Lynette Byrd
Lead Attorney Lynette Byrd

If you have been contacted by a company called Qlarant Integrity Solutions, this means that your practice’s Medicare or Medicaid billing history is under review. In order to avoid demands for recoupments and other penalties, you need to engage experienced legal representation promptly. At Oberheiden, P.C., our federal health care lawyers defend providers in Qlarant investigations and audits nationwide.

Qlarant Integrity Solutions (“Qlarant”) is a Maryland-based company that performs Medicare and Medicaid investigations and audits on behalf of the Centers for Medicare and Medicaid Services (CMS). In 2018, Qlarant was awarded contracts to serve as both an Investigations Medicare Drug Integrity Contractor (I-MEDIC) and a Unified Program Integrity Contractor (UPIC). In these roles, Qlarant investigates and audits health care providers’ billings under all Medicare and Medicaid programs on CMS’s behalf, and it has been granted the authority to impose substantial penalties for providers suspected of program billing fraud.

While Qlarant and CMS’s other “fee-for-service” contractors serve an important function by limiting fraud, waste, and abuse in the Medicare and Medicaid systems, Qlarant’s reviews can also lead to substantial unjustified liability. When investigators and auditors exceed the scope of their authority, and when they improperly apply the Medicare and Medicaid rules and regulations, it is innocent and law-abiding health care providers that face the consequences.

Experienced Health Care Fraud Defense Lawyers for Qlarant Investigations and Audits

At Oberheiden, P.C., our federal health care defense lawyers have extensive experience and a proven record of success protecting providers against penalties in Medicare and Medicaid matters. Our team includes former health care fraud investigators and prosecutors with the U.S. Department of Justice (DOJ) and other agencies, and together our attorneys and expert consultants bring centuries of combined experience to defending clients in Qlarant investigations and audits.

Qlarant’s website states: “The Qlarant investigation team consists of former federal law enforcement officers experienced in investigative techniques that successfully uncover fraud, waste, and abuse for prosecution. . . . With our expertise in law enforcement, our team can actively and authoritatively document and present cases . . . to law enforcement for criminal or civil action.” With our attorneys’ and expert consultants’ prior federal government experience, we can go toe-to-toe with Qlarant, and we can ensure that your health care practice is not unjustly penalized or prosecuted due to faulty allegations of Medicare or Medicaid fraud.

Our firm’s practice is nationwide in scope. As a result, we are able to defend health care providers in all jurisdictions under Qlarant’s authority. With regard to Medicare Parts C and D, this authority is nationwide. With regard to all other Medicare and Medicaid programs, Qlarant’s UPIC contract with CMS covers:

  • Alaska
  • American Samoa
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Guam
  • Hawaii
  • Idaho
  • Louisiana
  • Mariana Islands
  • Mississippi
  • Montana
  • Nevada
  • New Mexico
  • North Dakota
  • Oklahoma
  • Oregon
  • South Dakota
  • Texas
  • Utah
  • Washington
  • Wyoming

What is at Risk if Qlarant is Investigating or Auditing Your Health Care Practice?

As a CMS contractor, Qlarant has significant authority to impose penalties on health care providers that it determines have overbilled Medicare and Medicaid. In addition, it has the obligation to report health care providers to CMS and the DOJ when it uncovers evidence of fraud. As a result, while the direct consequences of an unfavorable investigation or audit result can be substantial, the indirect consequences – possible civil or criminal prosecution by the DOJ – can be far more severe.

In Qlarant investigations and audits, lack of intent is not a defense to liability. As a result, all health care providers need to be concerned about the potential for penalization, and all health care providers need to execute a strategic defense. Potential penalties in Medicare and Medicaid investigations and audits include:

  • Recoupment of overbilled amounts
  • Treble damages (three times the government’s losses)
  • Fines and costs
  • Denial of pending claims
  • Prepayment review of future claims
  • Loss of Medicare and Medicaid eligibility
  • Referral to CMS and the DOJ for civil or criminal prosecution

For many health care providers, an unfavorable audit determination or investigation result can have a snowballing effect: The DOJ may choose to conduct its own investigation (which can be far more invasive than a Qlarant investigation), and it may choose to pursue civil or criminal charges. Other federal agencies such as the Drug Enforcement Administration (DEA) may also choose to get involved, and this can put providers’ DEA registrations at risk. Furthermore, federal inquiries can also lead to disciplinary action by state licensing boards, and this means that providers’ medical licenses can be at risk as well.

