Does the Insurance Industry intend to destroy Chiropractic by driving DCs out of practice by nonsensical lawsuits?

[caption id="attachment_18" align="alignright" width="300" caption="Modesto DC suing for $5 million"][/caption]Friday, Oct. 02, 2009

Modesto chiropractor suing for $5M

Claim names SJ County, insurer, two DA workers

By Merrill Balassone
mbalassone@modbee.com Buzz up!

A Modesto chiropractor once charged with defrauding insurers and workers compensation out of millions of dollars wants to clear his name.

Wilmer Origel, who endured 18 days in jail, raids on his offices and suspension of his chiropractic license, filed a multi-million dollar lawsuit in federal court last week against those who unsuccessfully prosecuted him.

A San Joaquin County jury voted 10-2 in favor of acquitting Origel on charges of overbilling insurance companies in excess of $1 million, performing controversial adjustments on anesthetized patients and money laundering. Prosecutors decided not to retry Origel in November.

At 49, Origel said he's starting life over.

"I won my freedom, but they still won," he said. "I lost everything."

Origel is suing San Joaquin County, two employees of the district attorney's office and Travelers Property and Casualty Company of America, an insurance company Origel's lawyer said pulled the strings in the criminal probe.

Origel is seeking $5 million plus punitive damages.

The defendants in the case did not return calls or declined to comment on the lawsuit's specifics.

Among the case's controversial aspects is that Origel and other chiropractors performed and charged insurers for a procedure called manipulation under anesthesia.

It requires an anesthesiologist to provide pain medication before a chiropractor works on muscles or adjusts joints or the spinal column. Patients typically have such serious injuries that back or neck surgery are treatment options.

During the 2½ month trial, prosecutors alleged the procedure was illegal.

But some insurers, including the worker compensation program, cover MUAs, and the California Chiropractic Association recognizes MUAs as an alternative to more risky surgical procedures.

Origel's attorney, Rob Waters, said Traveler's Insurance pushed Origel's case forward to intimidate chiropractors from performing the expensive procedures. Prosecutors said they cost $35,000 to $40,000.

Waters said the insurance company won in one sense: Origel, who has practiced since 1989, suffered "professional death," at their hands.

"Just because an insurance company does not want to pay for a procedure does not make that procedure unnecessary or illegal," Waters said.

Origel was at the helm of Med-1 Medical Centers, a chiropractic office that also employed medical doctors. The six locations, including those in Modesto, Turlock and Ceres, are closed.

"They basically shut us down," Origel said. "They destroyed us. And I think that was their intent from the very beginning."

Origel said he filed the civil rights lawsuit in part to send a message.

"Out of 36 charges, they couldn't even get a misdemeanor," Origel said. "They didn't have a single shred of evidence. I need to strike back so they think twice before they attack an innocent person."

Bee staff writer Merrill Balassone can be reached at mbalassone@modbee.com or 578-2337.

For information on ways to effectively address the issue of healthcare fraud & abuse, a multi-billion dollar menace, contact us today for a free consultation.

Turning up the HEAT on healthcare fraud & abuse!

The US Justice Department created the Health Care Fraud Prevention and Enforcement Action Team, or “HEAT,” program to put a dent in the fraud perpetrated against Medicare and Medicaid. For details on HEAT, click here

The problem with the HEAT program is that it is limited to four states and ignores the vast majority of the country.

The Justice Department claims, rather naively that:

"Most health care providers are doing the right thing and providing care with integrity. But sadly, due to the illegal actions of a small but active group of heath care fraud perpetrators, billions of dollars are stolen from taxpayers each year. Medicare fraud schemes have grown bolder and more elaborate, resulting in billions of dollars in false billings and fraud schemes which are robbing Medicare and Medicaid blind and leaving our most vulnerable citizens at
risk. Medicare fraud affects every American. Not only is waste, fraud and abuse taking critical resources out of our health care system, it contributes to the rising cost of health care for all Americans and harms the short-term and long-term solvency of these essential programs.

