Advanced Practice Providers
Our lawyers provide vigorous legal representation for advanced practice providers in all areas of the law. From licensing and employment issues to federal health care fraud investigations, we are here for you.
Advanced practice providers play an important role in the United States’ health care system. Access to advanced practice providers means more access to health care; and, according to Texas Children’s Hospital, “[r]esearch has shown that patients are just as satisfied receiving care from Advanced Practice Providers as they are from a physician.”
Like physicians and other health care providers, advanced practice providers face legal challenges in virtually all aspects of their practice. From professional licensing and registration with the Drug Enforcement Administration (DEA) to professional liability and allegations of federal health care fraud, advanced practice providers must constantly remain cognizant of the legal implications of their work. At Oberheiden, P.C., we provide comprehensive legal counseling, advice, and representation for advance practice providers in all aspects of licensing, compliance, enforcement, and litigation.
Our practice encompasses the representation of advanced practice providers across the country. Our lawyers, many of whom previously served as federal health care fraud prosecutors with the U.S. Department of Justice (DOJ), are thoroughly knowledgeable about all aspects of advanced practice and federal health care program compliance. Our team also includes compliance consultants and auditors, federal workers’ compensation experts, and other non-lawyer professionals who bring decades of combined experience to assisting advanced practice providers including:
- Advanced practice registered nurses (APRNs)
- Certified nurse midwives (CNMs)
- Certified registered nurse anesthetists (CRNAs)
- Clinical nurse specialists (CNSs)
- Licensed practical nurses (LPNs)
- Nurse practitioners (NPs)
- Physician assistants (PAs)
Our Services for Advanced Practice Providers
While much of our practice is devoted to federal health care law compliance and enforcement (including matters involving Medicare, Medicaid, Tricare, and U.S. Department of Labor (DOL) benefit programs), we serve advanced practice providers in other areas as well. As your legal counsel, our goal is to provide comprehensive, responsive, and full-service legal representation regardless of your specific area of need. For example, in addition to federal compliance program development and audit defense, we also routinely assist clients with professional licensure and DEA registration matters, and we have extensive experience in employment, business, and professional liability matters as well.
So, how can we help you? Our federal health care lawyers and consultants are available to assist you with matters including:
Professional Licensing and Disciplinary Matters
As an advanced practice provider, your professional license is one of your most valuable assets. When your privilege to practice is threatened, you need to do everything within your power to protect it. Our lawyers represent advanced practice providers in all license-related matters, including self-reporting, ethics and professional liability complaints, investigations, board and administrative hearings, and appeals.
DEA Registration, Auditing, and Enforcement
Advanced practice providers who register with the DEA in order to prescribe medications must consistently adhere to the conditions of registration. The DEA conducts both routine and ad hoc audits and investigations, and allegations of registration violations could put your ability to prescribe at risk.
Federal Billing and Coding Compliance
We represent advanced practice providers with respect to Medicare, Medicaid, Tricare, and DOL billing and coding compliance. All of these programs have their own unique rules and restrictions regarding the reimbursement eligibility of advanced practice provider services, and our lawyers and consultants are intimately familiar with the regulations under each of these programs.
Federal Health Care Fraud Audits and Investigations
Allegations of health care fraud under the False Claims Act or the federal health care fraud statute, 18 U.S.C. § 1347, can have devastating consequences if not handled appropriately. While audits and investigations can lead to civil monetary penalties (CMP), program exclusion, and even federal criminal charges, our lawyers have an extensive track record of resolving these matters in ways that protect our clients’ ability to practice medicine.
Federal Civil and Criminal Defense
In addition to representing advanced practice providers in audits and investigations, we also represent APRNs, CNPs, LPNs, NPs, PAs, and other clients in federal civil and criminal litigation. Whether you have been charged with a civil health care fraud violation or you are facing criminal charges for multiple alleged statutory offenses, we can use our experience on both sides of high-stakes federal cases to protect you.
