Healthcare Fraud

Post 2 of 2: The Pretrial Diversion Program in Georgia: Answering Questions Relating to the Offense

September 29, 2022 | Little Health Law

QuackbustersandtheShockTroopsofMedicalMcCarthyism-e1664472813118 This is the second post in a series related to the Pretrial Diversion Program in Georgia. The first post provided an overview of the Pretrial Diversion Programs in Georgia and the potential impact on a successful participant’s criminal record. This post focuses on how successful completion may impact a participant’s responses to questions relating to the offense on employment, licensing, and credentialing applications. If you have questions regarding this blog post or need counsel relating to your professional responsibilities after an arrest or conviction, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

For clients who have been arrested and charged with an offense, the concern is how to answer offense-related questions on questionnaires while participating in and after completing a pretrial diversion program. Continue reading ›

Post 1 of 2: The Pretrial Diversion Program in Georgia: An Overview

September 26, 2022 | Little Health Law

ny-medicare-fraud-img-e1664218102664 Our healthcare and business law firm works with many providers and other professionals who have been arrested and charged with misdemeanors. Our clients will, of course, hire criminal defense counsel to handle the criminal proceedings but professionals generally hire our firm navigate the professional consequences of an arrest. Many of our clients are first time offenders who are presented with the option of participating in a pretrial diversion program. Whether to participate in such a program should be discussed with criminal defense counsel. This is the first blog post of two on this subject, and it focuses on providing an overview of the Pretrial Diversion Programs in Georgia and the potential impact on a successful participant’s criminal record. The second post will focus on how successful completion may impact a participant’s professional responsibilities thereafter responding to questions relating to the offense on employment, licensing, and credentialing applications. If you have questions regarding this blog post or need counsel relating to your professional responsibilities after an arrest or conviction, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Eligible Offenders

Pretrial diversion programs are authorized under O.C.G.A. § 15-18-80. Thereunder, “the prosecuting attorneys for each judicial circuit . . . shall be authorized to create and administer a Pretrial Intervention and Diversion Program.” Each county may have different guidelines on who is eligible for a Pretrial Diversion Program and different requirements for successful completion. Continue reading ›

3 Tips if You’re Facing an Insurance Audit

August 23, 2022 | Little Health Law

iStock_000033418316_Medium-e1626470315777 Many of our healthcare and business law firm’s clients periodically face audits by insurance companies or governmental organizations, usually through a contractor. Audits can be unnerving times for a practice to go through. This blog post outlines 3 tips for handling an insurance audit. The Centers for Medicaid and Medicare recently published that the flexibilities allowed during COVID-19 will soon end and practices should ensure compliant safety and billing practices. As a result of this change after two and half years, practices may see increased audits. If you have questions regarding this blog post or need counsel navigating an audit, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

Take it Seriously at the Initial Record Request (and Not Just When They Ask for Repayment).

Many practices call us after the auditor requests repayment. Almost always, the process starts before then with the auditor initiating an investigation by requesting additional records and information. After the repayment is requested, however, there is an uphill battle to argue on behalf of your practice that no or less repayment is warranted. The best chance that your practice has of both reducing any requested overpayment and persuading the auditor not to expand its investigation to more patients or a larger time period is during the response to the initial request for records and documentation.

The Anti-Kickback Statute’s Rules on Per-Use or Per-Click Rental Equipment Leases

January 21, 2022 | Little Health Law

223220955_d39c2ebad0_b-e1642805878743 Many of our healthcare and business law firm’s clients are in the business of renting expensive medical equipment for use by medical practices. Generally, these arrangements raise compliance questions under the Physician Self-Referral Act, referred to as Stark Law, and the Anti-Kickback Statute (“AKS”). Should a regulator find an arrangement violates either law, the consequences are severe. The perhaps unfortunate truth is that rarely can a sincere and analytical attorney tell you with confidence that an arrangement does or does not violate either law. The analysis usually places an arrangement on a scale of low to high risk of noncompliance. To assist in understanding whether an arrangement complies with Stark Law and AKS, the rules provide specific exceptions and safe harbors, respectively. Both Stark Law’s exceptions and AKS’s safe harbors outline ways in which an equipment rental agreement may satisfy the protections. One question that frequently arises with our clients is whether they can structure an equipment rental agreement to have a per-use (often called a “per-click”) payment term, wherein there is no set monthly amount but, rather, the lessee pays the lessor a predetermined amount for each time the equipment is used.

In this blog post, we outline the basic rules for equipment rental agreements under AKS and whether per-click payment terms satisfy AKS’s Equipment Rental safe harbor. Continue reading ›

Stark Law’s Rules on Per-Use or Per-Click Rental Equipment Leases

January 14, 2022 | Little Health Law

iStock_000033418316_Medium-e1626470315777 Many of our healthcare and business law firm’s clients are in the business of renting expensive medical equipment for use by medical practices. Generally, these arrangements raise compliance questions under the Physician Self-Referral Act, referred to as Stark Law, and the Anti-Kickback Statute (“AKS”). Should a regulator find an arrangement violates either law, the consequences are severe. The perhaps unfortunate truth is that rarely can a sincere and analytical attorney tell you with confidence that an arrangement does or does not violate either law. The analysis usually places an arrangement on a scale of low to high risk of noncompliance. To assist in understanding whether an arrangement complies with Stark Law and AKS, the rules provide specific exceptions and safe harbors, respectively. Both Stark Law’s exceptions AKS’s safe harbors outline ways in which an equipment rental agreement may satisfy the protections. One question that frequently arises with our clients is whether they can structure an equipment rental agreement to have a per-use (often called a “per-click”) payment term, wherein there is no set monthly amount but, rather, the lessee pays the lessor a predetermined amount for each time the equipment is used.

In this blog post, we outline the basis rules for equipment rental agreements under Stark Law and whether per-click payment terms may satisfy Stark Law’s Rental of Equipment exception. Our next post will analyze the same question under AKS. If you have questions regarding this blog post or wish to evaluate the risks in your equipment lease arrangement, you may contact us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.

NAVIGATING THROUGH A CMS PAYMENT SUSPENSION- UPIC AUDITS

May 18, 2020 | Little Health Law

About 20% of United States tax dollars are spent on heathcare. Naturally, reducing improper payments has been a priority of CMS. Thus, all medical practice managers and healthcare providers should be aware of CMS’s process of contracting with Uniform Program Integrity Contractors (UPIC’s), private entities hired by CMS Health-Audit-300x200 to audit providers suspected of fraud. UPIC contracts combine Zone Program Integrity Contractors (ZPIC’s) and Medicaid Integrity Contractors (MIC’s) to coordinate Medicare and Medicaid auditing. UPIC’s focus primarily on Medicare claims, and seek to distinguish between provider billing errors or fraud.

UPIC Audit Lawyers

Our business and healthcare law firm follows legal trends in the healthcare industry. UPIC’s are private sector organizations that review Medicare claims in order to assist the government in recovering overpayments to healthcare providers. UPIC audits are often generated through data analysis or by review of consumer complaints and most often target specific healthcare providers. UPIC’s conduct screening, medical reviews, and investigations, while also implementing remedies and collaborating with state and local governments to ensure compliance with payment guidelines. UPIC’s are organized regionally, with Georgia and South Carolina falling in District 4 and managed by Safeguard Services. In recent years, home health agencies, DME companies, therapy clinics, and laboratories have been targets for fraud investigations through extensive audits.