With these risks in mind, health care providers that are being targeted by Qlarant must take prompt and proactive measures to prevent devastating results. With our experience, we can take action immediately to protect you and your practice against unnecessary consequences.

How Do We Protect Health Care Providers Against Qlarant Investigations and Audits?

Our approach to defending health care providers in Qlarant investigations and audits is aggressive, comprehensive, and decisive. We work quickly to stop improper practices in their tracks, and we rely on our team’s extensive experience to convince investigators and auditors that their assumptions and conclusions are misguided. Our attorneys and expert consultants diligently pursue favorable outcomes for our clients, and we do not stop working until we have achieved the results our clients expect and deserve.

When you engage Oberheiden, P.C. to handle your Qlarant investigation or audit, our team will:

1. Promptly Intervene in the Investigation or Audit

When dealing with Qlarant, it is important to get involved in the process as early as possible. Once you contact us, we will make intervening in your investigation or audit our top priority. We will quickly gather the information we need to make a strong first impression, and we will let the Qlarant personnel handling your investigation or audit know that we are prepared to vigorously dispute all fraud allegations against you and your practice.

2. Conduct a Confidential Internal Compliance Assessment

In parallel with dealing with Qlarant, we will conduct our own assessment of your practice’s Medicare and Medicaid billing records. The outcome of this assessment will be strictly confidential and subject to the attorney-client privilege. By determining what, if anything, Qlarant’s investigators and auditors will find before they find it, we can develop a proactive defense strategy that allows us to stay one step ahead.

3. Present All Available Defenses to Allegations of Medicare and/or Medicaid Billing Fraud

When Qlarant seeks to impose recoupments and other penalties based on allegations of Medicare and/or Medicaid billing fraud, we will utilize all available defenses to protect you and your practice against liability. This may include exposing improprieties and flaws in Qlarant’s practices, correcting improper interpretations of the Medicare and Medicaid billing regulations, and various other factual and legal defenses.

4. Protect You Against Other Health Care Fraud Allegations

In many cases, Qlarant will not solely target providers’ Medicare and Medicaid billing practices, but will also seek to impose penalties for violations of the Anti-Kickback Statute, Stark Law, and other federal health care fraud statutes. With our attorneys’ and expert consultants’ extensive experience on both sides of federal health care fraud cases, we can strategically and effectively defend against these types of allegations as well.

5. Help You Deal with Self-Disclosure and Any Other Legal Requirements

If your practice has inadvertently overbilled Medicare or Medicaid, then you may have an obligation to self-disclose the violation to CMS. However, dealing with self-disclosure can be complicated (and dangerous), and health care providers must be extremely careful when voluntarily providing information to CMS. That said, when self-disclosure is appropriate, proactively addressing the issue before Qlarant addresses it for you can be critical to mitigating or avoiding any potential civil or criminal liability.

6. Interface with CMS, the DOJ, and All Other Federal Agencies on Your Behalf

If it appears likely that Qlarant will refer your practice to CMS or the DOJ, or if there is a risk that the DEA or another federal agency will launch an investigation, our attorneys can begin interfacing with the authorities on your behalf in order to gain control of the situation. In addition to handling CMS contractor audits, we also have extensive experience in federal agency investigations, and we have resolved the vast majority of our clients’ cases without charges being filed.

7. Challenge the Outcome of Your Investigation or Audit if Necessary

Finally, in addition to representing clients during investigations and audits, we also handle Medicare and Medicaid appeals. There are multiple stages in the appellate process, and our attorneys can continue to pursue your case as long as necessary in order to achieve a just result. Our attorneys handle administrative appeals as well as appears in federal court.

Contact Us Now for a Free and Confidential Case Assessment

If you need to speak with an attorney about a Qlarant investigation or audit, we encourage you to contact us promptly for a confidential case assessment. To speak with a member of our federal health care fraud defense team as soon as possible, call 888-356-4634 or request an appointment online now.