Department of Labor / DOL Consultant for Medical Providers
If your clinic or medical practice serves federal government employees or other U.S. Department of Labor (DOL) program beneficiaries, then hiring a DOL consultant can be critical to avoiding fines, recoupments, and other penalties. At Oberheiden, P.C. our federal health care lawyers and non-lawyer professionals serve as DOL consultants to providers nationwide.
As a clinic operator, health care practitioner, or medical practice administrator who bills the U.S. Department of Labor (DOL), compliance needs to be one of your top priorities. In order to avoid unwanted scrutiny from the DOL’s Office of Inspector General (OIG), you need to ensure that all of your personnel strictly adhere to a well-documented compliance program, and you need to be prepared to affirmatively demonstrate your compliance in the event of an audit or investigation.
Hiring an experienced DOL consultant can not only help you confidently bill the Federal Employees’ Compensation Program and other programs, but it can also allow you to focus more of your time on what should be your top priority: providing quality care to the patients you serve. At Oberheiden, P.C., our federal health care lawyers and non-lawyer DOL consultants strategically advise program-participating providers nationwide. We can help you develop a fully-compliant DOL billing program; and, if you are facing an OIG audit or investigation, we can help you address any compliance issues while protecting you against costly penalties.
Billing Compliance Program Development
Developing a DOL billing compliance program requires not only thorough knowledge of the applicable laws and regulations, but also a detailed understanding of how these laws and regulations apply to the unique aspects of your clinic or medical practice. As a result, no two DOL billing compliance programs will ever be (or, at least, should ever be) exactly alike. Our lawyers and DOL consultants understand the importance of developing and implementing a custom-tailored DOL compliance program, and we work closely with our clients to ensure that the programs we create accurately reflect our clients’ unique needs.
When developing compliance programs, our lawyers and DOL consultants start by systematically assessing our clients’ needs. Whether this involves evaluating a new medical practice or determining what changes are necessary for an existing clinic to begin billing DOL programs, we thoroughly examine all relevant aspects and issues. Along with establishing DOL program eligibility, this typically includes assessment of:
- Contracts with third-party providers (including providers of ancillary services)
- Patient documentation
- Marketing and referral relationships
- Billing and coding software
- Documentation practices
- Record keeping and document storage practices
- Employee screening and background checks
- Internal training programs
- Entity-level organization and management
- Supervisory structures
Once our DOL consultants gain a complete picture of what is needed, then we begin the process of developing a compliance program that can be effectively distributed, implemented, and updated as necessary in order to reduce our client’s risk of being penalized for DOL billing mistakes or other statutory violations.
Billing Compliance Program Overhauls with our DOL Consultants
Is your DOL compliance program putting your clinic or practice at risk for a federal audit or investigation? Could your current compliance documentation actually do more harm than good if scrutinized by the DOL? When it comes to DOL compliance, simply having a compliance program is not enough. If you are relying on a generic or outdated compliance program, or if you are unsure whether your compliance program is adequately promoting compliance, then it is likely time for an overhaul.
Our lawyers and DOL consultants regularly work with health care providers who need to update or replace their existing compliance programs. Similar to when we develop compliance programs from scratch, our process for overhauling DOL compliance programs begins with auditing our client’s practice to determine what is necessary. Oftentimes, our clients need more than they realize, and promptly implementing an updated program proves crucial to mitigating their risk of federal liability.
Is it time to overhaul your clinic’s or medical practice’s DOL compliance program? You may need our DOL consultants’ services if:
- It has been a year or longer since you last revisited your DOL compliance program.
- You have entered into contracts with ancillary service providers, vendors, or marketers without giving due consideration to the DOL compliance implications.
- You have engaged (or are thinking about engaging) a new third-party billing administrator.
- Your billing administrators constantly struggle to locate the patient records needed to substantiate DOL billings.
- You live in constant fear that DOL agents are going to show up at your door and ask to review your clinic’s or practice’s medical and financial records.
DOL Consultants for Internal Audits and Investigations
There are two primary reasons for DOL health care providers to conduct internal audits and investigations: (i) to identify flaws and deficiencies in existing compliance practices and procedures; and, (ii) to respond to an actual or potential breach of DOL billing regulations or federal law. Our DOL consultants advise providers with regard to both proactive and reactive federal workers’ comp audits and investigations. We can assist you in determining whether your clinic’s or practice’s existing DOL compliance program is sufficient; and, if necessary, we can help you identify the source of a violation and determine the appropriate next steps.
