Las Vegas Home Health Compliance Lawyers
As a home health care provider or certifying physician in Las Vegas, compliance needs to be one of your top priorities. Our federal health care lawyers and consultants can help make sure you are not exposing yourself and your staff to the risk of civil or criminal prosecution.
While many aspects of home health compliance may seem overburdensome, unnecessary, and even antithetical to quality patient care, agency owners and certifying physicians must make decisions regarding compliance in light of the realities of today’s law enforcement environment. Federal authorities including the Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General (OIG), and the U.S. Department of Justice (DOJ) are actively targeting the home health sector in Las Vegas, and non-compliant service providers are facing severe penalties – including recoupments, fines, program exclusion, and even federal imprisonment.
As a result, home health agencies (HHAs) and certifying doctors in Las Vegas need to take their compliance efforts very seriously. Questions cannot be left unanswered, and nothing can be left to chance. When auditors or federal investigators show up at your door, “I didn’t know,” is not going to be a valid defense. In fact, in our experience, the majority of federal health care fraud audits and investigations target unintentional billing violations. Federal laws including the False Claims Act and the Anti-Kickback Statute penalize mistakes regardless of intent, and all providers are expected to adopt compliance programs that are appropriately-tailored to their federally-funded practices.
We Provide Comprehensive Compliance Services to Home Health Agencies and Certifying Physicians in Las Vegas
Our firm provides comprehensive compliance services to home health agencies and certifying physicians in Las Vegas. From our initial compliance assessment through the implementation of our custom-prepared compliance program throughout all levels of your HHA or medical practice, we will work closely with you to ensure that we are offering solutions that provide comprehensive protection in light of the unique aspects of your home health practice. We stake our reputation on our ability to protect HHAs, doctors, and other health care providers against federal prosecution for health care fraud; so, when you choose our firm to represent you, you can feel confident knowing that we have just as much of a stake in your compliance program as you.
With a compliance team that includes career health care fraud defense attorneys, former DOJ health care fraud prosecutors, and non-lawyer consultants and auditors, we are able to offer unique insights into the world of federal health care compliance. Our lawyers and consultants have centuries of combined experience, and we have worked with health care providers across the country. We understand the risks home health agencies and certifying physicians face – particularly in high-enforcement areas such as Las Vegas – and we rely on our experience to offer clear, practical, and effective compliance solutions for clients of all sizes.
What Does it Take to Maintain a Compliant Home Health Practice?
So, you know you need to focus on compliance. What does it take to maintain a home health practice (as either a home health agency or certifying physician) that complies with the applicable Medicare, Medicaid, Tricare, and U.S. Department of Labor (DOL) billing regulations, as well as the multitude of federal statutes that apply to program-participating health care providers?
When it comes to federal home health compliance, there is not a one-size-fits-all approach. Home health agencies and doctors must develop and implement customized compliance programs that reflect the unique risks they face on a daily basis. Examples of the types of issues that our lawyers and consultants will be looking to address within the specific context of your home health practice include:
1. Program Billing Compliance
Billing mistakes, no matter how “minor” in context, cannot be overlooked. Auditors and federal investigators will be looking for any evidence that your HHA or medical practice has overbilled the government, and civil penalties can include $11,000 per individual billing violation.
2. Patient Marketing
Relationships with marketing agencies, lead-generation firms, and health care providers who refer patients all need to be structured to avoid Anti-Kickback Statute and Stark Law implications. Unlawful payment of referral fees and other forms of “remuneration” are common, and most providers are unaware that their agreements violate federal law.
3. Medical Director Agreements
Medical Director (MD) agreements raise similar concerns. Any type of percentage-based or volume-based compensation structure is going to have potential Anti-Kickback Statute implications.
4. Third-Party Billing Administrator Agreements
Can you avoid the risk of a federal billing fraud investigation by delating billing duties to a third-party administrator? The DOJ has answered this question with a definitive, “No.” If you utilize the services of a third-party billing administrator, you need to be confident in your choice, you need maintain oversight of your home health billings, and you need to have strong contractual protections in the event that mistakes are made.
