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Screening and Evaluating Employee Suitability: The New “Seventh Element” of Compliance.

Screening and Evaluation(May 17, 2017): The recently issued Resource Guide for Measuring Compliance Program Effectiveness,” a product of Office of Inspector General staff and compliance professionals roundtable discussions, reconfigures the traditional “Seven Elements of an Effective Compliance Program” by making the “Screening and Evaluation of Employees, Physicians, Vendors and other Agents” an element unto itself – or the new Seventh Element of Compliance! The Resource Guide, prepared under the auspices of the Health Care Compliance Association (HCCA), serves to once again underscore the critical role of exclusion screening and background checks in compliance.

Paul Weidenfeld, Counsel at Liles Parker, has recently assessed this important change and provided an overview of the impact this change for the folks at Exclusion Screening.  For more information on the critical role of screening and evaluating employee suitability in health care, click here.

OIG And DOJ Issue Important New Compliance Guidance

(April 14, 2017) Recently, the Office of Inspector General of the United States Department of Health and Human Services (OIG) and the Criminal Division of the Fraud Section at the United States Department of Justice (DOJ) have issued guidance on measuring the effectiveness of corporate compliance programs.  In February, DOJ placed on its website a document entitled “Evaluation of Corporate Compliance Programs.”  That document lists 119 sample questions that DOJ’s Fraud Section has in the past found relevant in its evaluation of the effectiveness of corporate compliance programs for the purpose of deciding whether to prosecute cases, and in recommending sentences for criminal violations.  These questions are separated into eleven (11) topic areas: analysis and remediation of underlying conduct, senior and middle management, autonomy and resources, policies and procedures, risk assessment, training and communication, confidential reporting and investigation, incentives and disciplinary measures, continuous improvement, periodic testing and review, third party management, and mergers and acquisitions.  While not specifically addressing health care organizations, per se, the guidance is highly relevant to organizations and practices since they are questions that Federal prosecutors will be asking when evaluating compliance programs in any criminal investigation.  The guidance can be reviewed in its entirety at https://www.justice.gov/criminal-fraud/page/file/937501/download.

Even more recently, on March 27 of this year, OIG published a parallel and more inclusive document focused specifically on the health care industry, “Measuring Compliance Program Utilization – A Resource Guide.” The Guide, which is 52 pages in length, sets out a checklist of questions broken down into seven standards based on the standard seven elements of an effective compliance programs, and further broken down into various subcategories under each element.  The guidance is the product of a round table on January 2017 that brought together a group of compliance professionals and staff from OIG “to discuss ways to measure the effectiveness of compliance programs.”  While the guidance is clear that it is not a “one size fits all,” it provides a number of ideas of “what to measure” and “how to measure” these programs, and should be mandatory reading for all compliance officers in organizations, whether a small physician’s office or a large hospital system or health care organization.  The guidance can be accessed at https://oig.hhs.gov/compliance/101/files/HCCA-OIG-Resource-Guide.pdf.

Liles Parker attorneys, and frankly any knowledgeable attorney who specializes in health care, have for many years advised clients that is essential to establish a compliance program that is implemented effectively.  Among other things, an effective compliance program establishes the culture of compliance for an organization in following the law, that should demonstrate an ethos from the top down through every employee and professional.  It also provides management with the opportunity to detect and correct problems and potential issues before they either emerge or become widespread. Many, if not most, whistleblower lawsuits are the result of employees feeling that their concerns, when reported internally, were not investigated.

Moreover, Congress has mandated compliance plans for skilled nursing facilities and the revised requirements of participation require them for both nursing and skilled nursing facilities so that the effectiveness of these programs will become part of the survey process.  And, if an investigation arises, the conversation with enforcement agencies is dramatically different when an organization can demonstrate that it has an effective program as opposed to no program, or one that sits on a shelf.

One of the criteria that OIG has had for determining whether a compliance program is effective is whether the organization measures the effectiveness of its program, itself.  At a minimum, every organization should do this once per year.

Finally, in September 2015, DOJ issued a memorandum entitled “The Individual Accountability for Corporate Wrongdoing.”  Among other things, the memorandum, referred to as the Yates Memo,” instructs prosecutors and investigators to hold highly placed individuals within an organization accountable for the organization’s misconduct.  Prior to the issuance of the Yates memo, those of us involved as defense counsel in investigations were frequently able to obtain releases for individual members of an organization in settlements of civil and administrative investigations.  Since the issuance of the Memo, releases of individuals now occur on only the rarest of occasions.

Conclusion

For all of these reasons, it is imperative that every health care provider establish an effective compliance program and that it periodically measure the effectiveness of that program.  These guidances provide important and helpful information in how to accomplish that result.

Compliance GuidanceLiles Parker attorneys have extensive experience in developing compliance programs, providing compliance guidance, and working with clients in investigations.  Clients having questions related to these issues should contact Michael Cook at (202) 298-8750, mcook@lilesparker.com

 

Basic Policies and Procedures for a Compliance Program

Now that you have appointed an individual to be responsible for the compliance program and created a compliance committee to help the compliance officer, the focus should turn to basic policies and procedures. If an effective compliance program is like a house with a solid roof to protect the inhabitants from bad weather, policies and procedures function as the studs and support structure. Like walls, policies and procedures establish the outlines of a program, delineating areas of focus. Another way of looking at this is that the basic policies and procedures serve as the constitution of your compliance program. Accordingly, every compliance program should have certain policies at a minimum. The most important ones are (in no particular order):

  1. Code of Conduct. This is the basic commitment to comply with federal, state and local applicable rules and regulations applicable to healthcare and your practice. The importance of this policy cannot be overstated. To put it very simply, this policy must say you will not lie, cheat or steal.

  2. Appointment of a compliance officer and description of duties and powers. If the compliance officer is like the president, then this policy describes what executive powers that individual has.

  3. Ineligible persons and sanctions screening. This policy state that you will not employ, contract with, accept referrals or prescriptions from, or make referrals to individuals or entities that are sanctioned, excluded or debarred from federal and state health care programs.

