By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Every year the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), publishes a “Work Plan” disclosing the areas of health practice upon which it intends to concentrate its audit and anti-fraud activities for the upcoming year. This gives a “heads up” to healthcare providers in those areas to get their houses in order.
COVID-19 Pandemic “Vacation” is Over.
With the “winding down” of the closures and working-from-home isolation techniques due to the COVID-19 pandemic, the OIG and other government agencies and contractors will be returning in full force to not only conduct, but to catch up on audits and investigations of over-billings, kickbacks, and other healthcare fraud activities.
New Areas Added Target Suspected Fraud Activities.
Furthermore, the OIG has recently added several additional areas to its Worklist upon which it will be concentrating. These include:
1. Spinal Pain Management Services
2. Appropriate Use of CARES Act (COVID-19) Relief Funding
3. NIH Oversight of Foreign Grant Recipients’ Compliance with Audit Requirements
4. Impact of Substitutions for Medications Paid Under Part B
5. Use of Telehealth for Behavioral Health Services paid by Medicaid
6. Audit of Indian Health Service (IHS) for Employee Background Screening
To see the types of services The Health Law Firm provides in defending Medicare and Medicaid audits, click here.
To see information on The Health Law Firm’s defense of clinical investigators and researchers accused of research fraud, visit our website here.
To see the types of legal services that The Health Law Firm provides to Indian Health Services (IHS) physicians, VA physicians and military physicians, click here.
The Health Law Firm’s Services.
The Health Law Firm and its attorneys routinely represent physicians, dentists, medical groups, clinics, home health agencies skilled nursing facilities (SNFs), group facilities for the developmentally disabled, hospitals, and other health care providers in preparing for and responding to audits and site visits for the Medicare Program, Medicaid Programs (all states), Zone Program Integrity Contractor (ZPIC) Audits, Recovery Audit Contractor (RAC) Audits, Zone Program Integrity Contractors (ZPIC) Site Visits, TRICARE Audits, and insurance company audits. It is extremely important to retain experienced counsel at the outset. Do not attempt to respond to an audit request by yourself. There are many pitfalls associated with incomplete, improper, or untimely responses. In the event of an appeal, with recent changes in laws and regulations, you may be limited to whatever documents you originally submitted. In most cases, for any appeal or any hearings on overpayment demands and fines, you will need to retain the services of an experienced health law attorney.
Contact Health Law Attorneys Experienced in Representing Health Care Professionals and Providers in the Office of Inspector General Investigations.
At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, home health agencies, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other healthcare provider. It also includes medical students, resident physicians, and fellows, as well as medical school professors and clinical staff. We represent health facilities, individuals, groups, and institutions in contracts, sales, mergers, and acquisitions. The lawyers of The Health Law Firm are experienced in complex litigation and both formal and informal administrative hearings.
To contact The Health Law Firm, please call our office at (407) 331-6620 or toll-free at (888) 331-6620 or visit our website at www.TheHealthLawFirm.com
Sources: U.S. Department of Health and Human Services. “Audit of Background Verification Process at IHS-Operated Health Facilities.” (April 15 2021). Web.
CJ Wolf. “The 2021 OIG Work Plan Updates You Need to Know.” Healthcity. (April 21, 2021). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law; he is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620; Toll-Free: (888) 331-6620.
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