What Triggers Medicaid Investigations in Las Vegas

 

If you are one of the Medicaid Service Providers, here are a few reasons that can trigger Medicaid Investigations Las Vegas:

•  Falsifying the patients’ diagnosis to justify the tests or any other procedure that are not medically necessary;

•  Billing the Medicaid for the services that hasn’t ever been provided;

•  Misrepresenting the procedures performed in order to obtain payments for the non-covered health care services;

•  Upcoding: it relates to billing for more costly services than ones that were actually performed;

•  Unbundling: it relates to billing each and every stage of a given procedure as if it was a separate procedure;

•  Filing Medicaid claims for staged and fake car accidents in Las Vegas;

•  Filing Medicaid claims for fake healthcare services and for fake medical conditions;

•   Filing Medicaid claims for any non-existent illness;

•   Illegal fee sharing;

•  Billing for health care services provided by any unlicensed personnel that is in violation of the Medicaid rules;

•  Illegal kickbacks.

Medicaid investigations and prosecutions can be duly conducted on the federal and state levels, suggests Healthcare Attorney LasVegas.

On the federal level, one can deal with the FBI, or the Office of Inspector General, and any other federal law enforcement agency.

On the state level, Medicaid fraud care are often handled by various organizations including:

•       Local district attorneys
•       The Office of Medicaid Inspector-General
•        The Medicaid Frauds Control Unit – Las Vegas Attorney General’s Office

Once your practice is flagged for Medicaid fraud, the investigation will duly begin and it could continue for several months or even for years.

When Should a Person Hire the Services of a Healthcare Lawyer?

 

Extended hospital stays and long-term illnesses brings with it lots of confusing as well as frightening concerns. Wouldn’t it be great if you have someone experienced in the field of healthcare in your side who is capable to guide you and help navigate you through the various treatment options, and also deal with your healthcare insurance provider? Here’s when you should hire the services of healthcare lawyer Las Vegas:

To Keep the Patient/Loved One safe

When someone gets ill, sedation or lack of energy in them can make it increasingly hard for them to communicate, regarding safety issues, properly with staff members at the healthcare center or hospital. Additionally, it might be the case that the patient simply doesn’t want to complain regarding the basic amenities such as room cleanliness or staff washing hands prior to coming in contact with you, even though these things are key responsibility of the healthcare facility.

You Are Not Happy with Your Present Physician

When an individual suffers from a long-term illness or needs to be hospitalized for a long period of time, it becomes critical that he/she has a physician that they feel comfortable having around and trust. When one isn’t comfortable or happy with their present physician, then a healthcare lawyer, as per healthcare business and corporate law Las Vegas, can be helpful. Healthcare lawyer can help the patient decide what is more important for them and help them choose the right treatment option too.

Purpose of A Healthcare Compliance Program

When it comes to healthcare, ethics and compliance aren’t simply legal requirements; they are critical components to quality and safe patient care too. Regardless of the specialty or size of the healthcare facility or practice, all the medical providers face concerns related to healthcare compliance.

Healthcare compliance is an ongoing process of legally abiding to professional and ethical standards that are applicable to the healthcare industry. Health care compliance requires effective development of policies, procedures, and processes in order to educate staff, define appropriate conduct, as well as to monitor that everyone adheres to set guidelines. A healthcare compliance program encompasses numerous areas including, patient care, billing, reimbursement, managed care, HIPAA, and OSHA.

The purpose of a healthcare compliance program is promoting organizational adherence to the applicable state and federal law, and also to the healthcare requirements of the private payer. An effective healthcare compliance program could help in detecting and preventing frauds, waste, and abuse. Compliance programs designed as per the Healthcarelaw Las Vegas helps establish a culture within the organization that promotes, detection, prevention, and resolution any conduct that doesn’t conform to the organization’s business and ethical policies, and the law. Compliance programs need to be articulate and must demonstrate the commitment of the organization to adhere to the law and the ethical standards.

A lot of commercial insurers require healthcare providers to have healthcare compliance programs at place, as an essential condition to be able to participate in their program. Medical providers that aren’t able to do so have greater risk of failing to participate in any healthcare program.

What Should You Do When Under Medicaid Investigation?

The moment that you realize that you or your organization is subject to a Medicaid investigation, you should talk to a healthcare lawyer or a Medicaid fraud defense lawyer as soon as possible, before you talk to any investigator. When you are under an investigation, always remember that “do-it-yourself” approach would be a wrong path. The way that a case is handled during the early stages would determine the overall outcome, and it would include the likelihood of whether any criminal charge would be filed against you. This is the reason why consulting a healthcarelawyer Las Vegas is so critical before discussing any matter with an investigator.

