General practitioners and specialists in all areas of medicine face legal and regulatory issues on a day-to-day basis. If you are a doctor and you have questions about your legal obligations, or if you are facing an audit, investigation, ethics complaint, or medical malpractice claim, we encourage you to contact us for a free and confidential consultation.
The medical and legal fields are inseparably intertwined. As a doctor, virtually all aspects of your practice have legal implications, whether you own your own private practice or you work for a hospital, clinic, or other medical facility. While most doctors focus on HIPAA compliance and mitigating their risk of medical malpractice liability, the reality is that these make up just a small portion of the broader realm of legal issues facing doctors in all areas of practice. Federal health care program (i.e. Medicare and Medicaid) compliance is of paramount importance as well, and even contracts with vendors and suppliers can potentially trigger federal civil or criminal liability.
At Oberheiden, P.C., our practice is devoted to representing doctors and other medical professionals and organizations. Our team of lawyers and consultants offers deep insights in all of the legal and regulatory issues that affect federally-funded medical practice, and we have extensive experience counseling and advising doctors with diverse legal needs. Whether you are preparing to launch a private practice or you need legal representation for an ongoing claim, dispute, or investigation, we can help, and we encourage you to contact to discuss your legal needs in confidence.
12 Key Legal Issues for Doctors Who Bill Federal Government Health Care Programs
We are committed to helping doctors avoid compliance issues and other mistakes that have the potential to jeopardize their practice. We provide our physician clients with full-service legal representation, assisting with business, compliance, licensing, and law enforcement issues on an as-needed basis. Within our health care law practice, we routinely advise doctors with regard to matters including:
1. Professional Licensing and Disciplinary Matters
As a doctor, your medical license is one thing you cannot afford to lose. If you are facing a patient complaint or disciplinary proceeding involving your state medical licensing board, our lawyers can represent you in fighting to protect your right to practice. We can advise you regarding any potential licensing implications of federal audits and investigations as well; and, if you are being targeted in a lawsuit or facing federal prosecution, we can structure your defense strategy around protecting your medical license.
2. DEA Registration, Auditing, and Enforcement
While obtaining the ability to prescribe medications should be a fairly straightforward and routine process, issues related to the nation’s opioid epidemic have caused the U.S. Drug Enforcement Administration (DEA) to crack down on doctors in recent years. Registering with the DEA, protecting your registration during audits and inspections, and maintaining strict compliance with the federal Controlled Substances Act (CSA) are all key legal aspects of operating a medical practice.
3. Federal Billing and Coding Compliance
Medicare, Medicaid, Tricare, and the U.S. Department of Labor health care benefit programs all have strict billing regulations, and these regulations vary from one program to the next. Billing and coding errors are some of the most-common triggers for federal audits and investigations, including intentionally and unintentionally using the wrong billing code, “unbundling” services, and billing for “medically unnecessary” prescription drugs.
4. Other Regulatory Compliance Matters
In addition to program billing compliance, medical record and privacy compliance are key issues for practicing physicians as well. While compliance programs under the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Act typically do not need to be custom-tailored to the same extent as billing compliance programs, doctors must nonetheless make sure that their efforts are sufficient to pass federal scrutiny.
5. Federal Health Care Fraud Audits and Investigations
In today’s world, even running a fully-compliant medical practice does not guarantee that you will avoid becoming the target of a federal health care fraud audit or investigation. If you have been contacted by a MAC, RAC, ZPIC, or agents from the DEA, Department of Justice (DOJ), Federal Bureau of Investigation (FBI), Office of Inspector General (OIG), or any other federal agency, it is important that you speak with an attorney as soon as possible.
6. Federal Civil and Criminal Defense
If you have been charged with a federal crime or a civil violation of the False Claims Act or another federal statute, executing a strategic and proactive defense is the only way to protect yourself against substantial – and potentially practice-threatening – penalties. Our federal health care fraud defense lawyers have extensive experience in federal civil and criminal cases, and we can use this experience to protect you.
