The Ultimate Guide to Mobile Healthcare Services
The sudden and widespread nature of the COVID-19 pandemic caught the country—and the world—off guard. In response to the alarming rate at which COVID-19 spread through the country, healthcare providers set up thousands of mobile healthcare clinics. However, mobile clinics have been around long before COVID-19.
Hospitals remain overcrowded, and will likely remain at or near capacity for the foreseeable future. Additionally, patients are now less willing to enter a hospital, knowing about the risk of transmission. The result is that mobile healthcare clinics will likely play an increasingly important role in providing medical services. This is especially the case as the state and federal governments work together to roll out the various COVID-19 vaccines, many of which will be administered at mobile vaccination clinics.
However, the laws and regulations governing mobile healthcare clinics are constantly changing, making it difficult for those who run these clinics to ensure their ongoing compliance. While the government relies on medical professionals stepping up during a time of need to provide much-needed service to citizens, it has also made clear its concern about the growing number of healthcare fraud cases involving mobile clinics.
If you have questions about whether your mobile healthcare clinic is in compliance, or recently learned that you are under federal investigation for healthcare fraud, waste no time in reaching out to the dedicated federal healthcare fraud defense attorneys at Oberheiden, P.C. Our knowledgeable team of attorneys consists of several former senior prosecutors and trial attorneys with the U.S. Department of Justice (D.O.J.), former agents with the Federal Bureau of investigation, and nationally renowned trial attorneys. We have centuries of combined experience helping healthcare professionals avoid civil and criminal liability, and look forward to meeting with you to discuss how we can help.
What Are Mobile Clinics?
A mobile healthcare clinic consists of a vehicle that travels to various community centers in urban and rural areas to provide a variety of healthcare services to patients. The primary benefit to mobile healthcare clinics is that they bring medical care to the patient. This not only saves patients time and money, but also increases the likelihood of patients seeking much-needed medical care.
Overall, mobile healthcare clinics have a positive impact on society because they appeal to patients who may otherwise overlook their health issues for fear of travel, or their inability to get to larger hospitals. During the ongoing pandemic, especially, increasing the availability of safe healthcare and more broadly distributing vaccines may actually help to curb the further spread of COVID-19. However, despite the valuable benefits of mobile clinics, they are the current focus of regulatory enforcement.
While some mobile healthcare clinics provide general healthcare to patients, most mobile healthcare clinics provide specialized services. A few of the most common types of mobile clinics include:
- Mobile Electromyography (E.M.G.) Clinics
- Mobile Electroencephalogram (E.E.G.) Clinics
- Mobile Electrocardiogram (EKG) Clinics
- Mobile Toxicology Clinics
- Mobile Blood Testing Clinics
- Mobile Genetic Testing Clinics
- Mobile Hospice Care Clinics
- Mobile Home Health Care Clinics
- Mobile Radiology Clinics
- Mobile Vaccine Clinics
- Mobile X-ray Clinics
Of course, there are many other types of mobile clinics, including those that provide emergency medical care and dental services. Some mobile healthcare clinics will even provide home visits for home-bound patients.
The Government’s Concern About Mobile Healthcare Clinic Fraud
Mobile healthcare clinics present several potential areas of concern for federal law enforcement agencies and prosecutors. At Oberheiden, P.C., we are prepared to effectively address any claim of healthcare fraud related to the operation of a mobile clinic. A few of the issues we most often see involve the following:
Anti-Kickback Statute Violations
The Anti-Kickback Statute (A.K.S.), codified in 42 U.S.C. §1320a–7b, is a federal law prohibiting a medical provider from offering, paying, soliciting, or receiving money—or anything else of value—in exchange for patient referrals, when the patient’s medical bills are paid by any federally funded program. While many cases involving alleged violations of the A.K.S. involve the payment of money for referrals, other common kickbacks include lavish meals, expensive hotel-stays or vacations, prestigious or high-paying positions. The A.K.S. is a criminal law, and can carry the possibility of incarceration and other criminal sanctions. However, those in violation may also face civil liability under the False Claims Act.
