HOUSTON, TX, January 03, 2014 /24-7PressRelease/
-- In recent years, an increasing number of health care providers in Texas and throughout the U.S. have faced investigations for suspected Medicare or Medicaid fraud. Late in 2012, the federal Department of Health and Human Services Office of Inspector General (OIG) projected that it would recover about $6.9 billion from audits and investigations for the year.
Fraud and abuse investigations
can be extremely costly and time-consuming for a health care entity. In addition to fines and other penalties, organizations may lose their ability to participate in Medicare and Medicaid programs. Health care entities can reduce the chances of an OIG investigation and related fines and penalties by developing and following a compliance plan.
What Do Compliance Plans Include?
A compliance plan
typically requires a health care practitioner or organization to follow a set of obligations designed to prevent and uncover questionable billing practices and other illegal practices. Health care organizations can voluntarily create compliance agreements to reduce the likelihood of billing issues or other problems.
Compliance plans are often similar to corporate integrity agreements. After an investigation, the OIG may require a health care organization to create a corporate integrity agreement in exchange for not excluding the entity from Medicare or Medicaid. However, health care organizations should consider voluntarily implementing a corporate integrity policy long before the OIG begins an investigation.
Compliance plans and corporate integrity agreements typically include:
- Hiring a compliance officer or appointing a compliance committee
- Establishing a confidential disclosure program
- Implementing a comprehensive employee training program
- Developing written compliance policies
- Reporting overpayments and other investigations and legal proceedings
- Obtaining annual reviews by an independent review organization
- Reporting on compliance activities annually
A voluntary compliance agreement can be used to uncover billing issues, improper business relationships, fraud and abuse, and other problems at a health care facility or practice. Through a compliance program, health care entities can avoid or reduce the risk of violations of the Stark law, the False Claims Act
and other laws. They may be able to reduce the risk of an OIG investigation and a forced corporate integrity agreement or other sanctions.
Following A Compliance Plan Or Corporate Integrity Agreement
To create a compliance plan, an experienced health care attorney will evaluate your type of practice, concerns about the practice, relationships with third parties, office leases and other potential areas of concern and will create a compliance program that allows your organization to detect problems. Corporate integrity agreements are created using many of the same steps.
Once a plan is written, compliance and implementation becomes the next step. These voluntary agreements are intended to be permanent and when followed, they can continue to detect and resolve problems. By implementing and following a compliance policy, you may be able to avoid or reduce the risk of an OIG investigation.
If the OIG does begin an investigation, legal representation is critical to protecting your health care organization. If the OIG finds that an organization violated the Stark law, False Claims Act or other laws, it could issue sanctions or impose a corporate integrity agreement on the organization. Following a corporate integrity agreement can be time-consuming and expensive.
An experienced lawyer can represent the organization through the entire OIG investigation, including negotiating a corporate integrity agreement. An attorney may be able to negotiate an agreement that will be less burdensome for the health care organization, advise your organization on compliance and help protect the business in other ways.
Protect Yourself With Experienced Legal Counsel
To learn more about whether your organization could benefit from a compliance plan or to find out how to protect yourself during an OIG investigation, contact a lawyer with experience in regulatory compliance in the health care industry.
The attorneys at Kerr, Hendershot & Cannon, P.C., provide legal advice and representation to a wide range of medical professionals and health care entities in Houston and throughout Texas. To learn more about the firm, visit www.k-hpc.com