THIS IS AN ADVERTISEMENT
Health care providers, now more than ever, function in a high-risk regulatory environment. Governmental investigations have become commonplace in the health care industry as regulators and legislators continue to prioritize enforcement actions against perceived provider fraud and abuse. Whistleblowers are filing cases in the health care industry faster than ever before and are seeking to benefit personally from provider activity that does not conform to regulatory expectations. No provider is immune, no matter how effective its corporate responsibility program. Unfortunately, the tremendous returns the government is receiving on its investment in health care investigations is not expected to change any time in the near future. In other words, chances are that if a health care provider has not already been the target of a compliance-related investigation, it may well be in the future.
In these difficult times, providers need experienced compliance counsel to both assist them in trying to prevent one of these investigations at their own institutions and also to defend them in the event they do become a target. The compliance team at Hall Render is multi-faceted and regularly works with a wide range of providers across the country with the full spectrum of regulatory compliance matters. Our compliance team has deep experience regarding particular compliance issues arising under the False Claims Act, Civil Monetary Penalties Law, Stark Law and Anti-Kickback Statute. For example, on a day-to-day basis we counsel providers on compliance questions that arise regarding particular coding and billing practices and relationships with physicians. We also routinely interact with compliance officers and general counsel regarding matters that have been reported up through their compliance programs and how best to implement any necessary corrective action. We also advise these providers on the most appropriate manner for voluntarily refunding or self-reporting for any past conduct that requires such an approach. The most important consideration is for providers to efficiently and effectively address the non-compliant activity to minimize future regulatory risk to the organization. We regularly work through the attorney-client privilege and work product doctrine, as necessary, to internally investigate a compliance issue with the provider, determine its magnitude and then assist the provider in implementing any required additional internal controls so that the problem does not recur.
Despite best efforts with their own corporate responsibility efforts, some providers will still become the subject of a government inquiry. Every day, our compliance team works with providers on properly responding to governmental audits and more formal investigations. We are involved in defending providers in a number of national enforcement initiatives, which may involve the U.S. Department of Justice, Office of Inspector General, Bureau of Federal Investigations, State Attorney General Offices and other health care enforcement agencies. Past experience with both the type of issue under investigation and, in some cases, the same individuals coordinating the government investigation, can be very helpful in developing the best defense approach to these cases. We believe that our vast experience in these investigations provides significant benefit to our clients. Our compliance team frequently presents and publishes on these topics.
Beyond the false claim and fraud and abuse inquiries, our compliance team also routinely handles a number of other regulatory compliance matters, including those involving EMTALA, licensure/certification, HIPAA and Sarbanes-Oxley. It is important for our client base to maintain knowledge of these related regulatory issues in case compliance investigations expand into other areas. For example, even though the Sarbanes-Oxley Act directly applies only to publicly traded providers, it also provides some helpful guidance to our nonprofit clients as it shifted the playing field for corporate boards and officers, making them much more accountable for the organization's financial and accounting compliance. This attitude has been extended to the governance of many nonprofit providers as well, making their organizational compliance efforts more effective. Our compliance team attorneys have worked with publicly traded companies, as well as nonprofit hospitals, to perform independent board investigations and reviews to ensure compliance with all applicable requirements.
Finally, our regulatory compliance practice would not be complete without team members who regularly assist our provider clients to improve their own internal compliance program practices. Maintaining effective compliance programs for providers in the health care industry has never been more important than it is now, and it is the best "preventative medicine" for keeping a government investigation from the provider's doorstep. Hall Render attorneys can conduct a formal compliance program assessment and make recommendations to ensure the provider has a fully comprehensive and active corporate compliance program, as well as develop a process to keep the current compliance policies up to date, and support the provider in maintaining the program's effectiveness. We work directly with client compliance officers and general counsel to advise them on the latest legal and Office of Inspector General requirements and standards. Through our focused assistance, a provider's compliance program will operate more efficiently and effectively while meeting organizational needs. We offer compliance training and education to not only an organization's compliance officer, but to all other stakeholders, such as compliance committee members, physicians and medical staff professionals, managers and employees and Board of Trustees/Directors. We also work with providers to perform proactive compliance risk assessments to help them identify problem areas before they escalate further. Hall Render can even staff a facility with our own on-site compliance officers on either an interim or permanent basis depending on the particular needs of the organization. In short, our compliance practice is uniquely positioned to meet all of a provider's health care compliance needs, no matter how challenging.