For in-house counsel whose background is more in line with how standard businesses are run and regulated, representing healthcare entities can be much more demanding and meticulous. Unlike many other industries and service providers, medical practices and healthcare facilities are under constant government scrutiny. The rules are complex. The policies are strict. The laws are unyielding.
And if there are any signs of healthcare fraud, waste, or abuse, a host of state and federal bureaus and private insurance carriers are at the ready to launch full-scale investigations. Any liability from these inquiries can result in harsh criminal penalties, along with civil fines and forfeitures that can add up to millions of dollars.
What can you, as general counsel for a healthcare venture, do when the DOJ and any of its counterparts — including the DEA, CMS, and state Medicare fraud control units — want to take a look under your healthcare entity’s hood?
You need a plan. And the first step to that plan is downloading our free eBook, In-House Counsel Guide to Government Healthcare Investigations: What Attorneys Need to Know About Response, Compliance, and Defense.
In this guide, we present an overview of the types of regulatory investigations that healthcare entities may have to face, and which state and federal bureaus are behind them. In addition, we present basic strategies for effectively responding to government inquiries, such as helming an internal investigation of your healthcare entity’s operations and developing a healthcare compliance program.
In your role as general counsel/in-house attorney for a healthcare or related entity, you are tasked with a variety of legal responsibilities. Many of these duties involve intricate, often exhaustive analysis of what a healthcare provider can and cannot do under the Anti-Kickback Statutes, Stark Laws, False Claims Act, and other protective healthcare fraud measures. The answers are not always clear-cut, and one wrong move before or during a government healthcare investigation can lead to severe penalties, including exclusion from Medicare/Medicaid.
The most effective way for in-house counsel to understand the specifics of government healthcare investigations, and how to address them, is through the healthcare attorneys who are engaged in the practice full time.
That is where our knowledge, experience, and broad skills in this sector of healthcare law make the difference.
Our In-House Counsel Guide to Government Healthcare Investigations is authored by Ronald W. Chapman II, chair of Chapman Law Group’s national, in-demand White Collar/Government Investigations practice group.
Ron’s insight into how the Department of Justice and other federal agencies — including the DEA, FBI, HHS, and FDA — deploy healthcare fraud actions make him one of the top healthcare-based criminal law attorneys in the U.S. His book of business is full of many court and motion victories for healthcare practitioners and entities charged with healthcare fraud and abuse.
More importantly, Ron regularly serves as defense counsel in federal healthcare investigations and uses unique strategies when leading corporate internal (or “shadow”) investigations.
It is this kind of acumen that will give you the grasp necessary to do right by your healthcare entity, should a governmental agency initiate a healthcare fraud investigation.
Chapman Law Group’s In-House Counsel Guide to Government Healthcare Investigations goes deep into the who and what of healthcare fraud inquiries, audits, and prevention measures. Among them:
There are several government bureaus that regulate, prosecute, and reprimand healthcare facilities that are found violating federal and state Anti-Kickback Statutes, Stark Laws, False Claims Act, and other healthcare fraud policies.
Our guide for healthcare general counsel goes over:
The consequences for healthcare practices and entities engaging in healthcare fraud are steep. Among those we cover in our government investigations guide for in-house counsel include:
The DOJ reports more than $31 billion in healthcare FCA judgments and settlements between 2009 and 2020, while several recent FCA settlements with pharmaceutical and medical device companies topped $1 billion each.
You don’t want the healthcare organization you represent to be included in these kinds of reports. Our In-House Counsel Guide to Government Healthcare Investigations gives you the know-how to prevent that.
The way government healthcare investigations work, a criminal investigation is usually underway long before the healthcare entity is even aware one is happening. As well, administrative cases often commence prior to a healthcare practice knowing that its claims and other data are being audited and mined for possible non-compliance or fraud. And what may begin as an administrative or civil matter could, as the case unfolds, progress to a criminal investigation.
You’ll learn in our In-House Counsel Guide to Government Healthcare Investigations about responding to:
In addition, in-house and general counsel for healthcare practices will have the necessary guidance for gathering, reviewing, producing, and preserving information, including:
It’s absolutely critical for a healthcare entity’s general counsel to make sure an internal investigation — also known as a parallel or “shadow” investigation — is happening once a government entity launches its own.
This will avail the corporate officers of the business judgment rule; because they will be looking into improper conduct and taking corrective action, they may obtain leniency in the event of enforcement.
But, more crucially, an internal investigation allows in-house counsel to gain detailed knowledge about the facts of the case in order to assess culpability — and to not rely on who or what the government is claiming is responsible.
Chapman Law Group’s In-House Counsel Guide to Government Healthcare Investigations will walk you through the necessary steps and standards, such as:
Every healthcare entity that takes Medicare, Medicaid, and third-party insurance carrier payments must self-monitor and self-report any improper payments, even if they are not fraudulent. This is a federal administrative requirement and, as in-house counsel for a healthcare venture, you will find yourself on the defense when investigations and prosecutions stem from such non-compliance.
But is there some way your healthcare practice entity can avoid investigations, audits, Qui Tam (whistleblower) cases, or hefty fines and criminal penalties from happening in the first place?
Yes — through an effective healthcare compliance program.
This proactive, pre-governmental investigation measure sets up the necessary structure for healthcare entities to, among other things:
And, when an effective healthcare compliance program is in place, agencies such as the OIG may reduce that healthcare organization’s culpability score, fines and penalties — or not even prosecute or impose penalties at all.
In our In-House Counsel Guide to Government Healthcare Investigations, we provide the steps that healthcare in-house counsel can take in building an effective healthcare compliance program for the entities they represent.
Our free eBook also includes helpful links to federal resources, publications, case law, and helpful articles related to federal healthcare investigations and compliance.
You don’t need to wait any longer for answers to how federal healthcare fraud, false claims, kickback, and self-referral (Stark Law) investigations happen — and how, as healthcare general counsel, you can work to address and even avoid them.
Simply sign up for our In-House Counsel Guide to Government Healthcare Investigations, and you’ll get instant access and downloadability to this invaluable manual.
Chapman Law Group’s attorneys have decades of experience in white collar/government investigations; healthcare fraud defense; healthcare compliance program building/consulting; and parallel/internal investigation management. With our guide, we will help you lead the way for your healthcare entity’s peace of mind.
Ronald W. Chapman II, LL.M.
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Chairperson of White Collar Defense & Government Investigations
Michigan Office
1441 W. Long Lake Road, Suite 310
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Phone: (248) 644-6326
Health providers are accused of COVID-19 false claims, telehealth fraud and kickbacks for medically unnecessary tests. Is your practice next?
In “Physician Guide to Basic Compliance Concepts,” Chapman Law Group’s national healthcare compliance attorneys cover how to spot and avoid healthcare fraud, handling investigations and audits, and keeping your staff in the right.
Chapman Law Group’s Ronald W. Chapman Sr. and Juan Santos hosted a CLE session on DOH, DEA, Medicaid at the Florida Pharmacy Association Law & Regulatory Conference in Sarasota.
The CDC Guidelines for prescribing controlled substances like opioids, and the DEA/DOJ investigations that follow, are putting physicians and their pain patients in a regulatory crunch.
OIG guidance requires that health care entities institute sufficient controls to prevent fraud waste and abuse. This includes receiving reports of suspected health care fraud,
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