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Are You Facing a Tricare Audit?

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The federal government is cracking down on Tricare fraud, regularly auditing healthcare providers for signs of possible collusion or other forms of illegal activity. Tricare providers such as physicians, pharmacies, compound pharmacies, and toxicology groups are all facing audits by Express Scripts, which administers the Tricare Pharmacy Program. In particular, many providers are currently being audited, 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. To protect themselves and avoid costly mistakes, when confronted with an audit request for the first time, many providers seek the help of a Tricare-experienced healthcare attorney.   

What Not to Do if You are Facing an Audit

Due to the legal implications of responding to a Tricare audit and the potential for further investigations, providers should not “try to be helpful” by providing information that the audit might not actually be requesting. Express Scripts’ audit questions can be confusing, and it is not advisable to try to provide what you think are the “right” or “correct” answers.

What to Do if You are Being Audited by Express Scripts

Instead of risking a mistake that can lead to follow-up audits, in-person audits, or even governmental investigations, Tricare providers should work with experienced Tricare attorneys to make sure that they are responding to their audits appropriately. An experienced Tricare attorney will be able to help you complete the audit without making costly mistakes.

Audit Question No. 5 (Express Scripts)

While most of Express Scripts’ Tricare audit questions focus on records and documentation, one question – 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. The purpose of this question is to uncover possible violations of the federal anti-kickback statute and the Stark Law, which governs physician referrals.

This is a complicated (and potentially dangerous) area, and physicians need to be extremely careful to avoid raising unnecessary suspicion. As a result, it is best to hire an attorney to help you understand the implications involved and craft an appropriate response.

Our Tricare Experience

Oberheiden, P.C. is a healthcare fraud defense law firm. All of our attorneys are intimately familiar with all nuances of healthcare law and have developed proven defense strategies to assist healthcare providers and marketing groups during Tricare and other healthcare audits and investigations.

Many of our attorneys served the Department of Justice in critical healthcare law positions prior to joining Oberheiden, P.C.

Our Tricare Clients

Oberheiden, P.C. is one of the country’s preeminent law firms in the area of Tricare audits and investigations. We advise clients across the country in Tricare-related matters. Some examples of our Tricare clients include:

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

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.

About Our Attorneys

The attorneys of Oberheiden, P.C. are former state and federal healthcare prosecutors and experienced healthcare fraud defense attorneys. Click the links below to learn more:

  • Managing Principal
    • Lead Defense Attorney in Healthcare Fraud Investigations
    • Significant OIG, FBI, DEA, DOL, and Tricare Fraud Experience
  • Former Federal Prosecutor
  • Civil and Criminal Healthcare Investigations
    • Department of Justice, Texas

Schedule a Free Consultation About Your Tricare Audit

Physicians and other healthcare providers with questions regarding an Express Scripts audit or government investigation involving Tricare should speak with an experienced attorney as soon as possible. At Oberheiden, P.C., our former federal healthcare prosecutors and nationally recognized healthcare defense attorneys provide free, confidential consultations to providers nationwide. To speak with one of our attorneys about your Tricare audit, call (800) 701-7249 or contact us online today. Weekend appointments are available.

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, P.C. is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503