(August 26, 2013): Medicare compliance challenges have increased (rather than decreased) with the passage of the Affordable Care Act and the implementation of Electronic Medicare Records (EMR) systems by physicians and other health care providers around the country. Late last week, Robert W. Liles, Managing Partner at Liles Parker, had the privilege of serving as a keynote speaker at the plenary session of the West Virginia Medical State Association’s annual conference. The 2013 West Virginia Physician Summit was conducted at the historic “Greenbrier,” located in White Sulphur Springs, West Virginia. As Robert’s presentation discussed, it is more important than ever that physicians identify and address any Medicare compliance risks facing their practice. Robert’s presentation outlined the following physician, practice group, and Medicare compliance challenges:
Risk #1: ZPIC / RAC / MAC Post-Payment Audits of Physician Claims Billed to Medicare.
Risk #2: Increased Likelihood of Pre-Payment Reviews by ZPICs. Plus, RAC Pre-Payment Reviews are Now Here. Rise of the UPICs!
Risk #3: Increased Possibility of Criminal Referral, Suspension or Revocation Action Recommended to CMS by ZPICs and RACs.
Risk #4: Increased Risk of Statutory Violations Due to Changes Under the Affordable Care Act (ACA).
- Failure to return overpayments within 60 days.
- Loosening of proof standards to show a violation of the Federal Anti-Kickback Statute.
- Expansion of the Medicare permissive exclusion rules.
- Importance of Medicare Compliance.
Risk #5: Increased Prosecutions by HEAT Teams Around the Country.
Risk #6: Increased Sanctions and Level of Risk Associated with Violations of HIPAA and/or HITECH Privacy Requirements.
Risk #7: Increased Collection and Investigative Activity by Private Payor SIUs.
Risk #8: Increased Enforcement by HHS-OIG of CMP Actions for Failure to Screen Employees.
Risk #9: Increased Audit and Investigative Actions by MFCUs, MICs and Medicaid RACs.
Risk #10: Increased likelihood of Qui Tam and/or Government False Claims Act cases against Providers.
In addition to the Medicare Compliance risks outlined above, Robert discussed the importance of conducting a “Gap Analysis” so that any deficiencies (in coding, billing or in business practices) could be identified and remedial steps could be taken, thereby bringing a practice into regulatory alignment with Medicare Compliance mandates. Is your practice currently facing a pre-payment review or a post-payment audit, please give us a call so we can discuss your options for responding to the CMS contractor’s actions.
Robert W. Liles serves as Managing Partner at the law firm, Liles Parker, PLLC (Liles Parker). Our firm is a boutique health law firm with offices in Washington, DC, Houston, TX, McAllen, TX and Baton Rouge, LA. We represent physicians, group practices and others health care providers around the country in connection with statutory and regulatory health care issues that may arise. For a complimentary consultation, please give us a call at: 1 (800) 475-1906.