Texas Health Care Law Blog

When your entire career is at stake

Nothing sends a chill up a professional’s spine like realizing you are under investigation. You have not received the letter yet informing you of this, but you suspect a complaint has been filed against you.

What happens next is extremely important. You can be passive and wait to be informed, or you can be proactive and contact an experienced professional license defense attorney immediately. You can minimize the harm an investigation can do to your ability to practice, or you can mount an emphatic and effective defense.

What to expect from a Medicaid or Medicare fraud investigation

Even honest billing mistakes can lead to devastating effects for a health care provider. Take overbilling for example. Health care providers occasionally receive overpayment for Medicare or Medicaid. These issues can easily be resolved with a refund. Unfortunately, if the issue is not fixed quickly then the provider can face serious consequences.

If you do not catch and resolve billing issues then the government may subject you to a Medicaid or Medicare fraud investigation. An investigation can negatively impact your business, your license and your reputation. The government may even seek to press fraud charges. Medical professionals aware of billing errors or fraudulent activity should contact an attorney specialized in health law immediately.

How to address Medicare overpayment claims

Doctors are extremely busy. In addition to caring for their patients, regulations force healthcare providers to fill out seemingly endless paperwork. Medicare Parts A and B healthcare providers face the additional burden of ensuring, at risk of punishment, that all of their received Medicare payments are correct.

In some cases, healthcare providers receive more money from Medicare than they are legally entitled to, known as an overpayment. The overpayment may be the fault of the provider due to a number of factors including: over-billing services, duplicating Medicare submissions or writing down incorrect codes. In other cases, Medicare is responsible for accidentally overpaying a healthcare facility. What should the healthcare facility do if it receives an overpayment?

Difficult patient issues perplex every provider

Providers report an increased number of problems with challenging patients.

These are the patients, or their family members, who become angry, raise their voices and make up their minds early in the interaction that you are not competent, or you are disrespecting them, or you are only after their money.

How can improper Medicare claims affect your practice?

The health care industry comes with stacks of government paperwork necessary for regulatory compliance. You can easily feel like you are drowning in forms, and rush to complete them. Unfortunately, hurrying through government forms, such as those required for Medicaid and Medicare claims, can lead to serious errors and consequences.

Common errors include: filling in the wrong procedural codes, listing the wrong medications or including equipment that was not used on a patient. Are you aware that even innocent mistakes can lead to serious Medicare and Medicaid fraud, or even criminal charges?

CEO culpability in the health care industry

Many business executives believe that building a great organization starts at the top. For chief executive officers, this means fostering an environment that is both ethical and profitable. Since the passage of the Affordable Care Act in March 2010, the health care industry has been at the crux of this balance, with new laws meaning increased scrutiny from a variety of media and government organizations.

As the saying goes, with great power comes great responsibility, and business executives are among the first to feel the effects of this adage, both good and bad. Since the crisis of the banking industry in 2008, CEOs have quickly felt the public pressure to come clean on a variety of business practices.

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What To Do When Being Investigated By the Medical Board

Not every board complaint is investigated, but those that are can have a grave impact on your medical license and your livelihood. For physicians who are facing a medical board investigation, it is crucial to take the proper steps to defend yourself against sanctions, license revocation, and more.

Defining "Advertising" and "Referrals" in the Healthcare Industry

It is often necessary for healthcare professionals, pharmacies, home health care agencies, and DME businesses to advertise. In doing so, these businesses need to proceed carefully with how they compensate their marketers-especially when dealing with clients who are covered by federal or state-provided healthcare (like Medicaid, Medicare, etc.). Toxicology labs, for example, where the medical work, supplies, and other transactions is easily quantifiable and documented, require vigilance on this front to ensure that you and your business do not violate the federal Anti-Kickback Statute.

Risks Involved with Physician Ownership of Toxicology Labs

The laboratory industry is undergoing heightened medical scrutiny, both for independent clinical laboratories and physician office laboratories. Expansion into this industry is filled with regulatory risk for violation of state or federal laws. Some of the issues being scrutinized are as follows:

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