Health Care Provider Counsel That Understands Your World And Industry

Whether you are an individual healthcare provider, institution, or provider group, you require and deserve legal counsel that knows your industry and how to best protect you. Too often healthcare providers spend valuable time away from their practice and responsibilities to “get legal counsel up to speed.” Part of being an effective legal counsel involves readiness on day one, to represent and protect your interests.

The Stratagem Law Group, PLLC, includes skilled professionals at the top of their professions from the legal and healthcare worlds: sometimes both. 

Health care compliance is all-encompassing, affecting the solo practitioner to the largest health system. The standards and expectations, validations, inquiries, and, for some, investigations are burdensome and extensive. For most, substantial resources are expended to ensure compliance and maintain oversight.

Whether your organization views health care compliance and ethics as overly burdensome and a distraction, as an opportunity to ensure quality and consistency, or somewhere in between, the reality is that it is here to stay and ever-expanding.

Stratagem Law Group, PLLC, provides the needed support for organizations to focus on their mission of patient-driven care delivery. We provide health care compliance program review, auditing and training that will continue to move your organization’s compliance program to mirror the excellence you provide inpatient care.

Helping You Develop Compliance Expertise

Health care providers and organizations have an obligation to provide their patients with the care they need. As specialists in inpatient care, these organizations are expected to be experts in care delivery. Federal rules require health organizations – and their board – to be involved in an effective compliance program.

Everyone in an organization is responsible for compliance. Compliance is derived from care delivery but is an expertise. The goal of compliance is to continue quality improvement; therefore, it is frequently changing.

Health Care Compliance Areas

Stratagem Law Group, PLLC, is skilled in providing proactive support for contracting, relationships, compliance, and most areas of operations and law for

• Physicians (MD, DO)
• Nurse Practitioners (NP, ARNP)
• Acute Care Centers (Hospitals, LTACH, FQHCs)
• Skilled Nursing Facilities (SNF, NH, CCRC)
• Home Health and Hospice
• Assisted Living (AL), Residential Care Centers (RCF), Adult Family Homes (AFH)

Support

“Effective” compliance program documentation and application to “federal sentencing guidelines”

• Written P&P
• Audits
• Response

Contractual relationships with vendors and providers

• Stark, AKS, FCA, promotional, third-party ventures considerations

Ongoing education, training and adaptation

Billing and coding compliance

• Accuracy
• Auditing

Response to and defense of alleged and suspected violations

• Investigation
• Remediation
• Disclosure
• Repayment (if applicable)
• Ongoing monitoring

The Cost Of Noncompliance

A finding of noncompliance from the federal government has potentially far-reaching consequences, including:

• Civil monetary penalty assessment
• Loss of reputation and community confidence
• Federal oversight and integrity agreement
• Exclusion from the Medicare and Medicaid program
• Criminal prosecution and imprisonment

Health care compliance is complicated. When enforcement agencies investigate noncompliance, the investigation will eventually become civil or criminal in nature.

Civil Fraud

In this track, the government agency makes a determination that health care fraud occurred; however, the fraud was not done deliberately or willfully, therefore falling short of justifying criminal prosecution.

Although the intent is the major component that sets civil and criminal prosecution apart, the term deliberate has landed otherwise nonintentional providers in the criminal defendant position.

The government expects providers to have a certain level of competence and understanding of what compliance is required of them when participating in the Medicare and Medicaid programs. As the adage goes, “ignorance of the law is no defense.”

Criminal Fraud

In a criminal prosecution, the government seeks to incarcerate the individual indicted. The range for health care fraud is from 0 to 10 years for each count. To place this detail in perspective, a count of health care fraud is one instance of fraudulent billing. For example, a surgeon is convicted for billing the Medicare program for surgeries he did not perform or were not necessary. Over the course of the period investigated, the court convicted on five instances or surgeries that did not occur but were billed. The surgeon is accountable up to 50 years in prison for the conviction.

What’s The Bottom Line?

The federal government indicts approximately 1500 physicians annually, maxing out its capacity. An ounce of prevention is worth a pound of cure. A provider’s management of their systems, responsible responses to government inquiries and handling of ongoing investigation can make all the difference between no findings or a criminal indictment.

We help providers position themselves in places of power before the investigation even arrives at their doorstep.

Contact Us

At Stratagem Law Group, PLLC, we provide innovative legal solutions for businesses in the health care industry. To find out how we can assist you, call our office at 888-472-1801 or use our convenient online contact form to set up an appointment with our attorneys.