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Healthcare Compliance Programs Lawyers

The concept of healthcare compliance programs began in 1997 with a publication by the Office of Inspector General (OIG) within the US Department of Health and Human Services (HHS). That first program was designed for individuals and small group physician practices. Since that time, there have been an entire series of HHS OIG compliance guidelines addressing other segments of the health care industry that includes: nursing facilities, HHS research grants and awards, hospitals, pharmaceutical firms, ambulance providers, hospices, home health agencies, clinical laboratories, third-party medical billing firms, and providers of medical supplies and equipment.

The Affordable Care Act mandated additional corporate healthcare compliance programs in 2010 for Medicaid and Medicare providers. The essence of this compliance program requires any Medicaid provider receiving $5+ million annually in payments have mandatory written policies that affect all employees and certain types of vendors regarding state and federal violation of anti-fraud laws, whistle blowers legal protections, and all policies addressing fraud detection and prevention. A well-defined compliance program is a prerequisite for Medicare and Medicaid participation.

Design of Healthcare Compliance Programs

Healthcare compliance programs are the guidelines for efficient internal controls that are governed by private, state, and federal health plans. Most compliance programs are still voluntary, but compliance programs are mandatory for participation in Medicaid and Medicare plans. However, the development of either a voluntary or a mandatory program will enhance the detection, prevention, and resolution of circumstances and situations that do not conform to legal health care requirements as well as ethical and business practices. An effective program needs to contain benchmarks for implementation and achievements that meet federal and state laws as well as the expectations of industry regulators.

List of HHS OIG Seven Core Elements

The HHS OIG has developed a list of seven core elements that every healthcare compliance program needs to address. They are:
1. Implementation of procedures, policies, and conduct standards
2. Designation of a compliance officer and committee to monitor the efforts and the enforcement of practice standards
3. Institute training and education sessions on compliance procedures, policies, and conduct standards
4. Development of effective communication lines with staff personnel that includes anonymous reporting avenues
5. Use of periodic self-audits to conduct internal monitoring and auditing
6. Enforcement of employee standards using well publicized disciplinary guidelines
7. Prompt response when discovering offenses and the development of corrective action plans

The HHS OIG has published a directory of recommended compliance program guidance documents that can be viewed at http://oig.hhs.org/compliance/compliance-guidance/index.asp.

Healthcare Compliance Program Lawyers

The healthcare community is experiencing an environment of ever increasing regulations and enforcement. A strong, enforceable compliance program is a positive, protective tool that ensures adherence with all laws and regulations that govern a specific practice. A well-structured program enables a provider to isolate and correct any deficiencies before they can negatively impact a practice. Consultation with a professional, experienced healthcare lawyer will enlighten healthcare providers on the development and implementation of compliance programs that addresses their specific needs and provides them with real protection aimed at minimizing, or eliminating, any potential risks within their particular practices.

A program that is finely tuned and followed is no guarantee that a practice will never be investigated. However, in the event that there is an investigation, having a solid compliance program, with all of the supporting documentation, demonstrates a provider’s commitment to patient safety, violation avoidance, and full adherence to all governing healthcare laws, policies, and regulations. An active compliance program improves the provider’s chances of having a violation viewed as an accidental, one-time, occurrence rather than evidence of a pattern of fraud.

Government and private sector payors are consistently concerned with the rising cost of health care and have increased their attention on finding and eliminating fraud, waste and abuse. The result of this intensity is an enormous rise in the number of audits related to Medicaid, Medicare, and third party payors. Any confirmed violations involving fraud will result in a practice or service be excluded from Medicaid and Medicare participation. A finding of fraud can also result in high fines, potential loss of professional licenses, and possible prison time. Any provider facing compliance audit investigations will need specialized healthcare audit lawyers. Our experienced attorneys help our clients with their defense against alleged compliance investigation audits.

Our health care lawyers work with providers in structuring business compliance programs that meet healthcare practice goals while staying current with all up-to-date federal and state laws, rules, and regulations. We not only work for our clients, we stand with our clients when representation is required.


Charle Butler
Charle Butler
2021-03-12
Verified
I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
Mesonista parsons
Mesonista parsons
2021-03-05
Verified
My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
debabrata chakraborty
debabrata chakraborty
2021-03-03
Verified
Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
Asata Hendricks
Asata Hendricks
2021-03-02
Verified
Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
Mike Moroff
Mike Moroff
2021-02-26
Verified
I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
2021-02-24
Verified
Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
L.C.
L.C.
2021-02-24
Verified
I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
2021-02-23
Verified
I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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"Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them..."

David Bruce

"Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet."

Rowlin Garcia

"Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind."

Francis Anim
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