Healthcare providers are expected to know, understand, and implement documentation and protocol consistent with federal and state laws, regulations, and ethical standards.
Compliance is critical, touching every area of facility management, patient treatment, billing, payment, and internal and external communications. Inadequate compliance programs often lead to lawsuits, fines, and negative press. Existing compliance programs also require routine updating for fraud prevention, oversight monitoring, and employee training.
Elliott Sauter is experienced in internal investigations, compliance audits, and criminal and civil defense of healthcare clients. We identify vulnerabilities and recommend necessary improvements to meet and maintain thorough organizational compliance.
As a team of former federal prosecutors, we understand the consequences of compliance violations. We use our deep industry knowledge and years of experience to build legal security plans for healthcare clients, and when necessary, defend them in all legal proceedings.
The 1996 Health Insurance Portability and Accountability Act (HIPAA) specified and mandated privacy and security regulations. HIPAA covers all physical and digital methods of record keeping, communication, and billing.
Public concerns about healthcare issues have led to more complaints and heightened government scrutiny. Therefore, HIPAA notification, communication, and documentation compliance procedures are needed to reduce risk at all times.
In addition, all compliance procedures must be implemented properly. Employee training and oversight on HIPAA compliance is key to successful risk reduction.
Billing & Coding Issues
Medical billing and coding is the source of many compliance violations. Many times, decisions are made by data-entry personnel with little or no medical training. This reality leaves physicians and institutions susceptible to preventable error.
Enforcement and government agencies utilize data analytics to find errors in billing and coding. Minor, accidental inconsistencies may lead to major financial woes.
Elliott Sauter helps our clients design and implement compliance training and oversight procedures to reduce the risk of coding and billing violations.
Employee complaints within healthcare organizations often reveal crucial information for institutional risk reduction. Your staff is in the best position to report compliance problems.
Addressing complaints quickly and professionally promotes a safe, open, and trustworthy environment that can significantly reduce risk factors.
To avoid the cost and complexity of violations and whistleblower lawsuits, Elliott Sauter provides clients with an assessment of past complaints and potential future issues.
Elliott Sauter conducts internal investigations and audits to determine deficiencies within your compliance program. Internal audits assess HIPAA violations, marketing practices, physician referrals, billing irregularities, and communication discrepancies.
Our internal auditing methods will improve organizational efficiency and reduce the risk of external agency audits for laboratories, nursing homes, pharmacies, surgical device companies, hospitals, and medical equipment suppliers.
Discovering compliance vulnerabilities is the first step. The second step is correcting deficiencies quickly and appropriately.
Implementing Compliance Programs
Implementing professional compliance programs is no longer optional. Rather, it is necessary in order to confidently avoid the legal consequences of complaints, citations, and lawsuits. Our experienced team of attorneys will work with you to build and implement your compliance program and to instill organizational confidence.
Elliott Sauter helps clients develop a framework to assign responsibility and authority for implementing compliance procedures. Creating a compliance culture is your best insurance against risk.