Anti-Kickback Statute Compliance
The Anti-Kickback Statute is one of the least-well-understood federal laws that applies to advanced practice providers. All types of contractual and non-contractual relationships have the potential to raise Anti-Kickback Statute implications; and, while the government must prove intent in order to obtain a criminal conviction under the statute, even unintentional violations have the potential to result in CMP and other penalties.
National Practitioner Data Bank (NPDB) Disputes
Do you have an unfavorable report listed with the National Practitioner Data Bank (NPDB)? If so, our lawyers can help you effectively respond to the report and set the record straight. We handle matters under the NPDB’s dispute process as well as dispute resolution proceedings before the U.S. Department of Health and Human Services (DHHS).
Professional Liability Insurance Claims and Litigation
In addition to handling federal matters, we also represent advanced practice providers in professional liability insurance claims and malpractice litigation. We understand what it means to you to disprove any allegations of professional negligence, and we can use our experience to protect your license, your finances, and your professional reputation.
Practice Organization and Management
From developing and implementing an effective Medicare or Medicaid compliance program to appropriately structuring professional corporations, limited liability companies (LLCs), and other entities, there are numerous legal issues involved in establishing and managing a professional medical practice. Our lawyers can walk you through all of the steps you need to take, and we can help you start and run your practice with confidence.
Employment Contracts and Disputes
From contracts with hospitals and other employers to employment tax fraud investigations, the employment aspects of working as an advanced practice provider or running an advanced medical practice can present legal issues as well. Our lawyers represent advanced practice providers in all employment-related matters, including contract negotiations, contract disputes, harassment and discrimination claims, and federal employment law compliance.
Q&A with the Federal Health Care Lawyers at Oberheiden, P.C.
Q: What are some of the most-common compliance issues that can lead to trouble for advanced practice providers?
Advanced practice providers face the same primary legal challenges as physicians, hospitals, and other health care providers. However, as an advanced practice provider, defending yourself can present some unique challenges as well, as many people are not familiar with the nature of advanced practice and the scope of services that advanced practice providers are able to offer their patients. As a result, some of the most-common allegations against advanced practice providers include:
- Anti-Kickback Statute violations
- Billing for non-reimbursable services
- Billing for “medically-unnecessary” services
- Controlled Substances Act (CSA) violations
- Other billing and coding violations
Q: How can I determine if my billing and coding compliance program is adequate? What if it isn’t?
At Oberheiden, P.C., we offer comprehensive compliance services that start with a thorough assessment of our clients’ existing compliance programs. We can tell you were your program’s strengths and weaknesses lie, and we can help you upgrade (or overhaul) your program to ensure that your practice is fully compliant.
Q: What do I need to know in order to avoid allegations of opioid diversion and other CSA violations?
Opioid diversion is a hot-button issue with the DEA and other federal law enforcement agencies, and health care providers are being targeted in criminal diversion investigations with increasing frequency. In order to avoid allegations of opioid diversion, you need to ensure that your prescription practices fully comply with the CSA, and maintaining thorough documentation will be critical in order to prove that your prescription practices are legally-compliant in the event of an audit or investigation.
Q: How can I enter into a contract with a hospital or physician group without violating the Anti-Kickback Statute?
While the Anti-Kickback Statute’s prohibitions are extraordinarily broad, the statute is subject to a number of regulatory “safe harbor” provisions. When entering into a contract with a hospital, physician group, or other provider, it is imperative that you structure the financial terms of your relationship with one of these safe harbors in mind.
Q: What should I do if I am being audited or investigated by the DEA, DOJ, DHHS, or another federal agency or task force?
If you or your practice is being targeted in a federal audit or investigation, it is important that you seek legal representation right away. Prompt intervention can be critical to mitigating both the immediate and long-term consequences; and, in order to protect yourself, you need a team of experienced federal health care fraud defense attorneys on your side.
Discuss Your Legal Needs with a Federal Health Care Lawyer in Confidence
If you would like more information about any of the services we offer to advanced practice providers, we encourage you to get in touch. To speak with an attorney at Oberheiden, P.C. in confidence, please call 888-519-4897 or request a free initial consultation online today.