Stark Law Violations
The Stark Law, named after Democratic Congressman from California, Pete Stark, is codified in 42 U.S.C. § 1395nn. The Stark Law is similar to the Anti-Kickback Statute and the Eliminating Kickbacks in Recovery Act of 2018 in that it places a limit on physician referrals. Specifically, the Stark Law prohibits healthcare providers from referring patients to another provider if the referring provider has a financial interest in the practice they are referring a patient to. The Stark Law is unique among criminal law statutes in that it is a strict liability offense, meaning prosecutors do not need to prove that a physician intended to violate the law, making the referring physician’s intent irrelevant. Violations of the Stark Law can also result in civil liability under the False Claims Act.
The Anti-Kickback Statute and the Eliminating Kickbacks in Recovery Act of 2018 (EKRA), is the most recently passed statute regulating physician referrals. Codified in 18 U.S.C. § 220, EKRA focuses on curbing the widespread prevalence of opioid addiction in the United States. EKRA prohibits mobile laboratory clinics and mobile toxicology clinics from soliciting or receiving any form of remuneration related to patients in need of treatment for their addiction. Additionally, EKRA makes it illegal for anyone to solicit or receive remuneration for a patient referral to any of these facilities. While EKRA is similar to the A.K.S. in many ways, two primary differences are that EKRA applies to privately paid services and, generally, punishes violators more severely. EKRA is a criminal statute; however, like the A.K.S. and the Stark Law, a violation of EKRA can also be prosecuted under the False Claims Act.
D.E.A. Compliance Issues
For those mobile healthcare clinics that provide addiction treatment services or otherwise prescribe controlled substances, ensuring compliance with the Drug Enforcement Administration (D.E.A.) is crucial. Common issues that can lead to D.E.A. enforcement action include:
- Forging a prescription for a patient;
- Failing to pursue non-narcotic treatment options;
- Improper storage of controlled substances; and
- Allowing unauthorized access to narcotic medication.
Mobile healthcare clinics that prescribe or dispense controlled substances must develop a strict compliance program, focusing on:
- Implementing thorough intake procedures;
- Investigating non-narcotic therapy options;
- Performing comprehensive examinations before prescribing medication; and
- Conducting periodic audits to ensure staff compliance.
Billing Compliance Issues
Given the complexities of state and federal regulations, medical billing is more of an art than a science. Regulations are constantly in flux, making it extremely difficult to identify a compliance program that survives the test of time. However, billing compliance is crucial for mobile healthcare clinics, especially because federal law enforcement agencies have begun reviewing these clinics and their practices with a fine-tooth comb. Common billing compliance issues facing mobile healthcare clinics include:
- Billing for medical services that were not provided;
- Incorrectly coding legitimately performed medical procedures;
- Billing multiple times for a single course of treatment;
- Billing under a physician’s name that was not present or did not treat the patient; and
- Billing one procedure under several separate billing codes to increase the amount reimbursed.
Billing compliance issues are some of the most common types of healthcare fraud. Thus, federal law enforcement agencies are on the look-out for any red flags indicating a mobile healthcare clinic is in violation of the law.
Licensing and Registration Compliance Issues
The sudden and urgent need for mobile clinics has led to a situation, on more than one occasion, in which healthcare providers fail to obtain all the necessary licenses and registrations before opening shop. At Oberheiden, P.C., we work with mobile healthcare clinic operators and physicians to ensure they are in compliance, and also represent these parties when they are under investigation for running a clinic without the necessary certifications.
Telemedicine Compliance Issues
While mobile healthcare clinics make access to healthcare much easier than before, many patients are still unable to make it to a clinic. Thus, mobile clinics frequently offer telemedicine or telehealth treatment services. For example, earlier on during the pandemic, especially, telehealth was crucial in getting patients tested for COVID-19. While telehealth was previously a very highly regulated area, as telehealth services become more widely used, regulations are becoming increasingly burdensome for providers. At Oberheiden, P.C., we advise all types of mobile telehealth clinics to ensure their ongoing compliance.
