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CCM Defense and Compliance Services

We Provide Defense and Compliance Services to Chronic Care Management (CCM) Providers Nationwide

Lynette Byrd
Attorney Lynette S. Byrd
CCM Defense & Compliance Team Lead
Former DOJ Attorney
envelope iconContact Lynette directly

Chronic care management (CCM) providers need to prioritize compliance. Not only are CCM providers subject to the same laws and regulations that apply to all providers that bill Medicare, Medicaid, and other payors, but they are subject to additional rules and restrictions as well. Those that fail to prioritize compliance can face swift and severe consequences—including recoupments, fines, and other penalties.

We provide comprehensive CCM defense and compliance services to providers nationwide. If your practice provides chronic care management services, you need to be confident in its compliance program, and you need to be prepared to deal with federal scrutiny when necessary. The Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Justice (DOJ) are making CCM compliance enforcement a priority, and CCM providers must be able to affirmatively demonstrate compliance to avoid unnecessary consequences.

How We Help Chronic Care Management (CCM) Providers

We assist CCM providers with all aspects of federal defense and compliance. As a federal healthcare law firm, we have extensive experience interpreting and applying the multitude of laws, rules, and regulations that apply throughout the healthcare sector. This includes everything from the Medicare and Medicaid billing eligibility rules to the laws governing physician referrals, electronic prescriptions, and other aspects of day-to-day CCM practice.

CCM Defense Services

Since CMS and the DOJ are focusing on CCM compliance, providers need to be prepared for the very real possibility of facing a federal audit or investigation. As noted above, these inquiries can present substantial risks; and, while most enforcement actions are civil in nature, criminal charges are a possibility as well. If auditors or investigators find evidence to suggest that a CCM provider has intentionally billed for ineligible services or knowingly used Medicare-reimbursed funds to pay for patient referrals, then criminal charges could be on the table.

Our CCM defense services include:

  • Risk Assessment and Defense Preparation – Is your practice at risk? We can conduct a comprehensive risk assessment to determine your practice’s exposure. Then, we can help you put the protocols in place so that you are prepared to respond to an audit or investigation appropriately.
  • CCM Audit Defense – We represent CCM providers in audits conducted by Medicare’s fee-for-service auditors (i.e., MACs and RACs) and other entities. These audits can present substantial risks, and providers must play a proactive role in the process to ensure a fair outcome.
  • CCM Investigation Defense – We represent CCM providers during investigations conducted by the DOJ and all other federal law enforcement agencies. If your CCM practice is under investigation, it is imperative that you engage experienced defense counsel immediately.
  • Defense of Civil and Criminal Fraud Charges – If you are facing charges as the result of an audit or investigation, we can represent you in all subsequent proceedings. Our lawyers have extensive experience in this area, and we have successfully represented numerous healthcare clients in administrative, civil, and criminal enforcement matters.

CCM Compliance Services

Chronic care management providers can reduce their risk of facing federal scrutiny by adhering to robust compliance programs. There is no one-size-fits-all CCM compliance solution; and, to meet their federal obligations, CCM providers must assess and address their specific compliance needs. Our CCM compliance services include:

  • Compliance Needs Assessment – We rely on our extensive experience in the federal healthcare sector to fully assess our clients’ compliance needs. We critically evaluate our clients’ current compliance efforts in all key areas, including (but not limited to) practitioner and patient eligibility, billing compliance, prescription compliance, and patient consent.
  • Compliance Program Development – After assessing our clients’ needs, our lawyers then craft custom-tailored compliance programs. Our CCM compliance programs are fully comprehensive and designed to facilitate effective compliance management on an ongoing basis.
  • Compliance Program Implementation – Implementation is key to effective compliance management. We provide training, contract negotiation, and other services to help our clients fully implement their CCM compliance programs.
  • Compliance Monitoring, Auditing, and Enforcement – We also help our clients manage their CCM compliance efforts on an ongoing basis. Our lawyers provide monitoring and auditing services designed to spot potential issues before they lead to problems, and we assist our clients with enforcing their employees’ compliance responsibilities internally when necessary.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd
Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester
Brian J. Kuester

Former U.S. Attorney

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney

Local Counsel

John W. Sellers
John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara
Linda Julin McNamara

Federal Appeals Attorney

Aaron L. Wiley
Aaron L. Wiley

Former DOJ attorney

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (DOJ)

Chris Quick
Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow
Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Speak with a Federal Healthcare Lawyer at Oberheiden P.C.

If you would like more information about our CCM defense and compliance services, we invite you to get in touch. Please call 888-680-1745 or contact us online to arrange a complimentary consultation.

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