Taking responsive action following the identification of a DOL billing violation or other legal issue requires a measured approach. Clinics and providers must act decisively, but they must also avoid overreactions and other missteps that could lead to further legal trouble. From employee discipline to self-disclosure of the violation, our lawyers and DOL consultants can assist you in making informed decisions that protect your business.
DOL Consultants for OIG Audits and Investigations
Our lawyers and DOL consultants also represent and advise health care providers during OIG audits and investigations. When facing an OIG audit or investigation, prompt intervention can be critical to mitigating the risk involved. By “intervention,” we mean asking questions and playing an active role in determining the course and outcome of the investigation. If you simply answer the auditors’ or investigators’ questions and hand over the documents requested, you could unnecessarily disclose information that could be used against you. You could also end up supplying incomplete information that suggests a regulatory or statutory violation while the complete facts would be fully vindicating.
Overbilling the DOL and engaging in other unlawful transactions (such as paying or receiving illegal “kickbacks”) are considered forms of health care fraud under federal law. Our lawyers and DOL consultants have centuries of combined experience on both sides of federal health care fraud audits and investigations. The members of our DOL consulting practice include career health care lawyers, former federal health care fraud prosecutors, a chiropractic physician who is a federal workers’ compensation expert, and non-lawyer auditors and compliance consultants who all offer deep knowledge and invaluable insights for defending clinics and other providers during OIG workers’ compensation audits and investigations.
DOL Compliance: Federal Workers’ Compensation FAQs
Q: What types of DOL compliance consulting does Oberheiden, P.C. offer?
We offer compliance consulting services for all DOL workers’ compensation and health care benefit programs. Our DOL consultants are experienced in dealing with all matters pertaining to:
- Federal Employees’ Compensation Program
- Energy Employees Occupational Illness Compensation Program (EEOICP)
- Longshore and Harbor Workers’ Compensation Program (LHWCP)
- Coal Mine Workers Compensation Program (Black Lung)
- Foreign Labor Certification (FLC) Programs (PERM, H-2A, H-1B and H-2B)
- Unemployment Insurance (UI)
- Workforce Investment Act (WIA)
- Job Corps (JC)
- Federal grant fraud involving the DOL
Q: What are some examples of common DOL compliance issues?
Unfortunately, there are far too many examples of DOL compliance issues to list them all. The DOL’s OIG aggressively targets clinics and other providers suspected of all forms of intentional and unintentional billing violations, and DOL-participating providers will often face substantial liability due to honest mistakes of which they were completely unaware. This is one of the main reasons why all providers need to have a comprehensive and up-to-date DOL compliance program in place. Some of the most-common examples of billing violations and other forms of “health care fraud” targeted by the OIG include:
- Use of incorrect workers’ comp codes
- Use of incorrect NCCI experience modification rates (EMR) and other similar types of errors
- Billing for mutually-exclusive codes
- Billing for medically-unnecessary services
- Delayed discharge of DOL beneficiaries
- Low or inconsistent return-to-work rate
- Inadequate supervision of ancillary care providers
- Inadequate documentation and recordkeeping practices
- Other violations of DOL workman’s comp rules and regulations
- Unlawful agreements with medical directors, marketers, and other third parties
Q: What are the risks of DOL non-compliance for clinics and other health care providers?
The risks of DOL non-compliance include recoupments, fines, damages, loss of program eligibility, and even the possibility for federal incarceration. Several of the statutes that the OIG and the U.S. Department of Justice (DOJ) use to prosecute providers suspected of health care fraud include provisions for civil and criminal penalties. While criminal prosecution generally requires evidence of intent, this intent can be inferred under many circumstances, and demonstrating good-faith efforts to adopt an effective compliance program can go a long way toward fending off federal charges.
Speak with a DOL Consultant at Oberheiden, P.C.
If you would like to speak with a DOL consultant about your clinic’s or practice’s compliance program needs, or if you need to inquire about our consulting services for DOL audits and investigations, we encourage you to get in touch. To get started with a free and confidential consultation, please call (214) 692-2171 or send us your information online today.