Tag Archives: Medicare compliance

Insulating your healthcare practice from fraud takedowns

Takedowns are a practice used by federal prosecutors to send a deterrent message to certain industries where the incidence of fraud and criminal activity may be widespread. When federal law enforcement conducts takedowns, they work with law enforcement nationwide and execute the takedowns at the same time. When these takedowns occur simultaneously, there is little warning before an investigator contacts individuals suspected or reported to be engaged in illegal conduct. The healthcare industry is a focus of federal investigators following tips on Medicare fraud. From over billing to treating non-existent or non-qualified patients, Medicare fraud is a compelling problem and task forces are organized and specialized in investigating claims and preparing for nationwide takedowns. Some in the industry predict, based on an increase in enforcement activity, that the Chicago area could be a target for takedowns during the summer of 2017.

The opportunity to insulate your healthcare practice from civil and criminal liability

Awareness of the focus on healthcare fraud leads to an opportunity for healthcare administrators and professionals to review their practices, the trends in fraud, and make any changes to the organization to prevent being targeted in enforcement investigations.

The resources used in using healthcare lawyers to perform health-care fraud and compliance audits are well allocated when the alternative significant civil and criminal fines and penalties could be assessed against your healthcare organization if an investigation leads to adverse findings.

Your healthcare attorney can audit your healthcare systems and help you maintain compliance with federal laws and regulations. Everyone in your administration should be aware of compliance and anti-fraud measures. Being able to demonstrate this preventative practice may be essential in the event of an investigation.

What happens if an investigator visits you and informs you of inquiry

How your hospital or medical practice responds to an initial inquiry of an investigator is imperative. Ahead of time, you should know a healthcare attorney you can contact immediately and you should be aware of how they will advise and represent you if necessary. Even if you believe that your practice is compliant and not in any risk, it is not a good idea to represent yourself without a lawyer when visiting with and responding to investigators.

Your attorney may help satisfy the investigators concerns uniquely, where they know what kind of questions they may ask and how to best communicate your compliance and anti-fraud efforts.

If an investigator contacts you it is important to be polite and offer to assist and comply with their requests. You may ask them for contact information you will give to your attorney to also assist. You do not need to answer any of their questions without your lawyer present. A professional investigator will be accustomed to the request for legal counsel and you should not worry about that looking like any suggestion or admission of wrongdoing or guilt.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

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Favia will work with the firm’s members in the Chicago office and nationwide on professional licensing matters.

Dedicated Medicare Compliance Practice: The QPWB Advantage, Michael V. Favia, Of Counsel

Michael V. Favia and Michael V. Favia & Associates, P.C., are Of Counsel to Quintairos, Prieto, Wood & Boyer, P.A. (QPWB), the full-service business law firm with offices located in several U.S. states and overseas.[i] QPWB maintains a Dedicated Medicare Compliance Group and works with insurance carriers in connection with direct and indirect claims involving Medicare reimbursement. Because attorney Favia and the firm are Of Counsel to QPWB, the firm has access to the benefits of this advanced compliance practice group.

There are a variety of services QPWBs compliance group can offer to self-insured companies and insurance carriers with worker’s compensation and liability claims. How and when to pay claims and submit reimbursements to Medicare can be daunting when mistakes can result in bad faith claims and unanticipated economic losses.

The QPWB Dedicated Medicare Compliance Group can assume a variety of responsibilities for insurance clients, including without limitation, claim investigation, conditional payment negotiation, and funding submissions where future medical expenses are certain or likely. Because every client and claim is unique, the QPWB group uses a proprietary system to properly assess and manage each and every claim.

“The QPWB Advantage:

  • We address each claim on its own merits and not in a cookie cutter manner;
  • As attorneys, we act as advocates on behalf of our clients focusing on every factual, legal and medical argument to help develop strategies to reduce exposure;
  • We make realistic recommendations so that clients can make informed decisions and work towards understanding and resolving compliance issues in the most economical fashion;
  • The firm provides attorneys with decades of experience in counseling self-insured and insurance clients;
  • Decades of experience meeting with opposing parties and attending Administrative and Judicial pre-trials to address compliance issues.
  • We provide individualized attention to the needs of our clients, from the smallest matter to the largest.[ii]

In addition to direct claim management, QPWB works with external vendors and attorneys focused on primary payer issues, cost projections, medical arguments and claim settlements.

For more information about direct and indirect insurance claims and Medicare compliance, please contact Michael V. Favia & Associates, P.C.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

[i] QPWB office locations are located in Arizona, California, Florida, Georgia, Illinois, Michigan, New York, Texas, and in the U.S. Virgin Islands.

[ii] See QPWB’s website for more information about the Dedicated Medicare Compliance Practice.