If you’re a health care practitioner and are subjected to Medicaid investigations, then you must avoid the following:

• Allowing anyone to remove or even review any document(s) or file(s) from your office or workspace unless and until they have a legal warrant.
• Discuss your case with anyone
•  Instruct your staff member(s) to lie
• Alter any document(s)

Such actions would compound your problems and would make your defense case even more difficult.

The chances of favorable outcome, in your case, would dramatically increase if your start your defense early on, especially when it comes to Medicaid investigations. The govt. authorities have invested already considerable resources and time in gathering the evidences and building case against you. The authorities are well ahead of game – therefore, the sooner your lawyer or defense team would get involved in this matter, the better would your chances get.

Tips to Help Onboard New Employees into Your Compliance Culture

The best way to getting the most out of employees is having them onboard into your compliance culture. Effective onboarding could be a really useful tool for healthcare compliance, and this is because integrating your healthcare compliance program into the onboarding process is one of the most effective ways of emphasizing the very importance of your program to the new employee and fully immerse the new hire into your healthcare compliance culture.

Onboarding presents the employer with an opportunity to indoctrinate the new employees into their compliance initiatives. An efficient and seamless way to make sure that full spectrum of your healthcare compliance program is properly understood as well as embraced right from the very beginning. Following are the crucial areas of any onboarding process where one could easily emphasize healthcare compliance program:

1. Hiring. Insert your compliance program directly into the hiring qualifications.

2. Orientation. Make your compliance program an integral part of orientation.

3. Warm welcome. Include the compliance in your company’s “welcome aboard” package.

4. Create onboarding folder. You could get your compliance officer put together an onboarding       folder for the new employees.

5. Training. Appoint mentor who has good knowledge of the compliance program, perhaps a person expert in healthcare law Las Vegas.

6. Get staff involved. You could make compliance program a part of the training, and also get the staff involved.

7. Expectations. You can include compliance program in the paperwork or the meetings regarding expectations that you have of the new hire.

How to Become A More Empowered and Responsible Patient?

Empowerment of patients can have many definitions; however, at the same time, most emphasis is often placed on the concept that the patients take active roles in one’s own disease management, while also supporting an active participation with constantly learning further about conditions and diseases as well as treatment options that are available to them at the moment.

Set Clear Goals

It is important to understand that the human body doesn’t necessarily reacts the same way that an individual might expect it to, suggests a healthcare lawyer Las Vegas. This is why it is better to set some treatment goals and further work towards goals that one has set. For instance, one may have to set a goal regarding swiftly healing the patients, while some may want to manage their conditions or disease, and further there are those who need to simply accept the disease or condition that they have and learn to cope with the situation.

Take Responsibility

Another important thing is realizing that one knows their own body better than others do. One must accordingly refer their resources and further use the knowledge to make much better decisions regarding treatment options. Additionally, it will be great if one could ensure that there is a health care compliance program in place, at the organization, so as to be clear how Medicaid investigation would be dealt with, if the situation arrives. And if a patient is finding it difficult to understand the various aspects of this process, they always have the option to seek the expert’s advice.

Legal Issues & Obstacles of Telemedicine

When it comes to the practice of telehealth or telemedicine, there are numerous legal obstacles, and the main one among those is licensure.

Healthcare providers, which include physicians or doctors, are licensed by the states. generally, their practice is often governed by the state where that are practicing physically (i.e. their ‘home state’) as well as the state where the patient is located (i.e. the ‘remote state’). For instance, if a California physician who specializes in cancer wants to offer consultation to a patient or patients in New York, then the physician needs to be licenses in California as well as in New York, both, as per healthcare law Las Vegas. Otherwise, New York city could find the physician who has California license guilty of practicing medicine in NY without NY license.

There are some states that have attempted to find a solution to this problem by forming a limited telehealth license for which the out-of state physicians and healthcare providers could apply. However, the problem is that this solution isn’t available in all the states.

In the other states, licensing law and healthcare compliance program allows the out-of state doctors to offer consultation to an in-state doctor regarding a given patient. Here, it is important to note that it isn’t the same thing as allowing an out-of state physician to provide their medical services to the in-state-patient remotely. Certain states also have reciprocity for the health care practitioners like nurses but not the same for physicians. Because there isn’t a national physician licensing, physicians are placed in potential legal perils and issues when they offer services to out-of state patients.