East New York Home Health Compliance Lawyers

For home healthcare providers in New York’s five boroughs – Brooklyn, Manhattan, Queens, Staten Island, and The Bronx – compliance failures can have severe consequences. Our East New York home health compliance lawyers and consultants can make sure that your practice, your license, and your personal freedom are secure.

Attorney Nick Oberheiden
East New York Healthcare Defense
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East New York meeting location – by appointment only: We do NOT accept mail or service at this location.
68 Jay St.
Brooklyn, NY 11201
888-680-1745

Home healthcare agencies serve a vital role in our society. They provide essential care to aging patients who are unable to seek treatment in a traditional medical setting, and this service provides much-needed peace of mind to seniors and their families. However, despite filling a critical gap in our nation’s healthcare system, home health agencies are subject to heavy oversight by federal authorities. When these authorities conduct audits and investigations, an effective compliance program can be the key to avoiding recoupments, fines, imprisonment, and other penalties. Once our East New York home health compliance attorneys know how much work needs to be done, then we can begin the process of developing a custom-tailored home health program that you can implement in all phases of your home health practice.

Compliance Lawyers and Consultants for Home Healthcare Providers in East New York

At Oberheiden, P.C., our health care lawyers and consultants provide comprehensive compliance services to home health agencies (HHAs) and certifying physicians throughout East New York. This includes HHAs and doctors in each of New York City’s five boroughs:

Brooklyn
Manhattan
Queens
Staten Island
The Bronx

Our compliance services start with a thorough needs assessment. Does your home health practice’s existing compliance program largely serve its purpose? Or, are there significant gaps that must quickly be filled? Can we supplement what you already have in place, or is it time for a complete overhaul?

Compliance Programs Focused on the Specific Needs of Medicare, Medicaid, Tricare, and DOL Home Health Providers in East New York

East New York Home Health Compliance Lawyers Home health agencies and certifying physicians that bill Medicare, Medicaid, Tricare, and/or any of the U.S. Department of Labor (DOL) healthcare benefit programs face a heavy compliance burden. Each of these programs has its own unique set of complex billing regulations, and all program-participating healthcare providers are subject to strict rules and prohibitions under federal healthcare law. Yet, while most home healthcare providers face the same legal challenges, in order to be maximally effective, a compliance program must be custom-tailored to the unique aspects of each individual provider’s practice. Our East New York home health compliance lawyers and consultants work closely with our clients to ensure that we are offering relevant, comprehensive, and actionable compliance advice that our clients can immediately put into practice.

So, what does it take for a home health agency or certifying physician in New York to avoid federal fraud charges as the result of an audit or investigation? Typically, our home health compliance programs focus on issues such as:

Program Billing and Coding Compliance – Like all healthcare providers, home health agencies and certifying physicians must have adequate controls in place to prevent upcoding, unbundling, phantom billing, and other common billing and coding violations.

Patient Marketing – Improper marketing arrangements and referral agreements can expose home healthcare providers to substantial penalties under the Anti-Kickback Statute and the Stark Law.

Medical Director Agreements – Medical directorships present Anti-Kickback Statute and Stark Law concerns as well. This is true for the medical director and the home health agency.

Third-Party Billing Administrator Agreements – Even if you engage a third-party billing administrator to handle your Medicare, Medicaid, Tricare, or DOL coding, any mistakes will ultimately remain your responsibility.

Patient Certifications and Re-Certifications – Certification and re-certification practices are often at the center of home health fraud investigations. HHAs and certifying physicians must both take adequate measures to prevent improper certifications.

“Homebound” Determinations – One issue with certifications is the determination of the patient’s “homebound” status. Certifying patients who are not truly homebound may be prosecuted as intentional healthcare fraud.

Home Health Not Preceded by Hospital or Nursing Home Stay – Certifying patients without a hospital or nursing home stay is a red flag for auditors and federal investigators as well. Without proof of justification, certifications will be second-guessed and heavily scrutinized.

Primary Diagnosis Insufficient to Justify In-Home Care – Hypertension, diabetes, high blood pressure, obesity, mental illness, and pain are all common conditions among aging patients, but none of these are independently sufficient to justify in-home care.

Care Plan Establishment, Review, and Adherence – All home health services must be provided pursuant to a care plan established and periodically reviewed by the patient’s physician.

Provision of Skilled Services Under the Care of a Physician – In the home healthcare context, services that are eligible for program reimbursement include skilled nursing care, physical therapy, speech language pathology, and continuing occupational therapy. There are some fine lines, and HHAs will often need to be able to demonstrate that their billings are justified.

“Face-to-Face Encounters” Between Patients and Physicians – Home health certifications should be based upon face-to-face encounters between patients and physicians (which should be meticulously documented). Home health patients must have ongoing interactions with their doctors as well (which, again, should be documented).

Documentation of Medical Necessity – In all situations, home health agencies and physicians must document the medical necessity of the services they provide. Without proof of medical necessity, otherwise eligible services will not qualify for reimbursement.

Repeat Home Health Readmissions – Repeated readmissions are another red flag for auditors and federal investigators. When readmitting a patient, there should be a clear basis for doing so and the grounds for the decision should be carefully documented.

Compliance Violation Response and Remedy – When someone in your practice identifies a compliance violation, written policies and procedures must be followed to respond to and remedy the violation as quickly as possible.