  4. Licensure status. Like the ineligible persons policy, this policy should address which individuals must maintain licensure and state that the practice will not employ, contract with, accept referrals or prescriptions from, or make referrals to individuals and entities that are not properly licensed. The policy should also indicate how you will verify licensure status and what actions will be taken if you cannot validate proper licensure status.

  5. Hotlines and reporting methods for employees, patients and others. This policy should clearly establish how individuals can report concerns and ask questions or request guidance. A key component must be a statement that the reporter may remain anonymous and will not face retaliation for good faith reports.

  6. This policy should outline the general steps that will be taken to investigate a report of possible problems. The policy should include direction for how to document the results of the investigation and what, if any, corrective actions were required and implemented.

  7. We all know how much the rules and regulations in health care are changing. This policy should indicate how you will be training staff, general topics, frequency of training, and how you will document completion of the training. This policy should also include the repercussions for failure to complete the training as required.

  8. This policy should outline your process for conducting audits. If you are billing any insurer, whether federal OR private, you should be conducting audits routinely. Identify what the risk areas are for your practice. The risk areas could be related to particular services, CPT codes, or a particular insurer. As with the Investigations policy, this policy should also detail what actions you will take in response to results that reveal a possible issue.

  9. Conflicts of interest. It is not possible to eliminate potential conflicts of interest unless you live on a desert island, isolated from contact with the rest of the world. Accordingly, the first step is identify possible conflicts of interest (for example, family or business relationships, outside employment, ownership interests, etc.). The policy should require that all potential conflicts of interest be disclosed. Once disclosed, the policy should provide a method for addressing the potential conflict of interest. Some conflicts of interest are so significant or impact the practice in such a way that the underlying situation must be unwound. For example, a contract might have to be terminated or a relationship ended. Other conflicts of interest can be managed. Again, the policy should provide for documentation of the disclosure and what actions are taken to end or manage the conflict of interest.

  10. Waivers of copayments and deductibles, discounts, charity care, and beneficiary inducement. One of the fastest ways to get in trouble is to inconsistently apply and collect copayments and deductibles or offer discounts, as insurers will take the position that this is an improper beneficiary inducement of the federal and state anti-kickback laws. There are ways to provide free or discounted care, but it must be done thoughtfully and following established procedures. In addition, this is a key area to develop documentation demonstrating adherence to the requirements.

  11. Since audits are likely to result in overpayments, you must commit to promptly returning any identified overpayments. A good place to start are the Medicare policy manuals, particularly those of the Medicare Administrative Contractor (MAC). Likewise, private insurers often have policies on refunding overpayments. Don’t forget that the Affordable Care Act requires that Medicare and Medicaid overpayments be returned within 60 days from the identification of the overpayment.

  12. Actually, the HIPAA policies are more an entire set of policies that address compliance with the Privacy Rule, the Security Rule, and the Breach Notification Rule. I will address HIPPA policies in more detail in a future article.

  13. Document retention. This policy should outline what your document retention and destruction policy and procedures are. Not every document needs to be kept forever, and you should create retention time periods for different kinds of documents (including patient medical records). Don’t forget to include electronically maintained documents. One provision the policy absolutely must contain is a requirement that if the practice is under audit, investigation or any other form of scrutiny, that no documents relating to that matter be destroyed, including deletion of emails.

This baker’s dozen of basic policies is only a starting point. A practice’s book of policies should include additional policies that address its particular needs or risks. In fact, I would be extremely worried if I walked into a practice and did not find at least half a dozen more policies specific to the practice. Also, the policies book need not be limited to compliance policies. The practice should also have HR policies, finance policies, patient care policies and OSHA policies

All policies should be reviewed on an annual basis and updated as necessary. This includes eliminating policies that are no longer appropriate or relevant and writing new ones. All policies should be written in a template that permits you to document when a policy was last reviewed and when it was last changed.

And finally, policies should not be like the recipe for Coca Cola, kept in a vault and only known to a few. All staff members should have access to and understand the policies, so a best practice is to place the policies in a binder in a common area, easily accessible by all staff members. If you have an intranet, post them on the intranet. Post them on a bulletin board in the staff break room. Make them widely available. Train on them, repeatedly. Never be in a situation where a staff member can say, “Oh, I didn’t know that was our policy!”

Next month we’ll examine exclusions and why they are so important in more depth.

H-Kocher-photo-2-199x300Heidi Kocher, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

Exclusion Screening Enforcement Actions by OIG are Increasing.

The failure to conduct exclusion screening of your staff and contractors can expose your practice to significant liability.

The failure to conduct exclusion screening of your staff and contractors can expose your practice to significant liability.

(December 8, 2015): Since the passage of the Patient Protection and Affordable Care Act of March 2010[1] (ACA) and progeny such as the HITECH Act [2], enforcement efforts have been better funded and consequently, better staffed. The enactment of HIPAA in 1996 [3] and the Balanced Budget Act (BBA) of 1997 [4], further expanded the OIG’s sanction authorities and scope of current CMP and exclusion authorities beyond programs funded by the Department to all “Federal health care programs.” Further, on May 31, 2011, CMS published guidance to providers regarding the enforcement of ACA Section 6501.

Termination of Provider Participation Under Medicaid and CHIP

Section 6501 of the Affordable Care Act, Termination of Provider Participation Under Medicaid if Terminated Under Medicare or Other State Plan amends section 1902(a)(39) of the Social Security Act and requires States to terminate the participation of any individual or entity if such individual or entity is terminated under Medicare or any other Medicaid State plan. (emphasis added) [5] On February 2, 2011, the Centers for Medicare & Medicaid Services (CMS) published the final rule implementing this provision, applicable to terminations occurring on or after the statutory effective date of January 1, 2011 [6]. See http://edocket.access.gpo.gov/2011/pdf/2011-1686.pdf

Subsequently, the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) is now engaging a specialized task force to check for excluded individuals. 2015 Enforcement Actions demonstrate a much higher focus on, among other areas, reviewing providers against employing excluded individuals than in previous years. While this was a relatively easy compliance area to meet, since the OIG issued its Special Advisory Bulletin and amended its Self-Disclosure Protocol in May and June of 2013, it has since become a hotbed of government reviews, tighter restrictions, shorter compliance deadlines and higher civil monetary penalties. As a result, checking exclusion lists has moved from being one of the easiest compliance steps for a provider to undertake, to being an essential compliance step for every provider.

