Miami, FL Hospital Compliance and Audits

The federal government is dedicated to fighting abuse, fraud, and waste in the healthcare system. Hospitals in large cities like Miami are the key targets of these fights because of their high susceptibility to these occurrences. Therefore, compliance should be a priority in hospitals, and if federal authorities launch investigations or audits, the suitable defense is crucial.

United States hospitals carry a lot of compliance obligations. When they receive a patient, they must determine the urgency of the situation, respond appropriately, offer a proper diagnosis, and offer the necessary treatment. Additionally, they should take measures to ensure they’re fully compliant with all the federal laws that regulate their various functions.

The federal government has regulations that manage practically all aspects of how hospitals operate, from the characterization of workers to contracts with third parties. While the obligations are broad, these institutions should strive to comply with them to avoid problems that may result in significant liabilities. If federal authorities investigate or audit a hospital and find cases of non-compliance, they can hold the responsible parties accountable for their actions.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

John W. Sellers
John W. Sellers

Former Senior Trial Attorney
U.S. Department of Justice

Local Counsel

Joanne Fine DeLena
Joanne Fine DeLena

Former Assistant U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney & Former District Attorney

Local Trial & Defense Counsel

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Aaron L. Wiley
Aaron L. Wiley

Former Federal Prosecutor

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (OIG)

Gamal Abdel-Hafiz
Gamal Abdel-Hafiz

Former Supervisory Special Agent (FBI)

Chris Quick
Chris Quick

Former Special Agent (FBI & IRS-CI)

Kevin M. Sheridan
Kevin M. Sheridan

Former Special Agent (FBI)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Dennis A. Wichern
Dennis A. Wichern

Former Special Agent-in-Charge (DEA)

Hospital Compliance and Audit Defense Attorneys in Miami, FL

Oberheiden P.C. is a well-known law firm that handles all matters concerning hospital compliance in Miami, FL, and across the United States. Whether a hospital wants to develop a comprehensive compliance program or is being investigated for potential non-compliance, we can provide the much-needed legal representation. We have experienced attorneys and consultants in the healthcare industry who have investigated and prosecuted for various agencies such as the U.S. Department of Labor (DOL), U.S. Department of Justice (DOJ), U.S. Drug Enforcement Administration (DEA), U.S. Department of Health and Human Services (DHHS), and others.

We don’t represent Miami hospitals alone; we’ve networked with attorneys and consultants throughout the country to serve hospitals no matter their location. We have also helped tens of institutions avoid significant liabilities for non-compliance issues. If you need hospital compliance assistance, we encourage you to contact us today for immediate action.

10 Major Elements that Make an Effective Hospital Compliance Program

When it comes to developing compliance programs for Miami and nationwide hospitals, various aspects need comprehensiveness and proper implementation. We have lawyers and consultants who are suitably knowledgeable in offering the required representation, and they can work with any relevant personnel to assess a hospital’s needs and risks and create adequate procedures and policies. Since various hospitals are different, we tailor everything to suit each one’s specific requirements.

Here are 10 major elements that make efficient compliance programs for hospitals. In each of these elements, we address even the smallest issues to protect the institution from liabilities in case it’s investigated or audited.

1. Compliance Program Documentation

There should be proper documentation of all the policies and procedures, and they should be thorough enough to cater to all the relevant compliance burdens. The persons responsible for documenting the compliance program should also do it with the specific hospital’s structure and organization in mind for effective implementation. Specificity is crucial; there is no ‘standard’ format dictating how a compliance program should be. The required efficacy may not be produced if everything is not custom-tailored based on an institution’s unique needs.

2. Contracts Involving Employees and Independent Contractors

Employment is a factor that is particularly challenging for different hospitals. It’s vital for the institution to clearly classify everyone involved in the hospital’s operations as either employees or independent contractors. If the hospital management isn’t keen to classify personnel suitably, the Internal Revenue Service (IRS), as well as the Florida Comptroller, can hold the responsible parties accountable. Additionally, a hospital should ensure the contracts it has with employees and independent contractors have enough protection measures to safeguard it from liability risks.

3. Proper Personnel Education and Training

After creating a comprehensive compliance program, next is the implementation process. Generally, the implementation process starts with the provision of education and training to all the relevant personnel. While educating and training, the process should be customized depending on the duties performed by either the employee or contractor, and the hospital should document it upon completion.

4. Compliance with Hospital Marketing Obligations

Many hospitals are not keen on the aspect of marketing in hospital compliance. They tend to overlook it, but it’s a high-risk area. When marketing their services, hospitals should make sure they’re not risking accusations involving the payments of DOL leads, Medicaid, Tricare, or Medicare using program-reimbursed funds. Hospitals can advertise themselves without risking trouble with federal authorities, but they first need to understand all the laws and regulations governing the marketing process.

