Chapman Consulting Group: The Blueprint to Ironclad Healthcare Compliance

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The Need for a Robust Healthcare Compliance Plan: Ron Chapman II’s Perspective

I have spent the last decade of my career practicing healthcare compliance and fighting hard against the federal government in healthcare fraud and false claims act litigation. While I have been fortunate with a number of trial victories and favorable settlements, I became increasingly frustrated at the collateral damage inflicted upon unsuspecting healthcare providers. Even the hint of a federal investigation into a practice can cripple it and cause its owners years of worry and turmoil. This is true even if they are ultimately successful in rebutting government allegations. While we litigated vigorously for our clients in court we noticed that often the battle was won or lost before the initiation of allegations. The most common statement my clients make to me is, “I wish I had thought about healthcare compliance earlier”.

Federal healthcare regulations number in the hundreds of thousands of pages. Interpretation of these regulations is a matter that even skilled healthcare compliance experts cannot agree upon. One study regarding evaluation and management coding revealed that a random selection of 600 physicians only agreed with the coding selection of experts 53% of the time! Managing a growing practice, mid-level staff, and the complexities of shifting government regulations is a nearly impossible task without the right support. And the risks of non-compliance with federal healthcare laws are great.

The expanding legions of federal prosecutors are foaming at the mouth for a new target to fuel their press hungry bosses. Blurring the line between fraud and mistake is the only way to feed their criminal and civil dockets. The seminal supreme court holding in Azar v. Allina provided some hope that un-promulgated guidance documents could not form the basis of an enforcement action. We were hopeful that LCDs, which do not have the force and effect of law, and are drafted with an eye towards protecting federal dollars and not providing adequate healthcare, would not be used as a basis for healthcare charges. But in July, Attorney General Merrick Garland issued a memo rescinding the prior Department of Justice policy and placing LCDs, NCDs and policy statements right at the forefront of false claims act and healthcare fraud litigation.

What does this mean for providers? Healthcare compliance is not a luxury, its a necessity. Stumbling into the healthcare field without a robust healthcare compliance plan that includes auditing, monitoring, policies and procedures, and an adequate investigations capability is akin to rolling the dice where the stakes mean the end of your practice or potentially your career. 

Thankfully, the DOJ has provided us some hope. It promises, through its policies, that entities with a robust healthcare compliance program will receive favorable consideration. This means that any entity willing to build a compliance program prior to the initiation of prosecution will receive favorable consideration by the DOJ in False Claims Act and Healthcare Fraud prosecutions.

Our Mission

Our mission is to provide a robust and affordable healthcare compliance program to small to mid-sized practices so that you can defeat regulator scrutiny and focus on the practice of medicine. If you would like the peace of mind of a robust compliance program – give us a call.

Azar v. Allina: The Truth About Medicare Coverage Determinations, LCD’s and NCD’s
Read more
CMS Seven Core Compliance Program Requirements + CCG Services
Read More
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Chapman Consulting Group: The Blueprint to Ironclad Healthcare Compliance

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The Need for a Robust Healthcare Compliance Plan: Ron Chapman II’s Perspective

I have spent the last decade of my career practicing healthcare compliance and fighting hard against the federal government in healthcare fraud and false claims act litigation. While I have been fortunate with a number of trial victories and favorable settlements, I became increasingly frustrated at the collateral damage inflicted upon unsuspecting healthcare providers. Even the hint of a federal investigation into a practice can cripple it and cause its owners years of worry and turmoil. This is true even if they are ultimately successful in rebutting government allegations. While we litigated vigorously for our clients in court we noticed that often the battle was won or lost before the initiation of allegations. The most common statement my clients make to me is, “I wish I had thought about healthcare compliance earlier”.

Federal healthcare regulations number in the hundreds of thousands of pages. Interpretation of these regulations is a matter that even skilled healthcare compliance experts cannot agree upon. One study regarding evaluation and management coding revealed that a random selection of 600 physicians only agreed with the coding selection of experts 53% of the time! Managing a growing practice, mid-level staff, and the complexities of shifting government regulations is a nearly impossible task without the right support. And the risks of non-compliance with federal healthcare laws are great.

The expanding legions of federal prosecutors are foaming at the mouth for a new target to fuel their press hungry bosses. Blurring the line between fraud and mistake is the only way to feed their criminal and civil dockets. The seminal supreme court holding in Azar v. Allina provided some hope that un-promulgated guidance documents could not form the basis of an enforcement action. We were hopeful that LCDs, which do not have the force and effect of law, and are drafted with an eye towards protecting federal dollars and not providing adequate healthcare, would not be used as a basis for healthcare charges. But in July, Attorney General Merrick Garland issued a memo rescinding the prior Department of Justice policy and placing LCDs, NCDs and policy statements right at the forefront of false claims act and healthcare fraud litigation.

What does this mean for providers? Healthcare compliance is not a luxury, its a necessity. Stumbling into the healthcare field without a robust healthcare compliance plan that includes auditing, monitoring, policies and procedures, and an adequate investigations capability is akin to rolling the dice where the stakes mean the end of your practice or potentially your career. 

Thankfully, the DOJ has provided us some hope. It promises, through its policies, that entities with a robust healthcare compliance program will receive favorable consideration. This means that any entity willing to build a compliance program prior to the initiation of prosecution will receive favorable consideration by the DOJ in False Claims Act and Healthcare Fraud prosecutions.

Our Mission

Our mission is to provide a robust and affordable healthcare compliance program to small to mid-sized practices so that you can defeat regulator scrutiny and focus on the practice of medicine. If you would like the peace of mind of a robust compliance program – give us a call.

 

  • (800) 653-2106
  • info@ccghealthcare.com
  • Serving All 50 States
Azar v. Allina: The Truth About Medicare Coverage Determinations, LCD’s and NCD’s
Read more
CMS Seven Core Compliance Program Requirements + CCG Services
Read More
Previous
Next

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