Last Updated on: 13th March 2023, 07:27 pm

Healthcare Regulatory Oversight and the Need for Experienced Legal Counsel

Introduction

Healthcare regulatory oversight has become increasingly important over the past five years since the full implementation of the Affordable Care Act. The Department for Human and Health Services has been conducting regular audits, while healthcare providers have also been focusing on internal self-audits to ensure their billing codes and procedures are accurate and up-to-date. However, vulnerabilities still exist regarding systemic potential for fraudulent billing, and many codes showing a major increase in the past few years have also included upper-level codes resulting in higher payments to the provider. When a subpoena for a formal audit is issued, it is time to retain an experienced New York City healthcare lawyer who understands what the government may want to clarify or has already found.

The Civil and Criminal Possibilities

General audits begin as civil legal situations that are normally primarily focused on potential billing problems. While human error can easily be a component of any problems found, even continual systemic billing errors can exist. The False Claims Act can result in significant fines in even civil situations and can include jail sentences when the case is egregious. The False Claims Act gives the informant, termed a relator in legal language, the legal standing to sue and share a percentage of any proceeds that are confiscated or returned to the government. Even when a case is not prosecuted criminally, a healthcare provider could be assessed a damaging civil fine as well as being required to pay restitution.

Defending Your Business

Healthcare audits are essentially digital forensic investigations of any subpoenaed provider. Serious cases of fraud could easily result in a provider being closed, which can be especially impactful to private practices. Any existing record of regular billing system checks can be used as positive documentation supporting claims that any problems are the result of errors or communication breakdown between the regulatory agencies and the providers themselves. Your New York City healthcare lawyer can evaluate any article of evidence and build a case for human error at the worst without having a civil inspection and audit ascend to a potential criminal issue.

Why Former Prosecutors are Most Effective

Many large law firms that focus on healthcare representation have a cookie-cutter approach to defending against healthcare audit investigations. However, this is not always true of private practice attorneys who are former prosecutors and understand what the regulatory agencies must find to justify criminal charges. The process of providing medical billing is a massive informational transfer and the potential for human error is always present. This is why self-auditing can be so effective. But when the government comes calling, your professional legal counsel will automatically know what they are pursuing in terms of possible criminal intent. The former official professional status of a defending attorney can serve as an indication that the healthcare provider in question is serious about repairing any problem as well. Even a routine system check can present trouble when discrepancies are found, and having your own legal team throughout the inspection can be vital to limiting financial damage and potentially passing the audit.

The Importance of Working with Spodek Law Group and Attorney Todd Spodek

When it comes to healthcare regulatory oversight, Spodek Law Group and Attorney Todd Spodek are committed to providing their clients with the best possible legal representation. They have extensive experience handling all types of healthcare audit investigations and can help defend your business against potential civil or criminal charges. Their team of skilled attorneys will evaluate any evidence against you and build a strong defense based on show don’t tell language. They will work tirelessly to protect your business and personal future, ensuring that you are prepared to face any regulatory challenge that comes your way.

Conclusion

In conclusion, healthcare regulatory oversight is an area of government operation that has increased significantly over the past few years. It is essential for healthcare providers to be aware of the potential risks and vulnerabilities in their billing system and to conduct regular self-audits to ensure accuracy and compliance. However, when faced with a formal audit or investigation, it is important to retain an experienced New York City healthcare lawyer who can effectively defend your business against potential civil or criminal charges. Spodek Law Group and Attorney Todd Spodek have the expertise and professionalism to provide you with the best possible legal representation. By working with them, you can rest assured that your business and personal future are in good hands.

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