| Healthcare providers across the country are now | | | | knowledge you need to identify the insurance |
| being targeted for healthcare fraud investigations. | | | | carriers' weaknesses and practice in an ethical |
| Many of those providers are clueless. They don't | | | | manner. |
| even know why they're being investigated. | | | | I have seen the exodus of hordes of providers due |
| Are Your Actions Causing You to Become a Target | | | | the insurance industry's stranglehold on the healthcare |
| for a Healthcare Fraud Investigation? | | | | industry, and I have taught many providers to fight |
| Do you engage in one or more of the following: | | | | back. When investigators come knocking on your |
| - Accept what the insurance carrier offers, without | | | | office-door, will you be prepared? |
| question | | | | Here's how you can prepare yourself now: |
| - Work with 3rd- party liability carriers and accept | | | | - Develop a healthcare compliance program. Do not |
| what your patients give you once they receive | | | | make the mistake of believing that a sham |
| settlement, and accept your patient's account of | | | | compliance program will suffice. You are better off |
| settlement negotiations | | | | having no compliance program than merely using one |
| - Allow your patients to retain an attorney to handle | | | | for window-dressing. The false sense-of-security |
| 3rd-party liability claims, and you accept the | | | | often proves disastrous! |
| attorney's offer of settlement without question | | | | - Create an audit-response program that effectively |
| - Work consistently with a limited number of external | | | | addresses deficiencies, both noted and alleged. |
| providers (physicians, surgeons, neurologists) | | | | - Establish a policy for refunds of monies paid in |
| - Fail to read the Explanations of Benefits ("EOBs") in | | | | error, when such errors are noted during internal |
| which the insurance carrier identifies the reasons for | | | | audits. |
| denial. | | | | - Develop an effective auditing process, assessing |
| - Consider peer reviewers' reports as nuisances and | | | | medical necessity and billing issues. |
| as costs of doing business with insurance carriers. | | | | - Meet with SIU agents who may have "flagged" |
| - Not bother to read, or don't receive, Controverting | | | | your files to identify specific areas of concern. |
| Affidavits in which both reasons for denial are | | | | - Develop a Hotline to address issues of concern |
| reported and aberrant practices are alleged. | | | | coming from employees, patients, insurance |
| - Fail to respond to Controverting Affidavits in which | | | | adjusters, etc. |
| reasons for denial are reported. | | | | - Attempt to enter into a Corporate Integrity |
| - Fail to respond to Controverting Affidavits in which | | | | Agreement between the targeted-provider and |
| aberrant practices (unbundling of services, medically | | | | investigators. |
| unnecessary services, medically unnecessary | | | | - Retain a compliance team knowledgeable in |
| referrals) are alleged, because you either consider | | | | healthcare law. Do not trust your fate to an attorney |
| such allegations harmless or you have neither the | | | | inexperienced in this arena. Rest assured, the |
| time nor ability to provide a response challenging such | | | | insurance carriers will not! |
| allegations. | | | | What Are Your Next Steps? |
| If the answer is yes, then you need to consider a | | | | Invest in a reputable health care compliance program |
| healthcare compliance program! | | | | now. Properly implemented and managed, a |
| While you can rationalize to yourself that these | | | | Healthcare Compliance Program could make the |
| issues are just the cost of doing business, a nuisance | | | | difference between losing your practice, losing millions |
| and can be ignored, the consequences can be | | | | of dollars, losing your freedom, and being in a position |
| disastrous. | | | | to proudly announce to healthcare fraud |
| How to Save Your Practice, License, and Freedom If | | | | investigators, "Come on in. I would be proud to show |
| You Have Become the Target of a Healthcare Fraud | | | | you our program." |
| Investigation? | | | | Sham programs create more problems for you than |
| I've spent decades in practice, and worked closely | | | | you even want to contemplate. When you become |
| with insurance carriers, defense attorneys, personal | | | | the target of a health care fraud investigation, you |
| injury attorneys, law enforcement, and others, I | | | | do not want to be forced to justify why an |
| understand your fears and concerns. More | | | | unqualified compliance "guru" is helping you in this |
| importantly, I know how to help you gain the | | | | process. |