Compliance Audits and Civil Investigative Defense

In the healthcare industry, the word “compliance” is a big one -- it carries much legal significance. Generally speaking, in healthcare context the word alludes to a maze of numerous regulatory requirements that govern how health care must be provided and compensated.  Healthcare compliance encompasses the essential need to adhere to rules, regulations, and laws that relate to healthcare delivery practices, which tend to change over time. Every healthcare provider -- big or small -- should be mindful of this need for “compliance” and have a compliance program and/or written compliance policies and strictly adhere to them.  A failure to do so may invite large problems.

Unfortunately, compliance requirements for healthcare providers are complex and not always clear in how they apply to some facts. All “compliance” laws are important.  And some (e.g., federal self-referral laws, such as Stark and the Anti-kickback statute) can bear very serious adverse consequences if violated.

Health Law Compliance Attorneys

As our health law practice focuses on protecting and advancing the best interests of medical providers, we encounter a variety of compliance-related matters that affect our clients.  The legal issues raised by particular facts in compliance matters can vary. For example, compliance laws and circumstances include:

• HIPAA/HITECH privacy/security and meaningful use rules
• HIPAA compliance audits
• False Claims Act, Stark, and the Anti-kickback statue and associated regulations
• State self-referral laws
• Fraud and abuse investigations
• Medicare Access and CHIP Reauthorization Act
• Medicare billing rules 
• Compliance plans and compliance officers
• Auditing and monitoring

The Good News

For healthcare providers, compliance should not be a bad word, however. Rather, compliance can be an opportunity to stand out from the competition and ideally to properly and safely provide great health care services. The starting point is awareness of the need and a commitment to proactively addressing compliance as a first priority.  As with many legal issues, prevention and avoidance of a problem is typically much easier and far less expensive than responding to a legal problem that might have been avoided in the first place.

Compliance is Not Optional

Fraud enforcement, in particular, has continued to grow in recent years, for good reason.  The examples of bad healthcare that may expose patients to serious health risks and the abuse of perceived reimbursement opportunities are many.  The federal government has a strong anti-fraud agenda and has increasingly sought criminal prosecution for healthcare noncompliance infractions. Federal law enforcement activities in this area of law are widespread and can involve pursuing providers and professionals civilly and/or criminally for a variety of potential fraud and abuse activities, including, for example: providing and billing Medicare for substandard care and “worthless services”; billing Medicare with the absence of medical necessity; upcoding to enhance reimbursement; violating HIPAA rules; hospital-physician relationships that create Stark and AKS violations; and misconduct involving opioids. If you believe there are compliance issues in your healthcare services business, it is important that you promptly speak with your lawyer about the circumstances.

We are available. 

Hamil Little’s compliance and fraud defense attorneys focus on protecting medical practices, physicians, hospitals and other healthcare businesses. Our staff will arrange a time for you to speak with one of our attorneys about your legal needs. Contact us at info@hamillittle.com to schedule a confidential consultation.

DISCLAIMER: Any result this law firm or any lawyer of this law firm may achieve on behalf of one client in one matter does not necessarily indicate similar results can be obtained for other clients.