Federal Workers’ Compensation Consultants Answer DOL Health Care Providers’ FAQs
As a physician, chiropractor, physical therapist, billing administrator, or other health care provider that bills the U.S. Department of Labor (DOL) under one of its workers’ compensation programs for private or public employees, compliance is a consistent concern. Hiring an experienced federal workers’ compensation consultant can help alleviate the stress and uncertainty of DOL compliance, and Oberheiden, P.C.’s team of consultants offers centuries of combined experience in all federal health care matters.
As federal workers’ compensation lawyers and consultants, we constantly hear from health care providers who have serious questions about their obligations under the DOL’s benefit programs. Here you will find answers to 15 frequently-asked questions (FAQs) about:
- Federal workers’ compensation laws, rules, and regulations;
- DOL billing compliance;
- Facing a federal workers’ compensation audit or investigation; and,
- Working with the federal workers’ compensation consultants at Oberheiden, P.C.
Federal Workers’ Compensation Laws, Rules and Regulations
Q: What are the worker’s compensation rules for health care providers who bill the DOL?
Health care providers that bill the DOL under the Federal Employees’ Compensation Program and other federal workers’ compensation programs must comply with numerous rules and regulations. These rules and regulations govern virtually all aspects of billing for services provided to injured workers, from what services qualify as “medically necessary” to the specific billing codes that must be used under specific circumstances (i.e. when services are required to be “bundled” rather than billed separately). Health care providers must strictly and consistently comply with all of the federal workers’ compensation rules and regulations in order to avoid scrutiny from the DOL’s Office of Inspector General (OIG).
Q: What federal statutes apply to health care providers that serve DOL workers’ compensation program beneficiaries?
Health care providers that serve DOL workers’ compensation program beneficiaries are subject to all of the federal laws that apply to providers that bill other programs (such as Medicare and Medicaid). This includes, but is by no means limited to:
- Anti-Kickback Statute
- False Claims Act
- Health Care Fraud Statute
- Stark Law
Violations of the federal workers’ compensation rules and regulations can trigger various provisions of each of these statutes; and, depending upon the circumstances involved, health care providers can potentially face civil or criminal prosecution by the OIG and the U.S. Department of Justice (DOJ).
Billing for Medical Services Provided Under DOL Workers’ Compensation Programs
Q: What is the National Council on Compensation Insurance (NCCI), and how is it relevant to health care providers who bill the DOL?
The National Council on Compensation Insurance (NCCI) is an independent organization that developed the code classification system used under DOL workers’ compensation programs and under many state workers’ compensation systems. More information is available in the Federal Issues section of NCCI’s website.
Q: Why is workers’ compensation code 8810 an issue for employers? What do providers who treat employees assigned workers comp code 8810 need to know?
Workers’ compensation code 8810 is the classification code assigned to clerical office employees. These employees are generally viewed as among the least likely to be at risk for being injured on the job. As a result, the insurance rates for employers are lower, and this often leads to questions as to whether employees have been properly classified with code 8810 or they have been intentionally misclassified in an effort to reduce the cost of workers’ compensation coverage.
While this is an issue for employers, its practical impact for workers’ compensation health care providers should be minimal—provided they are unaware that the employee has been improperly classified. The concerns are even further mitigated under DOL programs. Nonetheless, it is important for health care providers to be aware of these types of issues, as the OIG, DOJ, and other agencies may try to jointly charge employers, health care providers, and other entities as “co-conspirators” in large-scale health care fraud investigations.
Q: What should clinics and health care providers do if they believe an employer has applied the wrong workers’ comp class code?
As a health care provider that treats injured employees under a DOL workers’ compensation program, if you believe that a worker may have been improperly classified with the wrong workers’ comp class code, or if you otherwise believe that a patient may not be eligible for DOL workers’ compensation benefits, you should discuss the issue with your federal workers’ comp consultant or legal counsel. Even if you are not complicit in a fraudulent scam, failing to take action to prevent fraud can still lead to legal issues—particularly if you are “willfully ignorant” in billing the DOL for services that are ineligible for reimbursement.
