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Raiser & Kenniff, PC, can help create and implement an effective compliance program for healthcare providers. Our compliance program can help identify problems, and remediate them before they grow and impact your organization. In the current landscape, a compliance program is crucial in order to help providers identify and correct issues before outside auditors do.
Our Long Island law firm can help develop an effective compliance program, and keep your organization out of any future problems it may be encounter.We have many years of experience developing compliance programs for a broad spectrum of providers. Our firm’s philosophy is that compliance is the process of identifiying reasonable risks within a healthcare organization – and reducing those risks – by implementing a compliance program which puts in place practical policies, and procedures, in addition to promoting continuing education. The policies and procedures put in place address billing, documentation, and other requirements of Medicare and other third party payors. Our law firm can help you navigate, and understand, the various legal requirements pertinent to the identification of overpayments, and helping guide you through the process of determining when they are made, and how to repay those overpayments – in order to prevent future audits and problems.
In New York, depending on how much you bill – compliance programs are mandatory. Having one, encourages favorable treatment in the Federal Sentencing guidelines. Furthermore, recent health care reform legislation makes it mandatory for certain providers to have a healthcare compliance program. Typically, the OIG’s compliance guidance is used as a framework for compliance, based on the seven essential elements
1. Conducting internal auditing/monitoring
2. Designating a compliance officer, and creating a compliance committee
3. Conducting training and education
4. Responding diligently to offenses, and developing corrective actions
5. Developing lines of communication
6. Enforcing disciplinary standards through guidelines
7. Implementing compliance and policy standards.
The first step in creating a compliance plan is identifying the areas in your organization which need attention. This is done by discussing the issues with personnel to get an understanding of how the services are provided, documented, and billed – and to understand the system and procedures currently your organization have in place. In addition, our Long Island healthcare compliance lawyers also identify areas that need to be addressed in the policies and procedures to be created – by reviewing third party payor policies, and other information relevant to your business.In addition, our healthcare compliance attorneys in Long Island review OIG compliance guidance, and fraud alerts – that are unique to your specialty. Our experience working with providers in the medicare appeals process is crucial in determining areas of risk – and putting in policies that reduce their visibility. After we’ve identified areas which need attention – we draft a compliance program, and create policies, which assist you in enhancing compliance with legal and third party requirements. After the documents are approved, the next step is implementing the compliance program, in addition to educating your staff. The goal of the education process is to enhance compliance with the policies, and improve consistency and uniformity in billing and documentation procedures in your organization.
Who should perform an internal audit?
All internal audits should be done under the advise of attorneys. This allows us to asset attorney client privilege on all work product. All initial drafts are provided to us for review. While someone inside your organization can do the compliance audit – we recommend bringing in an outside auditor who has a fresh perspective, and can confirm that services are being billed correctly.
Why is an internal reporting system extremely important
It’s crucial, that when you implement a compliance program, you setup a hotline, drop box, or other method for internal reporting. This mechanism is something which should be emphasized during employee training. All employees should be asked to sign a statement that they agree to all compliance regulations. This provides protection for the organization because it displaces responsibility to the employees. Employees are required to bring compliance matters to the attention of the compliance officer, versus discussing the matters with outside entities.
We’re devoted to helping providers get help they need. We service physicians, physician groups, nurses, hospitals, pharmacists, psychiatrists, national hospital system, local + regional hospitals, psychologists, and virtually every single healthcare provider.
If you have questions about setting up, or implementing, a healthcare compliance program – we encourage you to contact our Long Island healthcare compliance law firm today.