"Eliminating fraud will cut costs for families, businesses and the federal budget and increase the quality of services for those who need care. The U.S. Department of Health and Human Services (HHS) and U.S. Department of Justice (DOJ) are working together to help eliminate fraud and investigate fraudulent Medicare and Medicaid operators who are cheating the system. Attorney General
Eric Holder and HHS Secretary Kathleen Sebelius are taking the fight against Medicare and Medicaid fraud to a new level. They have committed senior officials from HHS and DOJ to work together on the Health Care Fraud Prevention and Enforcement Action Team (HEAT)."

The HEAT Team will expand efforts to stop fraud and prevent it from happening in the first place. These efforts will include:

Stopping Those Who Perpetrate Fraud:

• Continuing to utilize Strike Force teams that fight fraud in Miami and Los Angeles;
• Creating Strike Force teams in Detroit and Houston; and
• Helping State Medicaid officials conduct provider audits and monitor activities to detect fraudulent activities.
• Using modern technology to complete in a matter of days analysis of electronic evidence that previously took months to analyze using traditional investigative tools.
• Background on the Health Care Fraud Prevention and Enforcement Action Team.
• Criminal Prosecution as a Deterrent to Health Care Fraud, Testimony of Lanny Breuer, Assistant Attorney General for the Criminal Division, before the Senate Judiciary

Committee's Subcommittee on Crime and Drugs, 5/20/2009.

According to the Justice Department, in criminal enforcement actions during 2008, Department prosecutors:

1. Opened 957 new criminal health care fraud investigations involving 1,641 defendants, and had 1,600 criminal health care fraud investigations involving 2,580 potential defendants pending at the end of the fiscal year; and

2. Filed criminal charges in 502 health care fraud cases involving charges against 797 defendants and obtained 588 convictions for the year. Each of these figures represents an “all time high” count of federal criminal cases, defendants, and convictions.

Another 773 criminal health care fraud cases involving 1,335 defendants were pending at the end of FY 2008. In 2008, the Government charged 37 defendants in 21 indictments involving more than $55 million in fraudulent Medicare claims .

Since its inception two years ago, the Strike Force, with a limited number of investigators and prosecutors, has:

• filed 108 cases charging 196 defendants who collectively billed the Medicare program more than half a billion dollars;
• taken 129 guilty pleas;
• handled 14 jury trials resulting in convictions of 18 defendants; and
• obtained 109 sentences of imprisonment, ranging from 30 years to 4 months of home confinement, with an average term of imprisonment of 48 months.

It seems strange to hear politicians claim that they will save $500 billion by reducing fraud and abuse when with a special task force in place the US filed only 108 cases charging 196 defendants in two years and took only 14 cases to trial regarding 18 defendants with minimal recoveries from the participants. To effectively limit health insurance fraud (both against government and private
insurance programs) that steal over $100 billion every year it will be necessary to do more than pilot projects that have only covered four cities in four years.

It is time to properly fund the enforcement divisions and get more serious verdicts like some of those reported in the “Good News” sections below.

For more information on this and related topics, click here.

Should chiropractors ignore coding requirements for "mechanical traction" and EMS?

LOCAL CHIROPRACTOR SENTENCED TO 5 YEARS IN FEDERAL PRISON FOR HEALTH CARE FRAUD


Atlanta, GA—DR. WILLIAM STEARNS, DC, 47, of Marietta, Georgia, was sentenced late yesterday to serve five years in prison by Senior United States District Court Judge Clarence Cooper, for participating in a $2 million health care fraud scam at the network of back pain clinics that he operated with two co-conspirators. STEARNS was convicted after a two-week jury trial in October 2008.

United States Attorney David E. Nahmias said, “This sentence is another reminder that health care providers who fraudulently bill for their services will be held accountable for their crimes. These defendant and his partners received millions of dollars to which they were not entitled, by lying to insurers about the services they were providing patients. Such lies contribute to the problem of soaring health costs for all, and those responsible may end up spending years in prison.”

STEARNS was sentenced to serve five years in federal prison, to be followed by 3 years of supervised release. There is no parole in the federal system. He was also ordered to pay $1.2 million in restitution.

