51 JFK Parkway, Short Hills, NJ 07078
← The Attorneys / Brian O'Loughlin
Brian O'Loughlin, Of Counsel, Health Law Alliance
Of Counsel
Health Law Alliance · Medicare, Medicaid & UPIC Audits

Brian
O'Loughlin

Former State Prosecutor · Qlarant Fraud Investigator · Registered Nurse
Practice
Medicare, Medicaid, and UPIC audit demands, fraud, waste and abuse (FWA) investigations, administrative hearings, civil and criminal enforcement matters, and related regulatory proceedings
Audit Contractor
Former healthcare fraud investigator for Qlarant, CMS's largest Unified Program Integrity Contractor (UPIC)
Government
State Deputy Attorney General · investigated and prosecuted public corruption and other white-collar frauds
Clinical
Registered nurse, active New York Registered Nurse license · Emergency Departments and Intensive Care Units · Quality Assurance/Improvement and Program Auditor roles
Education
Duquesne University School of Law · Adelphi University, B.S.
Qlarant
CMS's Largest UPIC
Former healthcare fraud investigator for Qlarant, CMS's largest Unified Program Integrity Contractor.
State Deputy AG
Former State Prosecutor
Responsible for investigating and prosecuting public corruption and other white-collar frauds.
Registered Nurse
Active NY License
Emergency Departments and Intensive Care Units, then Quality Assurance/Improvement and Program Auditor roles.
Duquesne Law
Juris Doctor
Duquesne University School of Law. Adelphi University, B.S.

Brian is the attorney who has been on all sides of the healthcare audit and investigative process. As a former healthcare fraud investigator for Qlarant, Brian used to put together UPIC Medicare and Medicaid investigations. Now Brian, who is also a registered nurse and former state prosecutor, takes those cases apart for clients.

Brian's experience as a former healthcare fraud investigator for Qlarant, CMS's largest Unified Program Integrity Contractor (UPIC), state Deputy Attorney General, and registered healthcare provider, gives clients unmatched perspective and experience in defending Medicare, Medicaid, and UPIC audit demands, fraud, waste and abuse (FWA) investigations, administrative hearings, civil and criminal enforcement matters, and related regulatory proceedings. Brian knows how to defend these cases because he used to build them for federal and state governments.

Inside the UPIC

As a Qlarant healthcare fraud investigator, Brian assembled and referred cases involving hundreds of millions of dollars in Medicare and Medicaid billing to CMS, HHS-OIG, and federal law enforcement. Brian also oversaw Qlarant's investigative pipeline and processes, including audits, document demands, investigative interviews, data mining and analytics, and statistical modeling. Whether it be Qlarant, or another UPIC like SafeGuard Services or CoventBridge, Brian has the inside knowledge and experience necessary to neutralize these inquiries at an early stage, before risks grow.

Clinical practice, not just the billing record

Brian also knows and understands the clinical practice of medicine and still maintains an active New York Registered Nurse license. Prior to law school, Brian worked in Emergency Departments and Intensive Care Units before transitioning into Quality Assurance/Improvement and Program Auditor roles. These roles provide critical insights on understanding medical necessity, documentation sufficiency, and underlying clinical rationale in ways that an auditor's clinical review rarely captures.

State prosecution

As a state prosecutor, Brian was responsible for investigating and prosecuting public corruption and other white-collar frauds. Health Law Alliance is built by former prosecutors, and enforcement pressure now runs through federal and state channels alike, with Medicaid administered at the state level. Brian's Deputy Attorney General experience sits directly on that track.

Pedigree
Experience on the other side of the audit
Hundreds
of Millions
In Medicare and Medicaid billing assembled and referred to CMS, HHS-OIG, and federal law enforcement as a Qlarant investigator.
3 UPICs
Inside knowledge of the contractors that run these audits - Qlarant, SafeGuard Services, and CoventBridge.
Active
RN
New York Registered Nurse license - Emergency Departments, Intensive Care Units, then Quality Assurance and Program Auditor roles.
Credentials
Education & Experience

Education

Duquesne University School of Law
Juris Doctor
Adelphi University
B.S.

Licensure & Experience

  • Active New York Registered Nurse license
  • Healthcare fraud investigator - Qlarant, CMS's largest Unified Program Integrity Contractor (UPIC)
  • State Deputy Attorney General - public corruption and white-collar fraud
  • Emergency Department and Intensive Care Unit clinical practice
  • Quality Assurance/Improvement and Program Auditor roles
  • Featured as a Qlarant healthcare fraud investigator by HireMilitary
What Brian Handles
Practice areas

Matters Brian personally leads - drawing on his UPIC investigator, state prosecutor, and clinical background.

Speak with Brian

Request a confidential consultation

Consultations are confidential and protected by attorney-client privilege. Our team responds within one business day - often sooner when time is of the essence.