HEALTH CARE SERVICES

Accreditation: The Medicare Modernization Act (“MMA”) requires accreditation of all HME companies that operate in a competitive bid area (“CBA”) and that bill Medicare. It is likely that all HME suppliers that bill Medicare, regardless of where they are located, will be required to be accredited in the near future. Brown & Fortunao has created an accreditation manual that includes comprehensive policies and procedures, forms and other materials that will assist the HME company with the accreditation process. We can also provide specific guidance on the various accreditation issues that will arise for your company.

Competitive Bidding: In addition to mandatory accreditation, the MMA established the competitive bidding process. Beginning in 2007 and continuing in subsequent years, CBAs will be designated by CMS. In order to bill Medicare for providing specified products in a CBA, the DME company is required to submit a competitive bid application, along with other documents. The DME company will be allowed to bill Medicare for the specified products in the CBA only if the company is awarded a competitive bid contract. Our firm assists companies in preparing bid applications; establishing networks and subcontract arrangements; implementing steps to expand in a CBA if a contract is awarded; and implementing steps to survive in the event that a contract is not awarded.

Corporate Compliance: Corporate compliance is the foundation of the OIG’s approach to insuring compliance by Medicare providers with federal statutes, rules and regulations. The OIG has published a number of guidelines setting out what needs to be contained in a corporate compliance program for the OIG to consider the program to be “effective.” Our firm has prepared a template Corporate Compliance Manual that we can customize for our clients. In addition, we have prepared on-site corporate compliance programs geared specifically to different types of providers.

Corporate Compliance Validation Audit: If a provider already has a corporate compliance plan in place, we recommend a Corporate Compliance Validation Audit (“Validation Audit”) that allows us to determine if the provider is complying with the terms of its corporate compliance plan. We conduct either an on-site or an off-site Validation Audit based on an initial questionnaire that addresses compliance issues. We discuss the results of the questionnaire with the provider in order to follow up on the information provided and to request relevant documents for us to review. With an on-site Validation Audit, an attorney visits the provider’s business to personally interview its management team and employees. With an off-site Validation Audit, we limit our audit to the information contained in the questionnaire, the information we obtain by phone, and the documentation the provider sends to us. The audit concludes with a report to the provider that (i) describes any deficiencies with the corporate compliance plan and (ii) sets out any corrective steps that the provider should take.

HIPAA Compliance: The privacy and security standards of the Health Insurance Portability and Accountability Act (“HIPAA”) apply to “Covered Entities.” Most health care providers fall within HIPAA’s definition of a Covered Entity and are required to comply with privacy and security standards. In order to be in compliance, the provider must appoint a privacy officer, train its workforce, and implement the required policies and forms. Our firm has prepared a template HIPAA Compliance Manual that we can customize for our clients. In addition, we have prepared on-site HIPAA training programs geared specifically to different types of providers.

Legal Review: Using a carefully designed questionnaire, we conduct a legal review that focuses on and corrects legal deficiencies that could otherwise come to the surface in the event of:

a whistleblower (qui tam) lawsuit by a current or former employee;
a third party audit; or
an investigation conducted by a governmental agency or a fraud control unit of a third party payor.
Mock Billing Audit: Providers are subject to periodic third payor billing audits in which the payor reviews selected files to determine whether they contain the basic required documentation and evidence of medical necessity. Consequences of poorly documented files include refunding prior payments received. When responding to an audit request, it is critical that the provider furnish both the basic required documentation as well as evidence of medical necessity. We provide mock audits for our clients that follow payor sampling procedures. As part of our report, we recommend steps that the provider needs to take to correct deficiencies before facing an audit.

Physician and Hospital Issues: Our attorneys have a great deal of experience representing hospitals and physicians. We work with hospitals on issues pertaining to medical staff relationships; compliance; mergers and acquisitions; quality assurance; and audits. We work with physicians on issues pertaining to credentialing; medical staff relationships; peer review; business arrangements with other providers; managed care contracts; quality assurance; and audits.

Preventative Maintenance: Before a health care provider enters into a contract, a business arrangement, or implements a marketing program, it is sound business practice to review these issues with an experienced health care attorney. If a business arrangement violates any of the federal anti-fraud statutes, then the risk to the provider can be high. We encourage our clients to have us review contracts and arrangements with us before they are implemented. This gives us an opportunity to point out problems and suggest revisions that can reduce risk.Sales and Acquisitions: Our attorneys have extensive experience in representing both buyers and sellers of businesses. This representation includes negotiating the contracts, conducting due diligence, preparing the documentation and handling the closing.

Sales and Acquisitions: Our attorneys have extensive experience in representing both buyers and sellers of businesses. This representation includes negotiating the contracts, conducting due diligence, preparing the documentation and handling the closing.

 

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