things to Expect & 3 Potential Outcomes

Oberheiden P.C. on

The U.S. Department of Justice (DOJ) is cracking down on healthcare fraud, and many providers are finding themselves facing serious allegations. This includes criminal allegations in many cases. If these allegations lead to a...more

Oberheiden P.C.

UPIC and ZPIC Audits Defense: What Healthcare Providers Need to Know

Oberheiden P.C. on

Zone Program Integrity Contractors (ZPICs) and Unified Program Integrity Contractors (UPICs) are federal contractors who work under the direction of the Centers for Medicare and Medicaid Services (CMS) to uncover fraudulent...more

Oberheiden P.C.

5 Defense Strategies for MAC/RAC Audits in 2025

Oberheiden P.C. on

Medicare pays billions of dollars in fraudulently billed claims each year. To recoup as many fraudulent reimbursements as possible, the Centers for Medicare and Medicaid Services (CMS) relies on various enforcement...more

American Conference Institute (ACI)

[Virtual Event] 8th Annual Advanced Forum on False Claims and Qui Tam Enforcement - March 24th - 25th, 8:15 am - 4:45 pm...

THE ONLY EVENT WHERE YOU'LL HEAR FROM Government, In-house Counsel, The Judiciary, the Defense & Relator’s Bar - ACI’s 8th Annual Advanced Forum on False Claims and Qui Tam Enforcement will address the underlying...more

Oberheiden P.C.

Is Your Medical License at Risk? What Doctors Need to Know about ALJ Hearings

Oberheiden P.C. on

As a doctor, allegations of medical malpractice or other unlawful or unethical conduct can have wide-ranging implications. In addition to facing civil liability and the prospect of a significant increase in your medical...more

American Conference Institute (ACI)

[Virtual Event] 11th Annual Advanced Forum on Managed Care Disputes and Litigation - July 22nd-23rd

ACI’s 11th Annual Advanced Forum on Managed Care Disputes and Litigation will be offered in a virtual format this year to help you make sense of these developments, and their profound impact for managed care....more

American Conference Institute (ACI)

[Event] False Claims and Qui Tam Enforcement Forum – Strategies to Respond to the Rapidly Changing Landscape of False Claims Act...

With more than 34.8 billion recovered by the government since 2010 under the federal False Claims Act, it has never been more crucial for private practitioners and corporate in-house counsel to keep abreast of the changes and...more

Baker Donelson

Disagreements over a Medical Judgment Cannot Form the Basis for Liability Under the False Claims Act

Baker Donelson on

A new federal court decision offers a ray of light to those providers defending false claims actions based on an alleged lack of medical necessity. On September 9, 2019, the United States Court of Appeals for the Eleventh...more

Sheppard Mullin Richter & Hampton LLP

The Eleventh Circuit Remands AseraCare, But Affirms High Hurdle for Proving Falsity

In a highly anticipated opinion in the AseraCare case, issued on September 9, 2019, the Eleventh Circuit Court of Appeals affirmed the district court’s holding that “a clinical judgment of terminal illness warranting hospice...more

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