As someone working with one or more of the over 100 Health and Human Services programs across the U.S., it’s important that you understand the body that regulates your work. Under the U.S. Department of Health and Human Services, the Office of Inspector General’s mission is to protect the integrity of department’s programs as well as the health and welfare of program beneficiaries.
What Medicare audits mean for your telehealth business
Telehealth represents an incredible step forward in medical technology. As a telehealth doctor, you represent the front line of healthcare for folks making their living in the rural parts of the country, and with that comes unique sets of challenges. More Texas-based telehealth providers than ever are being subjected to Medicare audits.
Texas Medicare fraud case highlights the need for integrity
Health care professionals are entrusted with the well-being of their patients through many services that people need when faced with poor health and medical situations. But, sometimes, even health care professionals and the executives who lead their agencies aren’t always on the straight and narrow.
A relevant and recent example relates to a federal fugitive from Texas who stole millions of dollars in a Medicare fraud scheme in which he and his associates preyed on vulnerable people such as the elderly, disabled and homeless.
Appealing a Medicare or Medicaid revocation
Medicare and Medicaid are critically important to many medical providers in Texas. Being denied the ability to bill for these patients would mean a substantial loss of income to many clinics, possibly forcing them to close. Unfortunately, the revocation of Medicare and Medicaid contracts is if anything becoming more common.
If this happens to your facility, there is a process of appealing the decision. It may be possible to have it reversed or, in some cases, even move to a corrective action settlement. Time is of the essence, however, and expertise in the somewhat arcane process is critical for success.
Medical marijuana arrives in Texas, but under high regulation
The medical field is constantly improving; new discoveries, better practices and technological advances allow you to provide the best modern healthcare for your patients. Recently, the health industry has explored the chemical THC, found in cannabis, as a possible treatment for some illnesses.
In fact, Texas has begun to dispense the first doses of medical marijuana to some epileptic patients. This event follows a long and difficult debate between its potential health benefits and the danger for substance abuse. Texas legislators, therefore, have taken a cautious approach within the Compassionate Use Act.
Do not use a family member as an interpreter
In a pinch, it can be very tempting to grab the nearest family member to help interpret for a patient. You can tell yourself "it is ok to do it this once" or "the patient's child speaks English" but in reality, this is a practice that should be avoided at all costs. Just because someone is bilingual does not mean he or she is qualified to be an interpreter.
Benefits of using a trained medical interpreter
The Stark Law: a basic overview of a complex statute
For a physician, navigating regulation and compliance is vital to operating a successful practice. By adhering to the correct legal guidelines, you can alleviate much of the anxiety and risk that comes with a failure to comply. Certain laws and regulations--such as the Stark Law--carry strict penalties as they deal with Medicare and Medicaid. A better understanding of laws like these can go a long way to running a legally sound practice.
For its part, the Stark Law is a statute aimed at preventing kickbacks through the use of federal health care programs. Essentially, it dictates that a physician cannot refer Medicare or Medicaid patients for "designated health services" to entities--or immediate family members--with which they have financial ties. While the Stark Law is complicated and riddled with exceptions, there are a few basic elements to be grasped at the outset.
Provider Implications of the Texas Telemedicine Policy
All over the United States, the telemedicine sector of healthcare has grown into an important component of medical treatment. It offers choice, convenience and access to consumers while paring down overhead and easing staffing stress.
Now that Texas is a telemedicine state, Texas can benefit from what many states have already sanctioned. The new Texas regulation allows physicians to treat patients they have not previously evaluated in person via telemedicine. It gives patients greater access to medical care, including mental health, with some notable restrictions.
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 a vigorous 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.