According to United States Attorney Nahmias and the information presented in court: In 2004, STEARNS and two partners, fellow chiropractors STEVEN LEVINE and CHRISTOPHER TOPEL, operated three clinics around the Atlanta area under the name Comprehensive Care Medical Group (“CCMG”). CCMG, under the direction of STEARNS, fraudulently billed Blue Cross/Blue Shield of Georgia for two separate back pain procedures, costing that insurer alone approximately $2 million.

First, STEARNS and his partners fraudulently billed for a procedure known as Vertebral Axial Decompression (“VAX-D”)—a non-invasive back pain procedure that uses a mechanical table to stretch a patient’s spine.


Blue Cross/Blue Shield of Georgia considers VAX-D to be investigational and not medically necessary, and made clear to health care providers that it did not cover the procedure.


STEARNS, along with LEVINE and TOPEL, were convicted of having lied to Blue Cross about what procedures they were performing in order to get paid for this non-covered procedure.


Specifically, instead of using the specific billing code assigned to VAX-D, CCMG used a different code that pertained to surgical nerve decompression procedures. The Indictment charged that STEARNS used that code because he and the others knew Blue Cross would pay for it, and would not pay for VAX-D. The proof at trial included testimony from the STEARNS’ former employees, several of whom were explicitly instructed to not refer to the procedure as “VAX-D” in patient files.

In addition, STEARNS also fraudulently billed for an electrical stimulation procedure using a device known as “Hako-Med.” Instead of billing for a relatively low-paying electrical stimulation procedure, the Defendant instead claimed to be performing surgical procedures known as nerve block injections. This was false, but allowed STEARNS to bill for rates five to ten times as high as if he had correctly billed for electrical stimulation.

The defendants were initially charged in an indictment in March 2007. Both LEVINE and TOPEL previously pleaded guilty. TOPEL previously received a sentence of 2 years, 10 months’ in federal prison. LEVINE’s sentencing is scheduled for March 17, 2009, at 4 p.m., before Judge Cooper.

This case is one of a series in which the United States has obtained convictions against medical professionals who have fraudulently billed insurance companies for “VAX-D.” All together, the VAX-D initiative in the Northern District of Georgia has resulted in 7 convictions of medical professionals, 6 of whom have been sentenced so far to a total of 19 years of imprisonment with monetary judgments over $8 million.

This and other VAX-D cases have been investigated by Special Agents of the Federal Bureau of Investigation.

Assistant United States Attorneys Justin S. Anand and Teresa D. Hoyt are prosecuting these cases.

For further information please contact David E. Nahmias (pronounced NAH-me-us), United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney’s Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.usdoj.gov/usao/gan.

Doctors Fight Back Against Denial by Algorithm - Miller McCune (March 7, 2009)

The technological "arms-race"
between insurers and providers continues

The man President Obama originally wanted to oversee his dream of affordable health insurance for most Americans, former Sen. Tom Daschle, withdrew his nomination for Health and Human Services secretary in early February. While tax issues were the headline reason he bailed, the financial disclosure statement he filed with the Office of Government Ethics revealed the health care industry — which he was about to regulate — paid Daschle more than $200,000 over the past two years in consulting and speaking engagements.

Included in one of those speaking appearances was an exclusive, invitation-only conference in May 2008 at the Gaylord Palms Resort in Orlando, Fla., held by Ingenix, a research firm owned by UnitedHealth Group, one of the nation’s largest health insurers. Daschle gave the keynote address.

At the time of the conference, Ingenix was openly under investigation by New York Attorney General Andrew Cuomo in a case involving UnitedHealth and Aetna, which was settled in January. The suit alleged a conspiracy to lower health insurance reimbursements when patients see a doctor outside their provider network; Cuomo said patients were defrauded of hundreds of millions of dollars of unpaid claims.

“For the past 10 years, American patients have suffered from unfair reimbursements for critical medical services due to a conflict-ridden system that has been owned, operated, and manipulated by the health insurance industry,” Cuomo said in January. “This agreement marks the end of that flawed system.”