I. So many exclusion screening databases to check, so little time…

A health care provider, biller, or supplier must check both federal exclusion screening databases including, the List of Excluded Individuals/Entities (LEIE), and the System for Award Management (SAM), formerly maintained by the General Services Administration (GSA), and the currently 38 existing State OIG Medicaid exclusion databases on a regular basis. In New York and Texas, this means monthly (every 30 days), and the list of states adding the monthly requirement continues to grow. Some providers find it difficult to devote the staff and man-hours required to perform this task. Exclusion database review services, such as Exclusion Screening, LLC, allow these providers to perform the voluminous task of searching and documenting the employee searches on multiple state databases.

II Formerly excluded employees or applicants must take affirmative steps to be taken off of the list of excluded individuals.

Employers should also be wary of employees who state they were previously excluded, but the exclusion period has run and they are no longer on the list. Simply stated, exclusions do not expire because there is no automatic reinstatement provision. A health care provider must apply to HHS OIG to be reinstated and to any State where they were previously excluded to be allowed to again participate. The individual must be approved and a written letter received before they can again work for a participating provider without breaking the law and risking penalty.

As OIG’s website states:

Reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted [7].

OIG has the authority to exclude individuals and entities from Federally funded health care programs pursuant to sections     1128 External link and 1156 External link of the Social Security Act External link and maintains a list of all currently excluded individuals and entities called the List of Excluded Individuals and Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP).[8] If an individual is excluded, and the employer participates in federal programs, the employee must be terminated. If an employee was excluded and states the period has run and they are no longer excluded, they must apply for reinstatement to OIG. Reinstatement is not automatic. OIG will send written notice if the application is accepted. The employee must wait until their name is removed from the exclusions list. Then the employee may again work for a provider who participates in a federally funded healthcare program. Finally, employers should remember that where an excluded individual provided services or items, directly or indirectly (as in administrative support) to Medicare, Medicaid or another federally funded health care program, such claims are tainted under the False Claims Act and may be subject to fines and penalties as previously stated.

An excluded party is in violation of its exclusion if it furnishes to Federal program beneficiaries items or services for which Federal health care program payment is sought. An excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a CMP of $10,000 for each item or service furnished during the period that the person or entity was excluded (section 1128A(a)(1)(D) of the Act). The individual or entity may also be subject to treble damages for the amount claimed for each item or service. In addition, since reinstatement into the programs is not automatic, the excluded individual may jeopardize future reinstatement into Federal health care programs (42 CFR 1001.3002).

III. A partial list of OIG’s 2015 exclusion screening enforcement actions.  Are you ready if audited in 2016?

In August 2015, HHS published a study which exposed a loophole in exclusion enforcement in Medicaid managed care programs. [9] It found that 25 States did not require providers who participated via managed care to be directly enrolled with the State. Texas requires every provider who treats Medicaid patients to enroll in the program.

Federal enforcement actions in 2015 increasingly assessed Civil Monetary Penalties against health care providers who employ excluded individuals. The number of enforcement actions and the amounts of penalties continue to trend upward. Note that enforcement is ongoing all over the country and for all types of provider entities.

This is particularly noteworthy for Texas providers, because in the HHSC Inspector General’s Quarterly Report to the Governor, September 21, 2015, new Texas Inspector General Stuart W. Bowen emphasized to Governor Greg W. Abbott that HHSC OIG is “clearing the decks” of old business and settling outstanding cases in anticipation of a concentrated effort beginning January, 2016 in increased effort in all areas, with a particular emphasis on the area of managed care fraud enforcement. This does not mean other providers will be neglected. Indeed, Mr. Bowen’s reputation as an overachiever at the national level means that exclusion screening will receive additional attention at the state level, whether in the managed care setting, or in the provider setting.

Providers should remember that claims tainted by utilization of services by an excluded individual date back to the date of hire and continue through the date of termination. The False Claims Act imposes a potential liability of $5,500-$11,000 and treble damages along with CMPs of up to $10,000 per violation. In § 3729(b)(1) of the False Claims Act, knowledge of false information is defined as being (1) actual knowledge, (2) deliberate ignorance of the truth or falsity of the information, or (3) reckless disregard of the truth or falsity of the information. That means a negligent failure to check the databases for excluded individuals will be regarded by the government as “knowledge” in the filing of false claims. The more immediate threat to providers comes in the form of Civil Monetary Penalties and return of overpayments, which must be made within 60 days from the time they are discovered and verified.

The following examples of enforcement actions taken by the federal government in 2015 illustrates that all providers and all areas of health care are subject to these increasing Civil Monetary Penalties. Avoiding this potential liability is relatively simply, though labor intensive. However, the cost of failing to do so has risen to the point where the survival of your practice or business may be jeopardized by your failure to do so.

02/04/15 – A California hospital agreed to pay $121,316.55 in CMPs to settle OIG allegations it employed someone it knew or should have known was excluded from California Medicaid.

02/25/15 – A Denver, CO skilled nursing facility agreed to pay $242,434.92 in CMPs because it had employed an excluded nurse. No payment may be made by any Federal health care program for any items or services furnished by an excluded individual.

03/17/15 – A Wilkes-Barre, PA healthcare staffing agency agreed to pay $24,775.56 to settle allegations it employed an LPN who was excluded from any Federal health care program.

03/19/15 – A Skokie, IL home health agency employed an excluded nurse. As a result the HHA was excluded for three (3) years from participation in all Federal health care programs.

03/13/15 – A northeast IN / northwest OH community-based health system entered into a $129,216.80 settlement agreement with OIG for employing an excluded lab tech.

03/31/15 – A Farmville VA mission and rehabilitation facility paid $399,573.85 in CMPs for employing an individual it knew or should have known was excluded from Federal programs.

04/16/15 – A Drexel, PA personal in-home care provider paid $69,130 in CMPs for employing an excluded individual for 18 months between July 2010 and December, 2011.