COVID-19 Compliance Issues
The COVID-19 pandemic has left hundreds of thousands of Americans in a vulnerable position. Because of this, federal law enforcement agencies are on high alert for any possible signs that a healthcare provider—including mobile healthcare clinics—are taking advantage of patients or federally funded programs, such as Medicare and Medicaid. At the same time, maintaining compliance in the wake of the COVID-19 pandemic is a real challenge, as the regulations governing the provision of healthcare are constantly in flux. Oberheiden, P.C., is one of the few federal healthcare fraud defense firms that has been advising clients on COVID-19 compliance since the beginning of the pandemic.
Unnecessary Medical Testing or Procedures
The False Claims Act provides that payment is not permitted for items or services which are “not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” This pertains to any treatment payable by any federally funded program, including Medicare and Medicaid. Mobile healthcare clinics that provide medical testing or conduct outpatient procedures, such as E.M.G. clinics, EKG clinics, E.E.G. clinics, X-ray clinics, and genetic testing clinics, are frequently targeted by federal law enforcement agencies for ordering unnecessary testing. If a mobile healthcare clinic orders what is later determined to be an unnecessary test or procedure, the clinic’s operator (as well as the ordering physician) may face civil liability under the False Claims Act. Even if a physician orders a test, a mobile lab must make an independent determination that the patient’s diagnosis supports the testing. This is because the lab, rather than the ordering physician, is the party submitting the claim for reimbursement.
An Example of a Mobile Clinic Fraud Case
While mobile healthcare clinics have recently come under heightened scrutiny, regulation is nothing new for these facilities. Over recent years, there have been several high-profile cases in which federal law enforcement agencies successfully pursued civil and criminal liability against mobile healthcare clinics. Below is just one example:
Several Physicians in Mobile Doctors Group Arrested on Medicare Fraud
In 2013, federal agents searched two locations of a mobile healthcare practice, seizing $2.6 million in what the U.S. attorneys classified as fraud proceeds. The Chicago-based group was allegedly billing Medicare for procedures that the group claimed were more complex than they were in reality. The practice group allegedly billed under Medicare codes that offered the highest reimbursement, although the amount of time spent with each patient was only between 10 and 30 minutes. The doctors also faced accusations that they falsely certified their patients were home-bound. Ultimately, the case resulted in several convictions. The C.E.O. of the practice group was sentenced to 15 months in jail and ordered to pay $1.8 million in restitution.
At Oberheiden, P.C., we have a track record of success when it comes to representing clients charged with federal healthcare fraud. Below are just a few examples of recent cases we’ve handled:
- United States v. Client: An Oberheiden, P.C. client was indicted for Medicare Fraud. The government claimed the damages to be $7 million. We obtained probation for our client.
- United States v. Client: An Oberheiden, P.C. client was indicted for Medicare Fraud. The government claimed the damages to be $3 million. We obtained probation for our client.
- United States v. Client: An Oberheiden, P.C. client was indicted for Medicare Fraud. The government claimed the damages to be $1 million. We obtained probation for our client.
These represent only a few of our success stories; there are countless others. When you bring Oberheiden, P.C. onto your defense team, you can rest assured you have a knowledgeable advocate who will be at your side every step of the way.
Mobile Healthcare Clinics Should Focus on Compliance, then Defense
As John F. Kennedy once said, “The time to repair the roof is when the sun is shining.” At Oberheiden, P.C., we take compliance seriously. While we offer an aggressive defense to those mobile clinics that are already under investigation, we also work with mobile healthcare clinics to develop comprehensive compliance protocols to prevent them from coming under federal scrutiny in the first place. Our dedicated team of healthcare fraud defense attorneys has a long history of developing sound strategies that, when properly followed, ensure compliance.
Contact a Mobile Healthcare Clinic Defense Law Firm for Immediate Assistance
If you operate a mobile healthcare clinic, and either have questions about whether your clinic is fully compliant or recently learned that you are under federal investigation for healthcare fraud, reach out to the dedicated federal defense attorneys at Oberheiden, P.C. as soon as possible. Our team of attorneys has centuries of combined experience working with healthcare professionals to ensure compliance. We also aggressively defend physicians and operators of mobile clinics in federal healthcare fraud investigations. To speak with a senior attorney or compliance consultant at Oberheiden P.C. in confidence, call 888-680-1745 or inquire online now.