Home Health Agency Medicare Certification – Could your home health agency obtain Medicare certification today? While certification is a one-time event, failure to continually satisfy the certification criteria can be grounds for denial of payment and program exclusion.

Documentation, Implementation, and Response: The 3 Keys to Effective Home Health Compliance

Once you know what issues you need to address, the next step is to determine how to address them. Based upon our experience with home health compliance and on both sides of federal healthcare fraud investigations and prosecutions, we have identified three keys to effective home health compliance:

1. Documentation of Policies, Procedures, Medical Necessity, and Compliance Efforts

Even if your home health practice is fully compliant, if you do not have the documentation to prove it, you are still going to be at risk during an audit or federal investigation. As a result, thorough documentation is at the core of any effective home health compliance program. Our East New York home health compliance attorney emphasizes ensuring that our clients have the policies, procedures, proof of medical necessity, and other documentation they need in order to quickly terminate audits and investigations in their favor. This includes:

Practice-wide compliance policies and procedures
Implementation and training documents
Medical necessity documentation and records storage
Written agreements with marketing agencies, medical directors, and other third parties
Violation of response policies and procedures
Internal reporting and disciplinary procedures
Documentation of internal compliance assessments and compliance program updates

2. Implementation of Compliance Policies and Procedures Practice-Wide

Home health agencies and certifying physicians don’t just need to have compliance policies, they need to effectively implement these policies as well. Medical professionals play a critical role in ensuring that compliance policies are effectively implemented and adhered to across the practice. Implementation should be conducted on a practice-wide scale, and it should include policy dissemination, training, feedback, and response. If a compliance policy has been implemented effectively, all personnel should understand their role in ensuring continual compliance, they should know how to identify compliance issues and how to report them, and they should have an adequate appreciation of why compliance considerations must always remain in mind.

3. Identification, Response, and Remedy of Compliance Failures

Even with a comprehensive compliance program that has been fully implemented, mistakes still can and will occur. When they do, the response should be swift, and it should reflect the legal risks involved. While program-participating healthcare providers may have an obligation to self-report known billing violations, any self-reporting should only be conducted after thorough consultation with your home health agency’s or medical practice’s compliance counsel.

Responding to a compliance failure involves identifying the source of the failure, determining whether any systemic issues need to be addressed, and settling on a safe and effective path forward. Home healthcare providers must also determine whether disciplinary employment action is appropriate, and they must assess whether it is necessary to prepare for the possibility of an audit or investigation. At Oberheiden, P.C., in addition to serving as senior counsel, our East New York home health compliance lawyer also represents New York home healthcare providers in audits and investigations, and we have an extensive track record of protecting our clients against civil and criminal prosecution.

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Frequently Asked Questions

When should I contact an East New York federal healthcare fraud defense attorney?

The sooner you reach out to an attorney, the more options they will have to favorably resolve the case with as little expense and hassle as possible. It is best to secure the assistance of an East New York federal healthcare fraud defense attorney before an investigation commences. This way, the attorney can help identify any weaknesses in your practice’s compliance program to reduce the chances of raising the government’s attention. Of course, this is not always possible. However, an attorney’s assistance is even more critical once an investigation is underway. An East New York home health compliance lawyer can help you identify the scope of the investigation, understand what is at stake, and help you develop an effective response. Often, these cases can be resolved without the filing of formal charges. To learn more about the best way to deal with a healthcare fraud investigation, contact an East New York federal healthcare fraud defense attorney today.

What is the Anti-Kickback Statute?

The Anti-Kickback Statute (AKS), codified in 42 U.S.C. §1320a–7b, is a federal law that prevents certain referrals for patients receiving government benefits through Medicare, Medicaid or other federally funded programs. The AKS prohibits the offering, paying, soliciting, or receiving anything of value in exchange for patient referrals. While cash referrals form the basis of most AKS violations, the statute covers the exchange of anything of value. For example, this includes expensive vacations, favors, meals, or even employment opportunities. The AKS is a criminal statute, and a conviction carries potential jail time other criminal sanctions, up to five years in state prison for each offense. However, those in violation may also face civil liability under the False Claims Act. If you are facing a violation under the Anti-Kickback Statute, it is crucial you protect yourself by reaching out to a dedicated East New York federal healthcare fraud defense attorney immediately.

Does the federal government take whistleblower claims seriously?

Yes, and in some cases, the government will intervene in the lawsuit. When a whistleblower approaches federal investigators with evidence of possible healthcare fraud, the government is bound to conduct its own investigation. If the allegations are significant and supported by enough evidence, the government may decide to take the case. If the federal government chooses not to intervene, that doesn’t mean the case will go away, as the whistleblower has the option to continue with the case at their own expense. Most whistleblowers do this because they stand to recover a portion of the total amount recovered in the event their case is successful. If you are at the center of a whistleblower’s allegations, reach out to a knowledgeable East New York federal healthcare fraud defense attorney as soon as possible.

Schedule a Complimentary Home Health Compliance Needs Assessment Today

For more information about our legal services for home health agencies and certifying physicians in New York, please contact us to schedule a complimentary home health compliance needs assessment. Each East New York home health compliance attorney has extensive experience working with health systems, ensuring that all aspects of compliance are thoroughly addressed. You can reach our East New York home health compliance attorneys by phone or online 24/7 888-680-1745 or tell us how we can help online now.