Q: What should clinics and health care providers do if they believe that a worker has misrepresented the cause of his or her injury or illness?
In order to be eligible for workers’ compensation benefits from the DOL, a program beneficiary must suffer a job-related injury or illness. Unfortunately, due to lack of access to private medical insurance, individuals will sometimes falsely claim eligibility for workers’ compensation coverage. If you believe that a patient has misrepresented the cause of his or her injury or illness, this too is an issue that you will want to discuss with your legal counsel or workers’ comp consultant. Typically, these types of issues will need to be handled on a case-by-case basis.
Q: What else do health care providers who treat employees under DOL workers’ compensation programs need to know about workers’ comp class codes?
Class codes and billing codes are central to the federal workers’ compensation system. When billing the DOL, clinics and other health care providers must ensure that they have an adequate understanding of the rules regarding employee classifications and billing codes in order to avoid billing for non-reimbursable services or expenses. Even unintentional oversights can lead to substantial penalties, and federal authorities look unfavorably upon health care providers that fail to devote sufficient time and resources to program compliance.
Facing a DOL Workers’ Compensation Audit or Investigation
Q: What do I need to know if my clinic or practice is being investigated by the OIG or facing a DOL workers’ compensation audit?
Facing an OIG investigation or DOL workers’ compensation audit is a serious matter that requires immediate attention. If you do nothing – or if you unnecessarily share information with the OIG or DOL – the consequences could be severe. Learn more about what to expect (and what to do) during a DOL inquiry.
Q: What are the potential penalties that can result from a federal workers’ compensation audit?
If an audit or investigation leads to civil charges under the False Claims Act or any of the other statutes listed above, potential penalties can include recoupments, fines, treble damages, attorneys’ fees, and program exclusion. If it leads to criminal charges, federal prison time could also be on the table.
Q: How can I protect my clinic or medical practice during a DOL workers’ compensation audit or investigation?
When facing a DOL workers’ compensation audit or investigation, the key to asserting a successful defense is to hire professional help right away. Experienced federal health care fraud lawyers and DOL workers’ compensation consultants will be able to determine the validity of the allegations against you and identify all legal and factual defenses you have available.
Q: What should I do if I am concerned that by clinic’s or medical office’s DOL billing practices are not fully compliant?
If you are concerned that your DOL billing practices may not be fully compliant, you should engage the services of a federal workers’ compensation consultant. The risks of non-compliance are simply too great to take your chances with an inadequate or outdated compliance program.
Q: What should I do if I am aware of DOL billing violations?
If you are aware of billing violations under the Federal Employees’ Compensation Program or any other federal workers’ compensation program, you need to approach the situation very carefully. Once again, hiring an experienced lawyer or consultant is the advisable course of action.
Hiring a Federal Workers’ Compensation Consultant
Q: How can federal workers’ compensation health care providers benefit from hiring an expense consultant?
Hiring an experienced expense consultant will allow you to bill the DOL with confidence. With a comprehensive compliance program in place, you can efficiently and accurately bill the DOL without putting your clinic or practice at risk in the event of an audit or investigation.
Q: What should I be looking for during an internal audit for DOL workers’ compensation billing compliance?
Conducting an internal audit is a critical first step for developing a comprehensive DOL compliance program. During this audit, your federal workers’ compensation consultants will be looking for information about what your practice is doing right, what it may be doing wrong, and how you can most-efficiently implement an effective compliance program.
Q: What other services can a federal workers’ compensation consultant provide to DOL-participating health care providers?
At Oberheiden, P.C., our federal workers’ compensation lawyers and consultants offer comprehensive representation and advice to program-participating health care providers. Whether you are starting a new clinic, seeking to begin billing the DOL, in need of a compliance program overhaul, or have been contacted by the OIG, we can help make sure your practice is secure.
Speak with a Federal Workers’ Compensation Consultant for Free
If you have additional questions about DOL compliance and would like to speak with a federal workers’ compensation consultant at Oberheiden, P.C., we encourage you to get in touch. To schedule a free, no-obligation consultation, please call (214) 692-2171 or contact us online today.