04/10/15 – a Winter Park, FL mental health counselor agreed to pay $120,000 in CMPs and was excluded for twelve (12) years from participation all federal health care programs for allegedly using an Orlando physician to submit claims for services not rendered or not supervised by a licensed physician.

04/27/15 – An Arlington, TX skilled nursing facility agreed to pay $70,000 in CMPs to OIG for allegedly employing an excluded licensed vocational nurse.

04/27/15 – An Beaumont, TX skilled nursing facility agreed to pay $163,740.54 in CMPs to OIG for allegedly employing an excluded individual.

05/13/15 – A Maryland cardiology practice paid $134,506.47 in CMPs for allegedly employing an individual it knew or should have known was excluded from participation in Federal programs.

05/14/15 – A Houston, TX respiratory and sleep disorder specialist agreed to pay $152,821.07 in CMPs to OIG for fraudulent claims provided at a non-participating facility using its NPI number.

06/01/15 – A Waco, TX managed care provider agreed to pay $100,000 in CMPs to OIG to settle allegations they employed 3 excluded individuals who provided items and services to Federal health care programs beneficiaries.

06/08/15 – A Dallas, TX area skilled nursing facility agreed to pay $77,772.08 to settle allegations it employed a certified nurse’s aide who was excluded from Federal programs.

As a final item, one should remember that both the ACA and Texas Medicaid require that all providers have a compliance plan in place. Exclusion screening, while very important, is just one part of a comprehensive, effective compliance program that every provider is required to have. Staying in compliance is the single best and necessary means to minimize your risk of liability.

For additional reading and guidance regarding exclusions, reinstatement, and the potential penalties for employing an excluded individual, please reference HHS OIG’s Special Advisory Bulletins from September 1999 and May 8, 2013 [10].   For questions regarding creating a compliance for your health care practice or business, please contact Richard B. Pecore at Liles Parker, PLLC at (202) 298-8750 or rpecore@lilesparker.com .

Pecore, RichardRichard Pecore, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

Join me on Thursday, December 10th for our free monthly webinar presentation where we will discuss what areas of government enforcement providers can expect HHS-OIG and Texas HHSC-OIG to focus on in 2016.

[1] The Patient Protection and Affordable Care Act, Pub. L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. 111-152, together called the “Affordable Care Act.” 42 U.S.C. § 18001 (2010).

[2] The American Recovery and Reinvestment Act of 2009 (ARRA) Public Law No. 111-5, 123 Stat. 115, included the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH), 42 U.S.C. §17935.

[3] Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104–191.

[4] Public Law 105-33.

[5] Although Section 6501 of the Affordable Care Act does not specifically include terminations from CHIP, CMS has required CHIP, through Federal regulations, to take similar action regarding termination of a provider that is also terminated or had its billing privileges terminated under Medicare or any Medicaid State plan.

[6] CMS Bulletin dated 05/31/11, CPI-B 11-05, 6501-Term.pdf https://downloads.cms.gov/cmsgov/archived-downloads/CMCSBulletins/downloads/6501-Term.pdf , last accessed 12/03/15.

[7] http://oig.hhs.gov/exclusions/reinstatement.asp

[8] See HHS-OIG website, Exclusions http://oig.hhs.gov/exclusions/background.asp, last accessed 12/08/15.

[9] Supra at Footnote 7.

[10] http://oig.hhs.gov/exclusions/effects_of_exclusion.asp (1999) and http://oig.hhs.gov/exclusions/files/sab-05092013.pdf (2013), last accessed 12/03/15.

Looking a Gift Horse in the Mouth (or how to deal with holiday gifts)

December 8, 2015 by  
Filed under Compliance, Featured, Health Law Articles

gift-presentLast month we discussed performing audits in your practice. With the winter holidays just around the corner, we are going to take a detour from our process through establishing a compliance program. November, December, January and February bring many holidays and parties. These are usually an opportunity for happiness and cheer, but they can also be present problems for physicians and practices.

Gifts of Food from Patients

One of the biggest concerns at this time of year is whether to give or receive gifts. Many practices will receive gifts of food, such as cake, cookies or the ubiquitous popcorn tins. Some will come from grateful patients. Assuming these are of nominal value, it is fine to accept such perishable gifts from patients. However, it is a very good idea to share such food gifts from patients with the office or departmental staff.

Non-Perishable Gifts from Patients

Non-perishable gifts from patients present a bit more of a problem. Often these gifts are hand-made. But by their very nature they often can’t be shared by office personnel. And refusing such gifts would offend, insult, or disappoint the patients, who have sometimes spent considerable time and effort on the gifts. In such cases, it is permissible to accept the gift from the patient. However, depending on the nature of the gift, the practice should consider donating the gift to a suitable charity. For example, a quilted wall hanging may be accepted and displayed. A crocheted shawl might be donated to a charity. In the case of something that might be donated and to avoid hurting patient feelings if they don’t see their handiwork later, practice personnel should be appreciative and thank the patient, but explain that the practice policy does not allow them to accept gifts of such value and that they will be donating it to an appropriate charity.

Gifts of Food or Perishables from Vendors, Suppliers, other Health Care Providers or Third-Parties

Let me start this section by saying that any gifts from vendors, suppliers, other health care providers or entities or third-parties are more problematic than gifts from individual patients. Gifts from patients do not implicate the Anti-kickback Statute. Gifts from vendors, suppliers or other health care providers do. Remember that the Anti-kickback Statute prohibits the giving, offering, accepting or receiving any remuneration whether in cash or in kind, in exchange for the referral of services or patients whose care may be reimbursed by federally funded programs such as Medicare. The Anti-kickback statute has no exception for gifts of nominal value or for items such as cookies or cakes.

That said, no physician practice will be prosecuted solely for accepting a holiday gift of food items, provided certain guidelines are kept in mind. As with food gifts from patients, food gifts from non-patients should be of nominal value and should not be a routine event. The food item should be of nominal value. The food should be delivered to the office and not in the form of coupons or paid-for expensive meals at a fancy restaurant. Thus, a tin of popcorn or a platter of mixed cookies from a local deli might be acceptable.

