Provided by: Jennifer Kirschenbaum, Esq.
August 10, 2017
Tuesday's email set up a scary regulatory picture for what sounds like, used to be, a pretty common structure practice. Can you give some examples on why you think management companies are at risk?
Thanks again, Dr. P
Sure. Just a quick google search came up with a great example of Big Brother providing us a great example - http://www.ocregister.com/2017/04/20/40-million-medical-insurance-fraud-went-down-in-orange-county-elsewhere-law-and-state-officials-say/. The Feds are going for headlines lately - and using complex laws to paint pictures of grand conspiracies. The broader the net cast and more money that can be clawed back for Medicare or Medicaid, the bigger the headlines and better for the prosecutor's career. Sometimes the allegations in the press are partly true - but usually not the full picture (in my experience defending clients - usually a good amount of appropriate care and services were in fact rendered).
For an understanding of what the Feds are looking to prevent, a great guide is the OIG Special Advisory Bulletin from 2013 - https://oig.hhs.gov/fraud/docs/alertsandbulletins/042303sabjointventures.pdf. Trust me when I say the adage of "no press is bad press" does not apply in all contexts.
To stay out of the news for an improper structure - BE SURE TO CALL BEFORE ENGAGING IN A NEW VENTURE, which includes -
1. signing a vendor contract that hasn't been vetted
2. starting a "new line of business" internally from your practice
3. letting a third party into your practice - maybe another provider or retailer looking to work with your patients
ETC. Call before you scheme or sign.
If you're past this point and realized you proceeded without counsel, call and we can look at what you have going on now and look to fix, if necessary. If its too late, call and we'll do what we can to help.
While not for public discussion related to facts, our office regularly defends civil actions taken by the government against providers - whether pre-litigation in the "audit" defense realm, or post-filing defending against Qui Tam or OIG - US Attorney False Claims Actions.
Contact me direct if you have a scenario you wish to discuss.