5. Contracts Involving Third-Parties

In addition to contracts concerning employees and independent contractors, hospitals should also be fully compliant with regulations governing contracts with third parties such as suppliers and billing companies. While these institutions should be primarily concerned about their contracts with billing companies, they should draft all agreements with third parties with enough protection measures, which are vital to shield the institution from potential risks and liabilities.

6. Billing and Coding Compliance

Hospitals and other healthcare should make sure they abide by billing and coding provisions. Unlawful practices when it comes to billing the DOL, Tricare, Medicaid, or Medical can lead to the recoupment of funds by federal authorities, civil monetary penalties (CMP), being excluded from various programs, and other substantial penalties. These can happen even if the billing occurred through a third-party company. As an administrator or executive, you should make sure your hospital abides by billing and coding compliance obligations, and also document your compliance efforts in case of any investigation or audit.

7. Internal Reporting of Compliance Violations

A hospital may strive to observe the established rules and regulations, but sometimes mistakes can happen inevitably. That’s why you should include understandable methods to anonymously report instances of non-compliance or any cases of violations that you suspect may have occurred. The reporting channel should be clear, and hospital administrators must be ready to act fast after receiving information about a potential non-compliance issue.

8. Compliance Violation Response

Apart from reporting, a compliance program should also include measures concerning violation response. The response may be internal, where the institution disciplines the responsible parties. The response can also be external, where the hospital determines whether it’s necessary to self-report. If a violation happens and the institution doesn’t take steps to address it, it can grow into a bigger problem that may be costly to resolve.

9. Recordkeeping and Documenting on an Ongoing Basis

There are times when a hospital will need to defend itself in an audit or investigation. During those times, well-organized documentation plays a massive role in ensuring effective defense. A hospital should not only document its policies and procedures in a comprehensive program, but it should also record its compliance efforts on an ongoing basis. And to easily retrieve these documents when needed, they should be stored in an organized manner.

10. Audit Defense Preparedness and Response

Hospitals can and will be audited for a variety of reasons. With this in mind, they should set up proactive defense measures in preparation for audits or investigations that may occur in the future. Defense preparedness should include procedures to follow, instructions to various personnel on how they should act when contacted by auditors or investigators, and a checklist of steps to avoid mistakes and liabilities.

12 Compliance Mistakes that Auditors Commonly Look For During Audits

When auditors evaluate a hospital’s compliance program and documentation of ongoing compliance efforts, they’ll be looking for several deficiencies. Depending on what they find, they may decide to conduct additional investigations. Even with proactive defense measures, avoiding liability wholly can be challenging if significant violations are found. Here at Oberheiden P.C., the following are 12 hospital compliance mistakes our attorneys and consultants have noticed while representing various clients over the years.

  • Inadequate documentation of compliance programs
  • Poor documentation of ongoing compliance efforts
  • Disregarding patients
  • Unlawful marketing practices and contracts
  • Poor employee and independent contractor characterization
  • Failing to determine medical need
  • Lack of legal safeguards in billing and coding contractual agreements
  • Telemedicine deficiencies
  • Underrating insurance audits
  • Thinking that having HIPAA policies translates to being compliant
  • Getting involved in unlawful contracts
  • Lack of contractual protections and oversight

To learn more, here is an in-depth explanation of the 12 hospital compliance mistakes.

We Represent Miami and Nationwide Healthcare Providers in Different Investigations and Audits

For Medicare services, Recovery Audit Contractors (RACs), Unified Program Integrity Contractors (UPICs) Medicare Administrative Contractors (MACs), and others working with the Centers for Medicare and Medicaid Services (CMS) can be strict and thorough when trying to recoup payments. This is because they’re paid based on the claimed overpayments they recover. Tricare and DOL investigators employ the same strictness and thoroughness, and private health insurance companies’ auditing rights are extraordinarily broad.

The administrators and executives of hospitals facing audits should know and understand several things. One, the audit can’t and won’t solve if you don’t respond appropriately. Auditors will look for reasons to recoup payments, and appealing the results can be an expensive, long, and tedious procedure. Second, proactive measures are critical to avoid significant liabilities and prevent the risks of potential future audits. These proactive measures can also save you considerable effort and time. Third, sometimes mistakes are unavoidable. But when they happen, the hospital can avoid or reduce liabilities by getting assistance from a qualified healthcare compliance defense attorney.

Contact Oberheiden P.C. Today to Speak to a Healthcare Compliance Attorney

If you’re an administrator or executive and need help with your hospital’s compliance program, get in touch with us here at Oberheiden P.C. We can provide defense if you’re facing an audit or answer any of your questions concerning healthcare compliance. To speak to one of our senior lawyers, contact us through call 888-680-1745. You can as well schedule a free appointment by filling out this online form.

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