Gifts of Non-Perishable Items from Vendors, Suppliers, other Health Care Providers or Third-Parties

Gifts of non-perishable items should never be accepted. As noted above, there is no de minimis value of a “remuneration” that is acceptable. The history of Anti-kickback Statute cases is full of examples of “gifts” that were really meant to be payments for referrals. A number of years ago, I was involved in a case where a marketing rep for an ancillary health care provider meticulously documented the Christmas gifts purchased for physicians and nurses who referred to the ancillary care provider and submitted that documentation for reimbursement as a marketing expense. The gifts ranged from simple small gift baskets of cosmetics to video game units plus games to expensive jewelry for the female physicians or the male physicians’ wives. Unfortunately, the rep’s documentation also included explicit notes as to the expense of each gift and comments that the higher value gifts were for physicians and nurses who referred more business. Partially as a result of this documentation, the ancillary health care provider was forced to make a self-disclosure to the OIG and entered into a five year Corporate Integrity Agreement, in addition to refunding significant amounts of Medicare reimbursements.

Gifts between Family Members who may be in a Referral Position

Finally a question often arises is whether it is acceptable for an individual who is in a position to benefit from a physician’s referrals to give a gift to a family member who is a physician. This situation often arises with in-laws of physicians who are health care marketing personnel or ancillary or downstream health care providers, such as home health agencies or an imaging center.   For example, a home health care agency owner may wish to give his brother-in-law, a physician, a gift. If the gift is within reasonable limits, is not excessive in kind or value, and is of the kind typically exchanged by family members, and there are no other indications of an improper business relationship, I find it hard to believe that the government would prosecute such an act. Thus a sweater is likely acceptable, but a new car is not.

Conclusion

As with many subjects in this arena, intent is key. Accordingly, providers should have a policy in place that deals with gifts. If a practice chooses to accept gifts, a written policy incorporating the above aspects helps establish a lack of improper intent. It also provides staff members with cover when they refuse gifts. If this path is followed, all staff members will have a stress-free holiday season.

H-Kocher-photo-2-199x300Heidi Kocher, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

CMS’ “Probe and Educate” Program is Underway for Home Health Agencies – Are You Prepared?

December 4, 2015 by  
Filed under Compliance, Featured, Health Law Articles

ArbitrationThe Centers for Medicare and Medicaid Services (CMS) has directed its contractors to initiate a “Probe and Educate” review process with home health agencies around the country. The focus of this program will be to assess agencies’ compliance with the new face-to-face (F2F) documentation requirements that became effective 01/01/15.

CMS has directed its Medicare Administrative Contractors (MACs) to request records for 5 claims from each home health agency within their jurisdiction to review on a pre-payment basis. This review will apply to claims with dates of service beginning on or after 08/01/15. If the MAC denies one out of the five claims under review, it will send an education letter to the agency summarizing its findings and the process will be complete. However, if more than one of the five claims is denied or if the agency fails to submit documentation in response to the request, then the MAC will send a “detailed” findings letter and repeat the review process with another 5 claims with dates of service on or after the date of the findings letter. The purpose of this second review will presumably be to assess the agency’s compliance with the MAC’s previous education efforts.

As part of the post-review education process, CMS has directed the MACs to offer agency-specific education (to include a one-on-one telephone call with contractor medical review staff) regarding the face-to-face requirements.

Although CMS has not explicitly outlined further consequences for agencies with high error rates determined through this “Probe and Educate” program, it is likely that MACs would continue the review process for delinquent agencies, implement more extensive medical review audits on either a pre-payment or post-payment basis, or refer non-compliant agencies to a Zone Program Integrity Contractor (ZPIC) for investigation.

In light of this new ongoing review program, home health agencies should:

  • Continue to obtain supporting F2F documentation on a rolling basis from referring physicians prior to submitting your EOE for the initial certification period. Agencies should not wait until Medicare requests records to obtain F2F documentation from referring physicians.
  • Promptly comply with the MAC’s request for documentation and ensure that all records submitted are complete and accurate. Records should be submitted via the MAC’s online portal or by some trackable method of delivery with signature confirmation.
  • Take advantage of the MAC’s offer to conduct one-on-one education with your agency, even if the review findings are largely positive. As all agencies know, the F2F requirement is extraordinarily vague, and agencies should always take advantage of educational opportunities offered by CMS and the contractors.
  • Contest any and all improper claim denials in the administrative appeals process.

Although these “Probe and Educate” reviews are, by definition, intended to be educational in nature, they could potentially result in serious consequences for non-compliant agencies. If a MAC has attempted to educate an agency regarding the F2F requirements and a subsequent audit by a MAC or another CMS review contractor determines that the agency has failed to adhere to the previous educational intervention, this could set the stage for an extrapolated overpayment assessment or a payment suspension.

Liles Parker attorneys assist home health agencies across the country with all matters related to reimbursement, enrollment, compliance, and corporate formation / transactions. If you have questions or concerns, please contact Adam Bird for a free consultation.

Bird,Adam-WebAdam Bird is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent home health agencies, hospices and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

Compliance Officers and Compliance Committees

October 29, 2015 by  
Filed under Compliance, Featured, Health Law Articles

Team of Doctors(October 29, 2015) Last month we discussed why having a functioning, effective compliance program is important. If done correctly, a compliance program that is functional, effective, and well-documented is as important as your medical malpractice liability insurance. Indeed, the Affordable Care Act now requires compliance programs and many private payers now explicitly require compliance programs in their physician contracts.

But compliance programs don’t just materialize out of thin air. I have yet to be able to wave a wand or say an incantation that will bring a compliance program into being. In order to implement a functioning, effective compliance program, somebody has to perform specific tasks. In many practices, a physician (or the physician in a solo practice) is named the compliance officer. In other practices, it is a senior staff member, often the office manager. And sometimes the compliance officer does not have any other duties in the organization, particularly in large practices. All of these models can work. However, where the compliance officer or manager also has other duties, it is critical that those duties do not cause a conflict of interest with the compliance duties. If the compliance officer or manager has other duties in the practice, care must be taken that the individual is permitted enough time to carry out his or her compliance duties. I have seen numerous practices where being the compliance officer takes a back seat to being the office manager or the head of accounting. Those are practices that often run into compliance problems on down the line.

