Health Care Compliance Atlanta

Overview of Healthcare Compliance

Healthcare compliance is a broad term that can encompass issues such as actual practice procedures that can lead to malpractice claims, all the way to billing compliance.

Our firm’s scope of healthcare compliance focuses exclusively on billing as it pertains to Medicare and Medicaid, and the collateral effects including Stark Law, kick-backs, and related matters.

Key Federal Fraud and Abuse Laws for Physicians

The five most important Federal fraud and abuse laws that apply to physicians are:

1. False Claims Act (FCA)

2. Anti-Kickback Statute (AKS)

3. Physician Self-Referral Law (Stark Law)

4. Exclusion Authorities

5. Civil Monetary Penalties Law (CMPL)

These laws are enforced by:

• The Department of Justice (DOJ)

• The Department of Health & Human Services Office of Inspector General (OIG)

• The Centers for Medicare & Medicaid Services (CMS)

Why Compliance Matters for Your Career

As you begin your career, it is crucial to understand these laws not only because following them is the right thing to do, but also because violating them could result in:

• Criminal penalties

• Civil fines

• Exclusion from Federal healthcare programs

• Loss of your medical license from your State medical board

How We Help Healthcare Providers

Some of our clients keep us on retainer to solve their ongoing controversies and questions with billing and employment matters. Others engage us for limited representation, such as assistance with Medicare and Medicaid audits.

Contact Us

Call us to discuss your needs.

Frequently Asked Questions

What is healthcare compliance in billing?

Healthcare compliance in billing refers to following the laws and regulations related to submitting claims to Medicare and Medicaid. This includes avoiding fraudulent billing, adhering to Stark Law and Anti-Kickback Statute provisions, and ensuring all documentation supports the services billed.

Why are federal fraud and abuse laws important for physicians?

Federal fraud and abuse laws protect government healthcare programs from misuse. For physicians, compliance with these laws such as the False Claims Act and Stark Law, is critical to avoid penalties like fines, exclusion from Medicare/Medicaid, or even criminal prosecution.

How can violating compliance laws affect a medical career?

Violating healthcare compliance laws can lead to severe consequences including criminal charges, civil penalties, exclusion from federal healthcare programs, and even revocation of a medical license by the state medical board.

Who enforces healthcare compliance laws?

Healthcare compliance laws are enforced by multiple federal agencies including the Department of Justice (DOJ), the Office of Inspector General (OIG) under the Department of Health & Human Services, and the Centers for Medicare & Medicaid Services (CMS).

How does your firm assist healthcare providers with compliance?

The firm offers ongoing legal support through retainers or limited-scope services. This includes handling billing-related disputes, employment matters, and representation during Medicare and Medicaid audits.