7. Anti-Kickback Statute Compliance
The federal Anti-Kickback Statute prohibits doctors from offering, paying, soliciting, or accepting kickbacks, referral fees, and other forms of “remuneration” in relation to referrals of federal program beneficiaries. The Anti-Kickback Statute’s prohibitions are extremely broad; and, while there are a variety of “safe harbors” under the statute, securing safe harbor protection often requires a conscious effort to meet a specific safe harbor’s requirements.
8. Stark Law Compliance
The Stark Law is a federal civil statute that applies specifically to doctors. It prohibits doctors from providing referrals for “designated health services” to entities with which they have a financial relationship. While the Stark Law’s prohibitions are subject to a number of exceptions that are similar (but by no means identical) to the safe harbors under the Anti-Kickback Statute, violations are common, and doctors must make a conscious effort to avoid entering into transactions with Stark Law implications.
9. Medical Malpractice Insurance Claims and Litigation
Being accused of medical malpractice can affect you on a few different levels. From a legal perspective, the financial costs of a medical malpractice claim have the potential to be substantial, and accusations of malpractice can potentially lead to state licensing and federal law enforcement action as well. If you have been accused of medical malpractice, or if you are anticipating a medical malpractice lawsuit as a result of something that happened in your office or the operating room, we encourage you to contact us to discuss your options right away.
10. National Practitioner Data Bank (NPDB) Disputes
The National Practitioner Data Bank (NPDB) is a repository maintained by the U.S. Department of Health and Human Services (DHHS) that stores reports of adverse medical events, medical malpractice payments, civil judgments and criminal convictions, and federal program exclusions. NPDB records can be inaccurate for a variety of reasons, and there are a couple of different options for disputing inaccurate records with DHHS.
11. Practice Organization and Management
Running a doctor’s office requires you to appropriately form a legal entity (such as a professional corporation or limited liability company), maintain appropriate entity records on an ongoing basis, submit annual filings, and satisfy other ongoing legal obligations. Not only could failing to do so result in your practice being deemed noncompliant, but it could also expose you to personal legal liability.
12. Employment Contracts and Disputes
Employment-related legal issues often present stumbling blocks for physicians and other doctors. Whether you are negotiating an employment contract or severance agreement, facing an employment-related dispute, facing allegations of discrimination or harassment, or dealing with a federal employment tax audit or investigation, our lawyers can help you make informed decisions while providing you with skilled legal representation every step of the way.
Why Do Doctors Across the Country Choose Oberheiden, P.C.?
Our lawyers and consultants have represented doctors and other health care providers in more than 45 states across the country. Here’s why:
- Our Health Care Law Focus – We focus our practice on health care law, with particular emphasis on federal health care fraud defense. Our lawyers have extensive experience working with general practitioners, specialists, surgeons, radiologists and other doctors.
- Our Prior Government Experience – Several of our lawyers served as health care fraud prosecutors with the DOJ and the U.S. Attorney’s Office prior to entering private practice.
- Our Responsive and Custom–Tailored Legal Representation – We make ourselves readily available to our clients, and we offer custom-tailored legal solutions focused on the unique aspects of our clients’ medical practices.
- Our Deep Insights in Federal Health Care Matters – With centuries of combined experience, our lawyers and consultants offer deep insights for billing and coding compliance, Anti-Kickback Statute and Stark Law compliance, and other federal health care matters.
- Our Proven Results in Compliance, Audits, and Investigations – As a result of our focus, experience, and insights, we have accumulated a substantial record of success in complex and high-stakes health care law matters.
Speak with a Federal Health Care Lawyer at Oberheiden, P.C.
So, what can we do to help you? If you have questions or need to speak with an attorney, the first step is to schedule a free and confidential initial consultation. To request an appointment with a health care lawyer at Oberheiden, P.C., call us at (214) 692-2171 or tell us how we can help online today.