One flawed system may have ended, but another persists even as the president tries find experts not tangled in conflicts of interest to recast the $3 trillion American health care system to focus on health and not money.

As Miller-McCune.com reported a year ago, companies such as Ingenix produce what insurers call “claims review programs,” but which those on the receiving end call “denial engines.” These computer programs sift through millions of submitted claims to, in essence, lower the amount of money insurance companies pay out to doctors. Insurers see this as cost containment, and any shortfall between what the doctor charges and what’s received generally gets passed on to the patient.

Now doctors are fighting back, settling for hundreds of millions of dollars with the help of the AMA and consultants who are trying to quantify the losses with hard numbers.

Driving denials
Ingenix’s dozens of digital products primarily analyze health insurance claims data. They help hospitals determine average fees and help physicians manage their billing, but mostly they help insurers scrutinize submitted charges.

The program under fire by Cuomo allegedly cooked the numbers in a database that collected out-of-network charges. When insurers paid the average cost of a particular service, the “usual and customary” rate, they artificially – and intentionally, said Cuomo — lowered that rate.

Using technology to reduce payments to physicians for out-of-network services just touches the surface of physician discontent. Doctors argue that insurers underpay or flat out deny, as a matter of course, legitimate health insurance claims worth billions of dollars each year. This in turn costs them more in lost time and money to recover. They say, in the end, it’s the patients who suffer, paying more and getting less when insurers use secretive methods that rely on proprietary software.

There’s a virtual arms race taking place between hospitals and physician groups on one side and insurance companies on the other, each spending millions of dollars on software programs and claims reviewers to counteract their losses. Leading software designers include IBM, McKesson, Bloodhound Technologies, TC3 Health and Fair Isaac (which sold the claims review part of its business to Mitchell International last May). These companies boast their products can reduce insurance payments between 3 percent and 7 percent.

The extent to how often insurers use computer-generated edits to reduce payments varies widely — anywhere from less than 0.5 percent to more than 9 percent — according to the AMA’s National Health Insurance Report Card. The use of “undisclosed proprietary edits” to reduce payments — as opposed to publicly stated reasons for the reduction — varied from none at all to nearly 72 percent of the time. This lack of transparency largely contributes to doctors’ frustration, said Frank Cohn, senior policy analyst for MIT Solutions a health care consultant firm to physicians and hospitals.

“We’re trying to put medical practices on an even playing field with the payers,” Cohn said.

Insurers say the programs improve efficiency and save costs through real-time billing where patients can see what they owe and doctors know how much they’ll get paid right at the time of service, said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, an industry trade group. Insurers reduce administrative costs through computer edits, in some cases offering cash back to doctors if they submit claims electronically.

Drawing the line
Attempting to put a cost to this, the American Medical Association last June tapped a group of consultants to analyze 5 million claims records from Medicare and seven national health insurers.

The study found that “inefficient and unpredictable” claims-review procedures by insurers cost the health care system $210 billion annually, diverting roughly 14 percent of physician resources. The research led to a campaign the AMA calls “Heal the Claims Process.”

Dr. William A. Dolan, a member of the AMA board of trustees, said doctors should be spending no more than 1 percent of their revenue on billing. As an orthopedic surgeon in New York, Dolan has seen bills for certain types of surgery automatically get bumped to a similar surgery with a lower reimbursement rate. He draws a distinction between sifting out fraud and the automatic denials or requests for medical records that insurers impose. The latter, he said, simply exist so insurers can pay less.
“There is medical fraud on the part of doctors, but that’s a small number of people,” Dolan asserted. “You can catch various forms of fraud with different software that identify certain codes. But here are insurance companies committing fraud by downright underpaying physicians for their work.”

Some companies are selling programs to both sides of the battle (to payers and providers), but in a war that insurers are by and large winning, doctors and hospitals should be skeptical of this dual role, said Cohn.

“It’s like owning a military base on a communist island or renting a room to my ex-wife,” he joked.

