As robust as the medical profession in Detroit and around Metro Detroit is, the diversity and density of its populations make it one of the top five regions in the U.S. for healthcare fraud. It is identified by federal, state, and commercial payors as hot spots for healthcare transactions and services that do not adhere to laws and regulations.
Detroit has one of the highest rates of federal healthcare fraud indictments in the country — so much so that, since 2010, the U.S. Department of Justice (“DOJ”) has operated a Detroit-specific “strike force” to prosecute healthcare fraud in and around Metro Detroit.
Some providers are billing for items or services not rendered or not provided as claimed, double-billing, or misusing provider identification numbers, resulting in improper billing. Others are submitting claims for equipment, medical supplies, and services that are not reasonable or necessary.
In recent months, federal agencies have gone after several healthcare fraud schemes:
It’s not just the feds who have a vested interested. The State of Michigan runs a Health Care Fraud Division (HFCD) to identify, prosecute, and prevent fraudulent activity by doctors, dentists, pharmacists, and other healthcare providers participating in the Medicaid program. Since its inception, the HCFD has obtained criminal restitution orders totaling nearly $19.5 million and civil judgments at more than $407 million. In total, the HCFD has obtained court orders and settlements requiring the return of over $426 million to the Medicaid program.
Is your Detroit- or Metro Detroit-based healthcare practice, durable medical equipment manufacturer, telemedicine company, or specialty healthcare clinic susceptible of being targeted next?
Then you need to call the national healthcare compliance attorneys at Chapman Law Group immediately. But first, you need to understand why healthcare compliance is needed for your practice in the first place.
Healthcare compliance is a system of processes, policies, and training that conform to state and federal laws and regulations that dictate the delivery of healthcare services and supplies.
All healthcare providers that bill Medicare, Medicaid, and/or commercial insurers are required to provide comprehensive and compliant claims for all services rendered and for all supplies/pharmaceuticals used in the delivery of patient care.
Using state-of-the-art observation techniques, comprehensive data analytics, and auditing, federal and state investigators are savvy at identifying healthcare providers that file false claims under Medicare, Medicaid, or private insurance.
And the penalties for non-compliant claims are severe:
With an effectual compliance program in place, healthcare practices take a proactive measure toward regulatory and legal adherence.
A compliance plan protects healthcare professionals and medical practices from administrative, civil, and criminal penalties imposed by federal and state governments, as well as from payment reviews and network exclusions.
When a plan is place, everyone at the healthcare practice will know how to identify and correct improper claims through a custom auditing and monitoring procedure. With employees responding to suspected issues in a timely manner by following the compliance plan, that healthcare organization may prevent a formal investigation from ever happening at all.
And, should a private insurer or government agency investigate and prosecute healthcare fraud, having a comprehensive compliance program prior to the offense will reduce that healthcare practice’s culpability score, fines, and penalties.
As lawyers whose sole client base is the healthcare profession, we at Chapman Law Group represent healthcare providers, medical suppliers, and related facilities against claims of conducting the business of healthcare operations in a non-compliant manner.
With our strong background in healthcare regulatory strategies and audit process representation, we know how to best prepare an appropriate defense to any allegations of non-compliance by government regulators or commercial insurers.
Our healthcare compliance lawyers have a unique understanding of the Detroit healthcare market. We are well-versed in compliance-related laws and regulations that can prevent an organization or provider from caring for a particular population of patients — or operating at all.
We work to establish, assess, and update a healthcare practice’s compliance program. These plans assist in identifying and preventing erroneous and fraudulent claims, eliminate billing mistakes, reduce the chance of a payor audit — and, most of all, serve as a proactive measure toward regulatory and legal adherence.
Additionally, the national attorneys at Chapman Law Group help startup and existing healthcare providers, suppliers, and facilities identify regulations, laws, and risks — all of which could affect a healthcare provider’s business before the doors are first opened.
Chapman Law Group’s legal experience and industry partnerships make us an excellent provider of Medicare and Medicaid compliance services. Our medical compliance attorneys work to find your claim weaknesses and correct them before Medicare/Medicaid discover the problems.
We are skilled at assisting clients with the highest risk area identified by the OIG: claims coding and billing. We can help you with claims compliance by prospectively addressing billing issues, whether related to missing charges, unstated procedures, inaccurate and non-compliant charging, or National Correct Coding Initiatives (NCCI).
Chapman Law Group helps to make sure that medical practices, through appropriate coding and claims submissions, do not run afoul of the five main federal fraud and abuse laws:
Chapman Law Group’s analysis of your charges/claims will pinpoint erroneous charges and identify whether non-compliant charging practices exist. Because of this rigorous process, we can review documentation relative to charges posted, provide real-time feedback to clinical staff, and work to correct documentation.
Our multidisciplinary healthcare compliance team is made up of highly skilled lawyers. One of our lawyers is a former HHS/Medicare attorney, while another is a former Medicaid Fraud Prosecutor. Additionally, each of our healthcare compliance attorneys holds, or is a candidate to receive, a Masters of Law in Health Law (LL.M.) post-graduate degree from Loyola University Chicago School of Law — the top school in the U.S. for Health Law.
We work with Detroit and Southeastern Michigan medical providers and medical practices who are reimbursed by government (Medicare, Medicaid, TriCare) or commercial insurance payors, including:
We are proud to serve licensed healthcare professionals in cities, counties, and communities across Detroit and Metro Detroit, including Ann Arbor, Dearborn, Sterling Heights, and Troy, as well as Oakland County, Wayne County, Macomb County, and Washtenaw County. In addition, our healthcare compliance lawyers work with practices statewide, such as Grand Rapids, Lansing, Flint, Saginaw, Midland, Muskegon, Bay City, and Kalamazoo.
Besides Detroit, we have offices in Miami and Sarasota, Florida; and Los Angeles and Southern California. Contact us today to learn more about what can do for your healthcare compliance needs.
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Our attorneys argued to the OIG that exclusion for the prescribed time period was unreasonable under OIG regulations, and that most factors that would lead to a greater exclusion period were inapplicable.
Our attorneys worked with the DEA and negotiated by offering a compliance program to bring the physician back into compliance with the DEA’s requirements.
The government made things easier for healthcare providers who want to end fee-for-service and go the value-based or coordinated care route.
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.
In general, a physician or other licensed healthcare provider is prohibited from making any referral to a person or entity that bills Medicare or Medicaid programs, and with which the physician has a financial interest. And there are hefty penalties for doing so.
The Federal Anti-Kickback Statute has a broad impact on health care business arrangements. We at Chapman Law Group are here to help you understand it all.
New healthcare business ventures can easily, sometimes unknowingly run afoul of Stark Law, Anti-Kickback, and the False Claims Act. Here’s how to be sure you are being fully compliant and not violating any state and federal laws.
Here’s why it’s important to take a closer look at whether your medical practice is staying compliant — and not engaging in kickbacks in health care.
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