The scope and complexity of healthcare regulation has grown exponentially in recent years. Wading through the sea of federal and state healthcare regulations can be an overwhelming task. Many healthcare providers feel they spend more time monitoring and ensuring compliance with these rules than they do on their work.
Physicians, hospitals, nursing care facilities, home health agencies, laboratories, imaging facilities and other healthcare providers who are reimbursed by government or private insurers must comply with the policies and procedures of the reimbursing entity in order to maintain billing privileges. Licensed providers (physicians, nurses) must observe the ethical, legal, and professional standards of their licensing organization in order to maintain their good standing. All providers must adhere to regulations regarding matters such as healthcare data privacy among many, many others.
Healthcare Compliance Attorneys
Our highly trained attorneys work with hospitals, medical practices, and other healthcare providers to help them understand and comply with the maze of regulations that affect their profession. Regulatory compliance issues that a healthcare compliance defense attorney can assist with include:
- CMS Requirements, including Conditions of Participation (CoP)
- TMHP Regulations
- Health Insurance Portability Accountability Act (HIPAA)
- OSHA Record-keeping Privacy
- Corporate Practice of Medicine Doctrine
- FDA Compliance Programs
- Stark Law
- Anti-Kickback Regulations
Medicare, Medicaid, HMOs, private insurance companies, as well as licensing agencies conduct compliance audits constantly. Typically, these come in the form of state licensing audits, billing/claim audits or Medicare conditions of participation compliance surveys. To stay prepared and in the best position possible, providers should periodically review their own compliance before their procedures and processes are examined by payors and licensing agencies.
Healthcare regulations change frequently. Providers are focused on their profession and may not be informed about the most recent developments. Our firm can help with the development of corporate compliance programs and periodic compliance audits in order to keep your agency from being caught up in the enforcement process. We work with consultants to perform “snapshot” audits which identify provider vulnerabilities, then create and implement corporate compliance programs for healthcare providers.
Continuous Compliance Changes
Corporate compliance programs are required by CMS for some, but not all provider types at this point in time. As CMS and TMHP make changes in the guidelines mandatory corporate compliance programs may be just around the corner for many.