While such computer programs play a worthy role in capturing a fraction of the billions of dollars in likely fraud, for the honest physician, these programs cause far more problems than they solve, Cohn said. Typically more than half of denied claims challenged by doctors are overturned on review, he said.

“What would you think of a judge who had 60 to 70 percent of cases overruled on appeal?” he asked, pointing to “denial engines” as the primary culprit.

A worthy role
Insurers by and large defend their billing software as useful tools to reduce administrative costs and improve care. The federal stimulus bill, with $2 billion for health information technology, should increase the use of computerized billing, an aspect sometimes lost by attention on electronic medical records, Zirkelbach said.

“As new technologies come on the scene, health plans are assessing their ability to streamline the billing process and ultimately improve the care patients receive,” Zirkelbach said. “There is a lot of evidence showing that new (billing) technologies are making things better.”

Billing software can allow a doctor to spend less time with balance sheets and more time with patients. Insurers can also use claims data to help doctors better comply with evidence-based medicine and make some determinations about quality, ferreting out such things as how many cardiac patients might return to the hospital within 90-days.

Not long ago, doctors made a similar advance against insurance companies. A series of settlements between the AMA and major insurers, including with Aetna in 2003 and Blue Cross plans in 2007 worth hundreds of millions of dollars, focused on diminishing the administrative hassles by insurers.

UnitedHealth and Ingenix declined to comment directly for this story, instead pointing to press releases. Aetna issued a lengthy written response touting numerous efforts to improve electronic billing since the 2003 settlement. Out of 1.6 million claims filed per year, 79 percent are submitted electronically and 80 percent are paid within 2.6 days, said Paul Marchetti, head of Aetna's national network and contracting services. He likened what Aetna does to a similar program under Medicare.

“Aetna’s claim system is a highly customized platform designed to meet Aetna’s commitment to paying physicians and other health care providers quickly and accurately,” Marchetti said.

In recent years, Aetna launched several initiatives designed at paying claims on time, correctly and transparently when there are denials or corrections — all with the assistance of software vendors and an online tool called NaviNet, where doctors can submit claims to multiple insurers through a single portal.

“Aetna is helping take the administrative hassle out of medicine,” Marchetti said. “That’s why we are aggressively investing in e-technology and introducing new services that directly help physicians and hospitals run successful practices and focus on the thing that matters most: caring for their patients.”

Insurers settle out-of-network
In the January settlement Cuomo hammered out, a nonprofit group will replace Ingenix in managing the database for out-of-network charges. UnitedHealth agreed to pay $50 million and Aetna $20 million toward its operation. Settlements with other insurers continue.


A few days after the civil settlement with Cuomo, the AMA announced a settlement of its own with UnitedHealth: $350 million, directed to physicians and plan holders. On Feb. 10, the AMA said it would join a similar suit against Cigna and Aetna. Referring to out-of-network charges, the AMA says the insurers used “rigged data to dramatically under-reimburse physicians,” according to a press release.

“(Insurers) haven’t been punished hard enough,” said Dolan, with the AMA. “Even $350 million can be peanuts to these companies.”

Marchetti called the AMA lawsuit “disappointing.”

“This will not help advance what we believe is our mutual desire to transform health care,” he said.
For others, the financial reparations may not be enough. “I’m disappointed Cuomo settled the way he did,” said Cohn, who worked with Cuomo’s office in devising an alternate fee schedule to the Ingenix program. “I’m all for physicians who commit fraud going to jail, but who’s out there putting payers who commit fraud in jail? Apparently they just have to pay a fine.”

Does United Healthcare Discriminate Against Chiropractors?

Who's "at it" again?

In an article titled, "United Healthcare: Here They Go Again" (Dynamic Chiropractic - April 9, 2007, Vol. 25, Issue 08), James D. Edwards, D.C., currently serving as an "Alternate Delegate" ("Tx-East") in the American Chiropractic Association, stated:


The American Chiropractic Association (ACA) has received reports that United Healthcare has implemented a new policy in several states to only reimburse physical medicine and rehabilitation (PM&R) services when performed by a licensed provider.


