Protecting Medical Providers Nationwide
Oberheiden, P.C. is one of the few firms with substantial experience in the areas of federal workers compensation regulations. Attorney Dr. Nick Oberheiden and his team are DOL compliance lawyers who have advised providers across the country how to protect their businesses in light of ever increasing government scrutiny and enforcement.
- Hundreds of Federal Health Care Investigations
- Former DOJ Prosecutors and U.S. Senate Confirmed Attorneys
- Nationally Available Defense and Trial Counsel
- Personalized Service, No Junior Lawyers
If you are concerned about doing something wrong at your clinic, have billing or compliance questions relating to workers compensation programs or patients, you should call Dr. Nick Oberheiden to request a free and confidential consultation today.
Purpose of a DOL Compliance Program
In the late 1990’s the government agency named the Office of the Inspector General (OIG), developed a major initiative to develop formal guidelines for physicians, clinics and hospitals to maintain clinical practice compliancy of federal rules and regulations. These OIG guidelines aimed to streamline a difficult and arduous processes of keeping up with and maintaining clinical practice compliance of government rules and regulations set forth for physicians, clinics and hospitals that treat federal workers or federally funded health care programs.
The OIG attempted to create internal control measures to assist in monitoring and adhering to applicable statutes, regulations and federal rules and requirements. As with most things that the government creates, this compliance program provisions and explanations have well-meaning intentions but become thousands of pages of difficult to understand rules, provisions and infrastructure recommendations that are too difficult to adhere to, keep up with or implement for the everyday practicing clinicians and hospitals.
The OIG states on their website that, “The goal of voluntary compliance programs is to provide a tool to strengthen the efforts of health care providers to prevent and reduce improper conduct. These programs can also benefit physician practices by helping to streamline business operations“. This statement demonstrates that the setting up of a compliancy program is a much needed and well-intended program, but the OIG does not make their compliancy recommendations easy to implement or understand to the average clinician and hospital. Most practicing clinicians do not want to be found to be in non-compliance with federal statutes and regulations and be accused of mistakes that can rise to the accusation level of “FRAUD”.
The truth is that the federal rules, regulations and suggested compliancy internal control measures are intimidating and difficult to keep up with for the busy practicing clinician. This fact alone has created an atmosphere of non-participation by practicing clinicians and hospitals to not participate in federal health care programs like Department of Labor Workers Compensation for federal employees. This difficult to navigate atmosphere of what is perceived by clinicians as over policed rules and regulations that are hard to understand, leaves a large population of federal workers with very limited health care choices and limited treatment options.
This is why the consultants and lawyers at Oberheiden P.C have worked for years to assist clinicians and hospitals with adhering and maintaining a successful voluntary compliance program to these OIG compliancy internal auditing measures of current federal health care programs rules, regulations, and applicable statutes.
Elements of a DOL Compliance Program
A voluntary compliance program is recommended and should be implemented by all practicing physicians and outpatient therapy centers in order to protect the possibility of erroneous or fraudulent conduct mistakes. In busy clinics and hospitals documentation, billing, coding and appropriate forms are filled out by employees that are not usually clinicians, have no formal background or requisite training and human error is inevitable. A properly implemented voluntary compliancy program assists in reducing the human error factor and aids in preventing repeated mistakes rising to the level of documentation errors, HIPAA violations, billing and coding mistakes becoming fraudulent billing or improper handling of patient employer forms.
The OIG recommends that a voluntary compliance program should contain seven components that provide structured measures of internal audits, controls and infrastructure for physicians and hospital to have a successful voluntary compliance program. The Office of Inspector General’s Office recommends the following components in order to have an effective voluntary compliance program:
- Conducting internal monitoring and auditing;
- Implementing compliance and practice standards;
- Designating a compliance officer or contact;
- Conducting appropriate training and education;
- Responding appropriately to detected offenses and developing corrective action;
- Developing open lines of communication; and
- Enforcing disciplinary standards through well-publicized guidelines.
These are the basic seven requirements that the OIG recommends for a voluntary compliance program. Over the years at Oberheiden, P.C. a more thorough and streamlined list of components have been developed to assist in protecting and galvanizing the success of our clients to maintain successful compliance with federal health care program rules, regulations and statutes. A well-designed compliance program will optimize proper payment of claims; minimize human error or computer error billing mistakes, reduce the risk of an audit by HCFA or the OIG; and assist in avoiding conflicts with federal self-referral and anti-kickback statutes.
Physicians and hospital providers that treat Department of Labor federal employee injuries should have an OIG voluntary compliance program to assure that they are not at risk for violations that can rise to expensive fines and criminal prosecution. Oberheiden, P.C. voluntary compliance programs provide training, documentation and updates to changes in federal rules and regulations to prevent potential instances of erroneous or fraudulent conduct. Treating DOL injured workers is a needed service for the many of millions of federal employees that need care and assistance with their injuries and claims. Treating physicians and hospital should be able to treat DOL injured workers without fear of retribution or prosecution with an effective voluntary compliance program.
We here at Oberheiden, P.C. are dedicated to providing compliancy programs for our clients that provide assurances that they are up to date with the latest federal rules and regulations and maximize their protection from erroneous mistakes by employees. Most physicians and hospitals do not understand the consequences of these common mistakes and how they can lead to non-compliant behaviors, billing mistakes and even fraudulent accusations that are difficult and costly to defend when the government audits or raids their offices.
On March 21, 2016, the Department of Health and Human Services (DHHS) Office of Civil Rights (OCR) announced that it was beginning its second series of HIPAA audits, known as Phase 2 audits. These are random audits, which means that any office that is a covered entity can be audited at any time, regardless of whether a complaint has been filed or not against the office. This is an example of the atmosphere of auditing and policing by government regulators and prosecutors. Many physicians and hospitals are being audited, raided and arrested for violations that often time the clinics and hospital were unaware that they were not practicing in compliance with federal health care regulations. Compliance programs are a necessary requirement for all clinicians that want to be up to date, prepared and maintain best practice standards of care.
Speak with Attorney Dr. Nick Oberheiden—Free Consultation.
Oberheiden, P.C. compliance programs provide you the clinician with the necessary training, documentation and updates to allow you to practice safely and breathe easier knowing that you are adhering to the latest federal DOL best practices and necessary voluntary compliance. Are you prepared for that knock on the door? Are you prepared for that long letter in the mail for an audit request? Oberheiden, P.C. will provide you with all you require to maintain compliance and have a successful clinical practice in today’s volatile atmosphere of auditing and prosecution. Are YOU protected? Contact us today.
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