Even more importantly than having the appropriate amount of time, the compliance officer or manager must be given the authority to implement required policies, procedures and practices. All too often, the compliance manager or office is given the responsibility for implementing a compliance program, but not the needed authority. Particularly in solo and small practices, it is not uncommon for the physician to name him or herself as chief compliance officer and then delegate the day-to-day compliance duties to another individual, while the physician remains chief compliance officer on paper. Regardless of whether the individual conducting the day-to-day compliance activities is the actual chief compliance officer or a subordinate performing delegated duties, the most important aspect here is that the compliance staffer not find himself or herself constantly overruled or second-guessed by the physician(s). Unfortunately, I have seen too many cases where a compliance officer is not given the required authority to do what needs to be done or where a physician or group of physicians discounts the sound advice given by the compliance officer.

A physician practice should also implement a compliance committee. A compliance committee has two main functions. First, the compliance committee serves as an oversight body. Second, the compliance committee can be a tremendous help in carrying out compliance duties. In a small practice, the compliance committee might end up consisting of most of the staff members. Conversely, in a large practice, the compliance committee often consists of senior physicians and staff members, such as the head of human resources, the chief financial officer and representatives of other key departments. The composition of the committee and the number of members is not as important as the committee members’ ability to provide oversight and additional resources and manpower in implementing a compliance program.

In terms of oversight, the compliance committee should meet periodically and receive reports from the compliance officer about the steps he or she has taken implement the compliance program.   Quarterly meetings are typical. The compliance officer or manager should chair the meetings. The compliance officer can and should report on implementation of policies and procedures, status of training, any incidents, payer audits and other related matters. The quarterly meetings should be documented and maintained among the practice’s key documents.

In terms of providing additional resources for implementing the compliance program, the compliance officer may have to depend on the representatives of other functions to actually perform or carry out specific duties. For example, the human resources department may be tasked with actually conducting background and sanctions screening or employee training, while the finance or accounting department may help with responding to payer audits or performing internal audits. In addition, other departments and functions can often smooth the way for the compliance officer to implement specific tasks, often by providing input into an initiative or suggesting more cost-effective means of achieving a goal. Finally, these other individuals can help a compliance officer by spreading the compliance message throughout an organization.

In summary, empowering a compliance officer and creating a functioning compliance committee are key to implementing an effective compliance program.

Next month: Basic policies and procedures

H-Kocher-photo-2-199x300Heidi Kocher, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

How to Implement a Compliance Plan in Your Practice

September 17, 2015 by  
Filed under Compliance, Health Law Articles

Confused-Doctor“My office manager went to a continuing education program, and she’s come back telling me we need a compliance program. I don’t know about that. I know I need to be in compliance with all those rules and regulations, but it seems to be complex and confusing. Do I really need one? How do I put a program into place without spending enormous sums? We’re a small practice and we don’t have a lot of extra time and money to spend on compliance activities.”

This is how my clients often approach me with questions about compliance programs. Or, they have been the recipient of an audit letter from either Medicare or a private insurer. Let’s face it, the requirements for compliance programs are here to stay. Not only are compliance programs now required by the federal government for any provider who receives Medicare or Medicaid reimbursement (see section 6401 of the Affordable Care Act), they are also required by many private insurance companies. Within the last year, I have seen increasing numbers of network provider contracts from private insurance companies include a requirement that the provider have a compliance program. So, having a functional compliance program is no longer an option but a requirement.

To that end, over the next year, we will be exploring the basic elements of an effective compliance program, as well as topics related to a solid compliance program. Let’s start with what a compliance program is and is not. A compliance program is not a document that is placed in a binder on a high shelf in your office, to be dusted off only annually or when faced with scrutiny by insurance companies or, God forbid, state or federal regulators. Instead, a compliance program should become part of the fabric of doing business in your practice. When implemented correctly, a compliance program can help identify potential trouble spots in your practice and give you a framework for addressing those trouble spots. Of course, a functioning and effective compliance program can also help minimize fines and, if things go south, could keep a civil matter from turning into a criminal matter.

A compliance program is also not a mumu – one size does NOT fit all. Just as there are differences between patients, there are differences between practices, the risks they face and the best methods of addressing those risks. An effective compliance program recognizes that while the structure of most compliance programs is similar, it takes into account the practice’s size and sophistication, the medical specialty, and the patient population. For this reason, compliance programs in a box or purchased off the Internet really are not desirable and often cost a practice more money in customization and sometimes tears down the road. A perfect example is the recent settlement by Anchorage Community Mental Health Services in relation to a HIPAA breach, where the government noted the ineffectiveness of the “sample” compliance policies and documents the provider put forward as its compliance program.

The basic elements of an effective compliance program are not complicated. They are:

  1. Designating an individual to serve as compliance officer and creating a compliance committee, particularly for larger organizations.
  2. Implementing a standard of conduct and policies and procedures relevant to the practice’s operations.
  3. Conducting effective training and education.
  4. Instituting effective methods of communication
  5. Conducting internal monitoring and auditing
  6. Enforcing the policies and standards through well-publicized disciplinary guidelines
  7. Responding promptly to violations and taking appropriate corrective action.

Each month we will explore each of these topics, discussing how to implement the element and sharing cost-effective means of doing so. Along the way, we will also discuss various forms of guidance available to practices in implementing their compliance programs. Let’s start with one right away – the federal government itself. The Office of Inspector General of the U.S. Department of Health and Human Services (“OIG”) has published a number of “Compliance Program Guidances”, intended to help different provider types understand and implement compliance practices specific to and appropriate for their particular branch. One of the guidances is specifically written for individual and small group physician practices and published in October 2000. It’s available here: http://oig.hhs.gov/authorities/docs/physician.pdf. In fact, this document is so basic to a physician practice’s compliance program that I strongly recommend that every compliance program have this document printed off, included among the compliance program documents, and readily available for staff member review. Although this document was published in 2000 (and therefore refers to CMS as HCFA and doesn’t make reference to the Affordable Care Act), it can be considered a bit like the U.S. Constitution – a document that creates the foundation for what comes after and points to a better future.

