Articles Posted in Healthcare Corporate Compliance

Photobucket WASHINGTON D.C. – Health care fraud task forces are turning their attention to the executive level of health care enterprises. In an effort to crackdown on those who would perpetrate health care fraud, investigators have begun aiming their efforts at the owners and operators of drug companies, medical device manufacturers, nursing home chains and any health care business involved with Medicare and Medicaid. Senior executives could find themselves facing criminal charges even if they had no knowledge of their company’s activities, but were in a position to stop it.

Prosecutors have become fed up with repeated violations, which cost taxpayers more than $60 billion per year and have decided to use enforcement tools that have long been in place, but simply not used. A simple writing of a check to repay the federal funds and a promise not to repeat the offense have been used too often, so now corporate executives must pay closer attention to how their company is billing Medicare and Medicaid lest they find themselves in hot water with the feds.

The crackdown may result in a company’s ban from participating in Medicare and Medicaid reimbursements, but the power to ban lies solely with the inspector general, not a judge. The FDA has also begun using the “Park Doctrine” which allows prosecutors to bring criminal charges against executives. Any corporate officer in the chain of command could charged with a criminal misdemeanor if found to have the ability within their power to prevent the fraud.

hcca.jpgFORT LAUDERDALE, FL (September 17, 2008) Health care fraud blog publisher, attorney Robert David Malove, will be attending the 2008 Fraud & Compliance Forum in Baltimore next month.

The AHLA/HCCA Fraud & Compliance Forum will provide practical guidance on the pressing legal and compliance issues that have arisen in the last twelve months. For health lawyers, the program will highlight the most important legal developments in areas such as Stark, the False Claims Act, and the Anti-Kickback Statute. For compliance officers, the conference will cover important issues such as Part D compliance plans, compliance effectiveness, and fraud and abuse. The program’s uniqueness stems not only from the important content for health lawyers and compliance officers but also from the additional value of bringing together legal counsel and compliance officers in one educational arena. The networking opportunities and synergistic advances in fraud and abuse compliance make this program an essential educational forum for both health lawyers and compliance officers.

The Fraud & Compliance Forum is jointly sponsored by the Health Care Compliance Association (HCCA) and the American Health Lawyers Association (AHLA). It includes an explicit designation of each session as “compliance focused” or “legal focused.” The Planning Committee has included enough sessions in each designation that an individual could attend all “compliance” sessions or all “legal” sessions for the entire program. Yet an attendee also has the option of selecting a diversity of sessions and networking with an expanded group of individuals. The Fraud & Compliance Forum has the benefit of combining the quality of HCCA and AHLA sessions with the expanded networking power of a combined program.

chiro%202.jpg Effective July 1, 2008 there is a significant change in the law in Florida concerning the employment of chiropractic physicians, and the law carries felony level criminal penalties.

Under the statute, F.S. 760.4167, any entity, including licensed health care clinics, that employ chiropractic physician and is not owned entirely by licensed chiropractic physician(s) are statutorily prohibited from exercising control over the practice of chiropractic medicine. The scope of the statute extends to the hours a chiropractor works, pricing of chiropractic services, any equipment used by the chiropractor, and the advertising and selection of patients, among other requirements.

The statute makes any employment arrangement with a chiropractic physician entered into before July 1, 2008 that does not comply with its terms null and void.

chiro.jpgEffective July 1, 2008, pursuant to Florida Statutes § 460.4167, no chiropractor may be employed by a health care clinic unless the clinic has a medical director that is an MD or DO. Specifically, the provision is intended to prevent D.C.s from acting as medical directors for such clinics.

The Board of Chiropractic recently addressed the issue of whether any such clinics already existing can be grandfathered. The answer by the Board is no. Therefore, effective July 1, 2008 any clinic that has a D.C. as a medical director or employs a D.C. and does not have an MD or DO medical director will not be able to submit claims or bill for services and D.C.s working for such establishments can be disciplined.

The Statute also addresses several issues for clinics that continue to employ D.C.s and sets limitations, including criminal penalties:

Professor Benson Weintraub, Esquire, a Ft. Lauderdale-based global health care attorney and counselor with an international practice and clientele, and a distinguished academic authority on the Federal sentencing of corporations and individuals, has been invited to present “Defense of a Criminal Healthcare Fraud Case” at Health Care Compliance Association’s (HCCA) 12th Annual Compliance Institute to be held in New Orleans April 13-16, 2008.

Weintraub has served as a full-time Professor of Law. During his legal career, Porf. Weintraub has successfully represented complex white collar targets, corporations, business entities, executives, defendants, and witnesses as a tenacious, exclusively federal white collar criminal defense lawyer for more than 25 years.

Among his credits has defended more than 60 Physicians, Health Care Delivery Corporations & Organizations, DME Distributors, Internet Pharmacies, Pharmacists, Pharmaceutical Manufacturers, and public officials on hospital regulatory boards throughout the nation.

The Compliance Certification Board (CCB) announced that Board Certified Criminal Trial Lawyer Robert David Malove, robert2.jpghas successfully completed the Certified in Healthcare Compliance Examination, thus earning the CHC designation.

Healthcare compliance is a relatively new industry, born out of the government’s crackdown on Medicare fraud. Compliance professionals come from a variety of backgrounds including coding, medical records, nursing, medical practice. law and government. Regardless of background, compliance professionals are tasked with assuring that health care providers follow federal, state and local regulations that govern the delivery of healthcare.

CCB President Debbie Troklus, noted, “The United States government constantly updates the laws and regulations surrounding Medicare to ensure proper billing and to eliminate fraud. These new regulations demand professionals who both understand the new regulations and how to implement programs to ensure compliance within their companies.”

Today, the person most essential to your healthcare organization’s long term success may not be a doctor, nurse, or technician. Increasingly, the most vital person in your company may be the one who helps you navigate a tangled web of regulations, certifications, and liability. Who creates and institutes policies and operational guidelines that help keep you open for business? Who is responsible for monitoring day-to-day operations to be sure that you can survive scrutiny from government auditors investigating potential fraud or Stark violations? That person is Florida Bar Board Certified Criminal Trial Lawyer Robert David Malove.

GW’s Healthcare Corporate Compliance Program is accredited by The Healthcare Compliance Certification Board (HCCB). The HCCB was established by the Health Care Compliance Association in 1999 to complete the process of developing an examination and manage the Certified in Healthcare Compliance certification program.

Given the dramatic changes in healthcare policy and regulation over the past decade, the importance of having a corporate compliance adviser has increased dramatically and become a top corporate priority. No other position can have so profound an impact on your healthcare organization’s success-or failure. Legislation such as the Health Insurance Portability and Accountability Act (HIPAA) and the Anti-Kickback and Stark Laws has created the need for university-based certification for this increasingly specialized-and increasingly complicated-field.