The new policy states, "PM&R services rendered by non-licensed individuals are not eligible for reimbursement, regardless of whether they are supervised by, or billed by a physician or other licensed therapy provider." This change is effective as of Jan. 1, 2007 for newly contracted providers and April 1, 2007 for currently contracted providers.


So, what exactly does this new policy mean for doctors of chiropractic? In Texas, where United Healthcare is applying the policy, it means a doctor of chiropractic will not be reimbursed for physical medicine or rehabilitative treatments unless those services are actually performed by the doctor or by a person licensed by the state to do so . . ..

Does Dr. Edwards actually identify a disparate situation for chiropractors vis-à-vis other licensed healthcare providers (e.g., MD, DO, PT, OT)? There is no evidence of such a disparity, at least per the reference cited.

However, there can be little doubt that chiropractors perform such services at a much higher rate than other physician-providers on a per-capita basis.


Does Dr. Edwards identify a new policy in reimbursement-standards within the Insurance industry? Dr. Edwards states, "[T]his change will greatly impact patients and providers across the country . . .." He goes on to state:




[I]f you are a non-licensed chiropractic assistant who applies a heat pack or assists a patient with rehab, you will not be reimbursed! Think that might change the way you practice? (ibid.)



I am unaware of any insurance carrier that will "reimburse" a "non-licensed chiropractic assistant." Furthermore, I'm not certain that the position articulated correctly posits United Healthcare's reimbursement standard(s).


It is significant to note that the CPT Guides are unequivocal in distinguishing between supervised and attended modalities. Additionally, CPT distinguishes between "modalities" and "therapies" in the following manner:



Modalities are defined as "Any physical agent applied to produce therapeutic changes to biologic tissues; includes but not limited to thermal, acoustic, light, mechanical, or electric energy." They may be attended or non-attended.


The definition of modalities was added to CPT 1995 to indicate the different types of service included in this section.


To clarify the work performed by the provider, the section is divided into two parts; Supervised and Constant Attendance.


• Supervised modalities are defined as the application of a modality that does not require direct (one on one) patient contact by the provider.
• Constant Attendance is defined as the application of a modality that requires direct (one on one) patient contact by the provider.


Therapeutic Procedures are defined as "A manner of affecting change through the application of clinical skills and/or services that attempt to improve function." These require direct patient contact.


The definition of therapeutic procedures was added to CPT 1995 to clarify the differences between therapeutic procedures, modalities, and tests and measurements. These procedures require direct one on one patient contact by a physician or therapist. [At times, the foregoing terms are collectively referred to as "Provider" by CPT - both meaning someone licensed by the State to perform health care services.]


Therapies is a kind of general term used by many people to describe all physical medicine procedures -- modalities, therapeutic procedures, acupuncture, and sometimes, even CMT.


Most insurance companies will refer to the CPT terms described above. (http://www.chiro.org/ChiroAssistant/Articles/Modalities_vs_Therapies.shtml)



It would appear that United Healthcare is merely applying the applicable CPT codes in the manner the AMA CPT Guides intended. It is not clear why Dr. Edwards perceives that the application of the codes in the manner intended would justify issuing this alarming statement:



The NCLAF ["National Chiropractic Legal Action Fund"] has repeatedly told the chiropractic profession that the concern is not if our adversaries will attack us again, but when they will attack us. And sure enough, here they go again. Fortunately, the NCLAF shifted its focus to building a legal "war chest" for just this type of attack, and has reserves ready to commit to the fight. The ACA and the NCLAF continue to protect and defend your practice, your patients and your profession.



I know of few chiropractors who would not be concerned regarding the current insurance-reimbursement landscape, particularly as it pertains to Chiropractic. However, is the fact that chiropractors are treated in the same manner as other similarly-situated providers justification to break open the "war chest" and rally the troops?


The Chiropractic profession has much to offer the Healthcare community. As we, as a profession, consider what it is that we have to offer, we should proceed judiciously in that arena in which we have clamored for parity for decades, threatening to play the "victim" card when we finally receive the parity for which the battle was fought.