H-Kocher-photo-2-199x300Heidi Kocher, Esq. is a health law attorney with the firm, Liles Parker, Attorneys & Counselors at Law.  Liles Parker has offices in Washington DC, Houston TX, McAllen TX and Baton Rouge LA.  Our attorneys represent dentists, orthodontists and other health care professionals around the country in connection with government audits of Medicaid and Medicare claims, licensure matters and transactional projects.  Need assistance?  For a free consultation, please call: 1 (800) 475-1906.

Despite CMS’ February Prediction, Medicare Advantage Payments Set to Rise in 2016

medicare-blocks-compressed(April 15, 2015): Despite a February proposal in which the Centers for Medicare and Medicaid Services (CMS) said 2016 Medicare Advantage payments would decline, on average, by 0.95%, Federal regulators are now saying 2016 Medicare Advantage payments will go up compared to 2015.

Medicare Advantage Payment Rates

CMS estimates that payments to insurers that offer private Medicare plans will rise about 1.25% next year, and insurers will probably see their overall revenue increase about 3.25% as they deliver, and bill for, more intensive services.

According to March 2015 data, Medicare Advantage enrollment is at an all-time high. More than 17.3 million people are enrolled in the program, which has been growing at more than 8% annually for the past several years. Insurers argued that cuts to payments would hurt seniors in the form of lost choices, benefit reductions, and higher costs. Bipartisan groups in both chambers of Congress also sent letters to the CMS urging positive rates for insurers and a “stable policy environment.”

Medicare Advantage Risk Adjustment Models for CY 2015

Because of the support, health insurers largely expected CMS to roll out favorable 2016 Medicare Advantage payment rates, but they were less sure about how the government would update the risk-scoring system.  In February, CMS said it would make a full transition to a new, updated hierarchical condition category methodology for 2016, which was first proposed in 2013. Insurers expressed concerns about this model because it would it would affect their risk scores and bottom lines.  Many, however, still believed CMS would gently transition to the 2014 risk-coding recalibration model, which uses the hierarchical condition categories. Medicare Advantage payments are adjusted for each beneficiary’s health status using those categories. The model allows plans to be paid more for patients who are sicker and have more complications.

In its final announcement, CMS wrote that it will blend the risk scores calculated using the 2013 CMS-Hierarchical Condition Category (HCC) and 2014 CMS-HCC models by 67% and 33%, respectively. CMS wrote that it strongly took into consideration the comments it received opposing the original proposal to use a “blend of the 2013 CMS-HCC model and 2014 CMS-HCC model in 2015.” CMS recognized that additional time is needed to transition to the 2014 model, and therefore agreed not to use risk scores from just the 2014 model.

Taking into consideration the final payment updates and changes for 2015, CMS was concerned that the use of the proposed 2014 blend percentages of 75% and 25% “would not have the same effects on payment stability that they had last year.” With this in mind, CMS decided to “blend the risk scores calculated using the 2014 CMS-HCC model with risk scores using the 2013 CMS-HCC model, weighting the normalized risk scores from the 2013 model by 67% and the normalized risk scores from the 2014 model by 33%.” CMS hopes this formula will help move to the updated model while also providing time for plans to transition to its use in payment.

The risk scores from the 2013 and 2014 CMS-HCC models will include the risk scores calculated from the institutional, community, new enrollee, and C-SNP new enrollee segments of the model. They will be used in Part C payment for disabled/aged beneficiaries enrolled in Medicare Advantage plans.

Conclusion

With the increase in payments, there will undoubtedly be an increase in scrutiny for Medicare Advantage claims.  Do you know the requirement differences for Medicare Advantage claims?  Do you understand how the risk-coding recalibration in 2015 will affect how CMS views your billing practices?  Call us toll-free at 1-800-475-1906 for a free consultation on how your business utilizes Medicare Advantage.

Robert Liles represents health care providers in RAC and ZPIC appeals.Robert W. Liles, Esq., is a Managing Partner at Liles Parker, Attorneys & Counselors at Law.  He focuses his practice on internal audits/investigations, fraud defense, and compliance and regulatory matters. The attorneys at Liles Parker represent a wide variety of health care providers and suppliers in administrative and civil proceedings. For a free consultation, call Robert at 1 (800) 475-1906.

Ismail Cropped 14Attorney Ismail Laher focuses on solving complex issues for Health Care Providers. Mr. Laher assists clients to better understand their option strategically on on a a wide variety of issues in civil and criminal proceedings, complex civil litigation, compliance audits & reviews, practice management and strategic client counseling. He also serves in the role of General Counsel on an as needed basis. Mr. Laher is a graduate of Harvard Business School and Georgetown Law  and was previously an associate attorney with Jones Day law firm in their Washington, DC office.  Mr. Laher focuses his practice on regulatory compliance oversight, practice management and strategic client counseling. He can be reached directly at 202-596-7863 or at ext 111 at the office 202-298-8750.

Administration’s FY 2016 Budget Proposal Includes Changes to Recovery Audit Procedures

Recovery Audit Program

RAC Audit changes coming in 2016

(2/27/15)  On February 2, 2015, President Obama released his fiscal year 2016 budget proposal. This latest proposal affects a significant number of Federal health care programs and includes over $1 trillion allocated to the U.S. Department of Health and Human Services (“HHS”). More than 85 percent of HHS’s budget is devoted to programs that fall under the purview of the Centers for Medicare & Medicaid Services (“CMS”).

 I.  Administration Goals

The administration’s primary health care focus is expanding access to care and providing higher quality of care. It attempts to accomplish this goal through a series of budget increases coupled with a greater emphasis on efficient practices. For example, the budget proposes several reforms to the Medicare program that purport to save roughly $423.1 billion over the next 10 years.