5. Patient Certifications and Re-Certifications
The processes of certifying and re-certifying patients for home health care services are fraught with legal implications for both the home health agency and the certifying physician. Improper certifications, oversights, lack of documentation, and financial incentives for certification are all common issues that can have severe consequences.
6. “Homebound” Determinations
Are you certain that all of your patients are truly “homebound,” as defined under the applicable program billing regulations? Determining whether a patient is a candidate for in-home care is as much about understanding the relevant billing rules as it is about making a medically-sound diagnosis.
7. Home Health Not Preceded by Hospital or Nursing Home Stay
Certifying patients for in-home care when the transition does not follow a period of hospitalization or nursing home residency is often viewed as a red flag by federal authorities.
8. Primary Diagnosis Insufficient to Justify In-Home Care
Similarly, certifications based solely on a diagnosis of hypertension, diabetes, high blood pressure, obesity, mental illness, or pain will often get home health agencies and certifying physicians into trouble. Both types of providers need to have clear guidelines in place to ensure that their certification practices do not trigger statutory or regulatory violations.
9. Care Plan Establishment, Review, and Adherence
Home health agencies must adhere to care plans that have been established by qualifying physicians, and these care plans must be reviewed on an ongoing basis. In addition to adhering to compliant care plans, home health agencies and physicians must also ensure that adherence efforts and reviews are documented consistently.
10. Provision of Skilled Services Under the Care of a Physician
Home health agencies face restrictions with regard to reimbursable services that do not apply to other types of health care providers. For example, in the home health context Medicare covers skilled nursing care, physical therapy, speech language pathology, and continuing occupational therapy – provided that these skilled services are rendered by or under the supervision of a qualifying physician.
11. “Face-to-Face Encounters” Between Patients and Physicians
Medicare also requires home health patients to have sufficient “face-to-face encounters” with their physicians. Consultations and treatment recommendations provided over the phone will not always be enough, and home health agency personnel cannot always serve as conduits between patients and physicians.
12. Documentation of Medical Necessity
Lack of documentation of medical necessity is a common theme in audits and investigations both within and outside of the home health sector. Even if a service is medically-necessary, if medical necessity is not clearly documented (with the documentation stored such that it can be located when necessary), there is a risk that recoupment will be sought during an audit or investigation.
13. Repeat Home Health Readmissions
While there are legitimate justifications for patient readmissions, auditors and federal investigators will generally view a high volume of repeat home health readmissions as a red flag. As a result, HHAs must have policies in place to adequately determine both: (i) when readmission is appropriate, and (ii) what documentation is necessary to support the decision to readmit.
14. Compliance Violation Response and Remedy
When mistakes happen, the response needs to be swift and direct. As a result, home health agencies and certifying physicians must also have policies in place for identifying, responding to, and remedying compliance violations.
15. Home Health Agency Medicare Certification
While Medicare certification is a preliminary step for serving federally-funded patients, complying with the conditions of certification is an ongoing process. Home health agency personnel need to be made aware of the conditions that are relevant to their job responsibilities, and ongoing compliance needs to be an active process.
We Do What is Necessary. Nothing Less. Nothing More.
Some of our clients have existing compliance programs that are pretty good, but just need a little bit more work. Others have programs with major deficiencies. Others still face substantial federal enforcement risks in multiple aspects of their home health practice. Whatever your HHA’s or medical practice’s needs may be, we will tailor our services accordingly. As your compliance lawyers and consultants, we work for you. Your satisfaction is our priority, and we want you to feel confident that you have made the right choice for home health compliance representation.
Schedule a Free Compliance Assessment at Oberheiden, P.C.
Do you have questions about home health compliance? Are you concerned that your Las Vegas home health practice is not fully compliant? To discuss your needs with a member of our federal home health compliance team in confidence, call us at (214) 692-2171 or request a free compliance assessment online now.