Regulatory Compliance in Healthcare: Averting Medicare and Medicaid Fraud

Healthcare Professional and Healthcare Lawyer Shaking Hands

Regulatory Compliance is a Mandatory, Daunting Set of Rules and Regulations That All Healthcare Practices Must Follow

Regulatory compliance in healthcare is very complex. It requires a multidisciplinary team to assist in reviewing your compliance program and preparing an appropriate defense to allegations of non-compliance. And unless you are a large hospital with a full-time team of compliance officers, you cannot be expected to ensure compliance on your own.

That’s because regulations, administrative rules and statutes often times seem to conflict with one another — leaving most healthcare providers to wonder whether they will ever really be in compliance, and whether they are susceptible to allegations of Medicare fraud, Medicaid fraud, or any other kind of criminal offense related to healthcare.

Every State Has Its Regulations, As Do Federal Authorities Including CMS and DEA

The Center for Medicare and Medicaid Services (CMS), together with U.S. Department of Health and Human Services (HHS), seems to be in the exclusive business of writing regulations. And every health care provider that accepts CMS funding must comply with all applicable regulations.

As CMS states in its “Small Entity Compliance Guides”: “The various guidance and procedure documents on this website number approximately 37,000, comprising over 7 million pages.” 

Additionally, each state has its own set of regulations, as do health insurance companies.

Of course, complying with theses regulations is just the beginning. Health care providers must also comply with:

    • Occupational Safety and Health Administration (OSHA) and state safety regulations
    • State board regulations relating to the delivery of health care
    • State licensing regulations (professional rules/regulations)
    • Facility regulations
    • Labor department rules
    • DEA rules

CMS has made an effort to communicate the details of each rule to health care providers through “small entity compliance guides.” There’s also the Medicare Learning Network, an online resource from CMS that breaks down Medicare policy into plain language, provides educational compliance information for Medicare fee-for-service providers; and offers a variety of training and educational materials.

But are those CMS resources enough? More to the point, do you have enough patience and know-how to understand them?

Doctor and a Lawyer shaking hands.

Your Health Care Practice is in Solid Hands with Chapman Law Group’s National Regulatory Compliance Attorneys

Regulatory compliance in healthcare is a scary process for most small healthcare providers. That’s why we at Chapman Law Group are here to help you make sense of what regulatory compliance means and how to go about staying within it.

Our national regulatory compliance lawyers will work with you before allegations of non-compliance are ever a concern — as well as after — to protect your interests and your right to continue to practice medicine. 

We will guide you through:

    • Medicare audits and the Medicare audit process
    • The Anti-Kickback Statute and Stark Law
    • DEA compliance
    • Compliance laws for health care

In addition, our healthcare compliance lawyers can work with you to put a healthcare compliance plan in place for your practice, and our defense attorneys are here to represent you should you face allegations of Medicare fraud, Medicaid fraud, or any other criminal matter connected to your healthcare practice.

Our national healthcare law offices are in Detroit, Michigan); Miami and Sarasota, Florida; and Los Angeles/Southern California.

Reach out to us to learn more about our regulatory compliance services.

Need an Attorney? Contact us now!

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