Moreover, the FY 21016 budget continues to prioritize cutting waste, fraud, and abuse in the Medicare and Medicaid programs. As outlined in HHS’ budget brief, the President’s proposal includes $201 million in investments in program integrity for FY 2016 and $4.6 billion over ten years. These investments include continuing to fund the full Health Care Fraud and Abuse Control discretionary cap adjustment, increasing mandatory Medicaid Integrity Program funding, and providing more funding to recovery auditors to undertake more corrective actions that will help reduce improper payments. In total, program integrity investments are estimated to yield roughly $21.7 billion in savings to Medicare and Medicaid over ten years. In addition, the Budget supports efforts to monitor and prevent fraud, waste and abuse in the private health insurance market including the Health Insurance Marketplace

II.  Reforming the Medicare Appeals Process

Health care providers should pay particular attention to the budget proposals that affect an area that has caused significant frustration over the last several years: Medicare and Medicaid contractors and appeals.

In December 2013, the Office of Medicare Hearings and Appeals (“OMHA”) declared that it would stop assigning administrative law judge (“ALJ”) appeals. The Medicare appeals system had become severely backlogged with pending appeals, due in large part to a significant increase in Recovery Audit Contractor (“RAC”) reviews of claims. CMS tried to alleviate this backlog through a RAC Audit “Pause”. This pause would allow RACs to complete their remaining claim audits and allow CMS to continue to refine and improve the Recovery Audit Program. Nevertheless, frustration with the arduous Medicare appeals process led three hospitals and the nation’s largest hospital association to sue HHS. In a subsequent effort to address the backlog and resulting delays, CMS presented a global settlement offer to hospitals to resolve certain backlogged claims on during Labor Day 2014.

As part of its ongoing efforts to improve the efficiency of the Medicare appeals system – and to reduce the backlog of appeals awaiting adjudication at OMHA – HHS proposes additional funding, administrative actions, and legislative proposals. For example,

  • $36 million is allocated for CMS to engage in discussion with providers to resolve disputes and additional funding for greater participation in ALJ Hearings at OMHA;
  • $270 million is allocated for OMHA, of which $140 million is in budget authority and $130 million is from legislative proposals. This figure constitutes a $53 million increase from FY 2015.

The Budget also expands adjudicatory capacity in new field offices in order to address the backlog for a number of appeals and maintain the quality and accuracy of its decisions. It also includes a package of legislative proposals that provide new authority and additional funding to address the backlog.

            A summary of the Medicare appeals process reforms is as follows:

  • Provide OMHA and Departmental Appeals Board (“DAB”) Authority to Use Recovery Audit Contractor Collections – this would allow program recoveries to fully fund related appeals at OMHA and the DAB;
  • Establish a Refundable Filing Fee – a refundable, per claim filing fee for providers, suppliers, and State Medicaid agencies, including those acting as a representative of a beneficiary, at each level of Medicare appeal, would be instituted. This filing fee would allow HHS to invest in the appeals system in hopes of improving responsiveness and efficiency. Notably, these fees would be returned to appellants who receive a fully favorable appeal determination;
  • Establish Magistrate Adjudication for Claims with Amount in Controversy Below New ALJ Amount in Controversy Threshold – appealed claims below the federal district court amount in controversy threshold ($1,460 in CY 2015 and updated annually) would be heard by attorney adjudicators. This would allow ALJs to hear claims that are more complex and/or include higher dollar amounts.
  • Expedite Procedures for Claims with No Material Fact in Dispute – OMHA could issue decisions without holding a hearing if there is no material fact in dispute;
  • Increase Minimum Amount in Controversy for Administrative Law Judge Adjudication of Claims to Equal Amount Required for Judicial Review – the minimum amount in controversy required for adjudication by an ALJ would be increased to the Federal Court amount in controversy requirement ($1,460 in 2015). Appeals not reaching the minimum amount in controversy will be adjudicated by a Medicare magistrate;
  • Remand Appeals to the Redetermination Level with the Introduction of New Evidence – appeals where new documentary evidence is submitted at the second level of appeal or above would be remanded down to the first level of review. This could incentivize appellants to include all evidence early in the appeals process and ensure the same record is review and considered at subsequent levels of appeal; and
  • Sample and Consolidate Similar Claims for Administrative Efficiency – the Secretary HHS could adjudicate appeals through the use of sampling and extrapolation techniques. Additionally, the Secretary would be authorized to consolidate appeals into a single administrative appeal at all levels of the appeals process. Parties who are appealing claims included within an extrapolated overpayment, or consolidated previously, will be required to file one appeal request for any such claims in dispute.

III.  Conclusion

HHS insists that these proposal will allow OMHA to alleviate the ongoing backlog of appealed claims within the Medicare appeals system. However, these measures are not addressing one of the most significant problems with the entire process – the contractors themselves. No where in the budgetary proposals has HHS identified measures that would address the problem areas that RACs are historically known to create. For example, RACs are still reimbursed on a contingency fee arrangement. This arrangement create adverse incentives whereby RACs pursue (and generally deny) as many claims as possible. Yet, the contractors are not punished for adverse results that may be later overturned at any one of the appeals levels, in particular at the ALJ stage.

Has your hospital, practice, Home Health Agency, Hospice, DME Company, or PT / OT / ST Clinic been audited by a RAC or Zone Program Integrity Program (ZPIC)? Liles Parker regularly counsels health care providers on how best to proactively prepare for an audit and mitigate audit risks. As long as RACs are incentivized to pursue as many claims as possible, the likelihood of an audit of your practice is not “if” but “when.” If you have any questions or concerns regarding any ongoing – or future – RAC or ZPIC audit, please do not hesitate to give us a call at 1 (800) 475-1906.

Saltaformaggio, RobertRobert Saltaformaggio, Esq., serves as an Associate at Liles Parker, Attorneys & Counselors at Law.  Liles Parker attorneys represent dental practices around the country in connection with Medicaid audits by federal and state agencies and CMS-engaged specialty contractors.  The firm also represents dental providers in connection with HIPAA Omnibus Rule risk assessments, privacy breach matters, State Dental Board inquiries and regulatory compliance reviews.  For a free consultation, call Robert at:  1 (800) 475-1906

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