Buffalo Healthcare & Physician Defense Lawyer

A Buffalo Physician Defense Lawyer for Doctors Whose License or Revenue Is Under Review

When your license, revenue, or hospital standing is under review, your initial written response is critical. You need clear guidance on what to provide (and what to withhold) before your response deadline.

Weiss Zarett Brofman Sonnenklar & Levy, P.C. defends Buffalo doctors and practice owners against regulatory and insurer reviews. Reach out today to share your notice safely and plan your defense.

What an OPMC Complaint or Payor Audit Can Cost a Buffalo Medical Practice

Under New York Public Health Law § 230, the Office of Professional Medical Conduct must investigate every complaint it receives, whatever the source. A patient, a colleague, a hospital, or an insurer can start that process, and you rarely control the timing. If the board finds misconduct, the penalties listed in Public Health Law § 230-a run from censure and reprimand to suspension, fines, and revocation of your license. In some serious cases, the Health Commissioner can order a doctor to stop practicing before a hearing takes place. Formal charges and discipline appear on the Department of Health physician lookup, where hospitals, payors, and patients can find them.

Money disputes move on a separate track. A commercial plan can hold your payments while it audits, and federal healthcare fraud inquiries in Western New York often involve the U.S. Attorney’s Office for the Western District of New York at 138 Delaware Avenue in downtown Buffalo, which covers Erie County and 16 other counties. How many weeks can your practice cover payroll with its insurance payments frozen? A prepared, documented response early in the process can narrow what the other side pursues, and that first response is where we start.

This information reflects New York law as of September 2026.

Healthcare Matters We Handle for Buffalo Doctors and Practice Owners

Most physicians who contact us are dealing with one of these, and some are dealing with two at once:

• OPMC investigations: Letters, interview requests, and records demands from the Office of Professional Medical Conduct, handled early, with the goal of closing the matter before any formal charges.
• Medicare and Medicaid audits: Overpayment demands, prepayment reviews, and appeals on claims paid by government programs.
• Commercial payor audits: Anthem, Cigna, and other plan audits, clawback demands, and payment holds that stall your cash flow.
• Federal healthcare fraud investigations: Subpoenas and inquiries from federal prosecutors, including settlement talks and corporate integrity agreements.
• Hospital privileges disputes: Restrictions, suspensions, and medical staff hearings that limit where you can practice.
• Workers’ Compensation provider authorization: Denied renewals and enrollment problems before the New York Workers’ Compensation Board.

If your matter is not on this list, tell us what the letter says and we will tell you whether it falls within our practice.

What Buffalo Physicians Should Do in the First 48 Hours After an OPMC Letter?

The first 2 days after the letter arrives are when the most avoidable mistakes happen. Four steps protect your position while we review the file:

• Hold off on calling the investigator back: Anything you say in an informal call can end up in the file, and it is hard to walk back later.
• Leave your records exactly as they are: Do not edit, add to, or back-date any chart. A late change can turn a single complaint into a second allegation.
• Write down the response date and every item requested: Knowing exactly what OPMC asked for keeps you from sending more than you need to.
• Check your malpractice policy: Some policies include coverage for licensing defense, which can offset what you pay out of pocket.

Questions Buffalo Doctors Ask a Healthcare Lawyer Before They Respond

Can a New Hyde Park firm represent a physician in Buffalo?

Yes. OPMC is a statewide program run from the Department of Health in Albany, so your matter does not depend on where our office sits. We serve clients throughout New York, New Jersey and Pennsylvania.

Will an OPMC investigation become public?

Usually not. By law, OPMC keeps its investigation files confidential. If OPMC files formal charges, the charges and any final discipline appear on the Department of Health physician lookup. That is why the response at the investigation stage matters so much.

What happens if an insurer freezes my payments during an audit?

We review the plan’s billing guidelines and the documentation behind the claims, then negotiate directly with the plan. In one matter, that approach reversed a payment hold and let the practice keep treating its patients.

Is a federal investigation in Buffalo different from an OPMC review?

Yes. OPMC looks at your license, while federal prosecutors in Buffalo look at billing and possible fraud, and the two can run at the same time. Partner Mathew J. Levy has negotiated settlements with the U.S. Attorney’s Office, including corporate integrity agreements.

How long does an OPMC investigation take?

Timelines vary with the complaint, the records involved, and whether OPMC requests an interview. We can give you a realistic estimate once we see the letter and your file.

If one of these questions describes where you are right now, reach out through our contact form to schedule a consultation.

Talk to a Buffalo Healthcare Attorney Before Your Response Date

Don’t leave your license or practice to guesswork. Reach out today for a confidential review of your case, and we’ll work together on the next steps.