It appears as though one may justifiably ask, "Is it United Healthcare or the Chiropractic profession that is 'at it' again?"



About the Authors:

Dr. Tom Rhudy is licensed as both an Attorney and Doctor of Chiropractic in the states of Texas and Missouri. Daniel J. Osborne, M.S., is a renowned expert on health care fraud issues and recognized authority on health care compliance.

For the past 20+ years the authors have devoted most of their efforts toward educating and assisting providers in the development of healthcare treatment and compliance programs and prevention of healthcare fraud and abuse, making every effort to improve the quality of care and representation provided to patients.

For more information about creating an effective Healthcare Compliance program, designed to prevent healthcare fraud and reduce healthcare costs, you may go here: http://www.HealthCareComplianceTraining.net

Do Healthcare Compliance Programs Prevent Healthcare Fraud and Reduce Healthcare Costs? Part III

Okay, now that you've developed your Healthcare Compliance policies and procedures, what's the next step? Great question!

After all, if you have policies and procedures, but no implementation, is the program effective? How would such an inert Healthcare Compliance program prevent healthcare fraud and reduce healthcare costs? You're right, it wouldn't.

I have provided a few recommendations regarding ways in which to conduct effective training for your Healthcare Compliance program. (I've also shared a few lessons learned along the way.)

Training Sessions: Once the foregoing are completed, it will be necessary to set a time and place for the training session(s). It is important to conduct the training in a manner most likely to capture the largest number of employees/agents for which the training is intended. Any employees/agents who do not attend the plenary training session should be required to either attend a make-up training session or provide evidence of having obtained the information contained in the training session.

Training Location: Ensure that the location of the training session is conducive to such training, and interruptions will be minimized. During one of our first compliance training sessions, the room in which we conducted the training was so hot that by the time we were finished, participants were practically stripped down to their underwear.

Sound System: Ensure that you have an adequate sound-system. Too often, speakers conclude that they do not need a sound-system. Remember, sound-systems are for the listeners, not the speakers. It is also important to avoid having individuals attending the training session sit in areas that are “dead-spots,” acoustically-speaking.

Sign-In Sheets: Provide a sign-in sheet, identifying the date on which the training session is conducted, the employee’s/agent’s printed name, and the employee’s/agent’s signature.

Pre-Test: Provide Pre-Test 1A to all employees/agents to determine the knowledge- base of the participants prior to the training.

Videotaping Training Session: Training sessions should be memorialized, preferably via video. It is recommended that the taping, irrespective of the medium, be performed by a professional. If you do not know where to obtain such a professional, it is recommended that you contact a court-reporting service for recommendations. It is difficult to convince investigators that you take your compliance training seriously when an inattentive videographer allows the camera to focus on the back of someone’s head for ten minutes and the audio includes private discussions amongst audience members.

Q&A: Conduct a Q&A session following the training. Remember the following: (a) have speakers repeat questions asked; (b) ask participants to rephrase ambiguous questions; and (c) refrain from addressing questions that are not relevant to the training session, stating that you will be happy to discuss the issue with the questioner at a convenient time following the training session.

Post-Test: Provide Post-Test 1A to all employees/agents to determine the knowledge-base of participants following the training session. This will be a good metric to assess the effectiveness of the training session.

I hope that this is beneficial. Remember, if you have additional questions, please feel free to contact me.

You may obtain additional information regarding ways in which to design an effective Healthcare Compliance program, a program that has demonstrated its effectiveness in preventing healthcare fraud and reducing healthcare costs, by going here:
http://www.HealthCareComplianceTraining.net

Do effective Healthcare Compliance Programs prevent healthcare fraud and reduce healthcare costs? Part II

Delegation of Duties: It will be necessary to appoint a Compliance Officer who is qualified to oversee a healthcare compliance program. If you do not have an employee in your organization with such training, we have provided, and make available additional, resources that will prepare the appointed individual to assume such a role.


1. Compliance Officer: The individual appointed must be someone who refuses to compromise the quality and integrity of the compliance program. Policies pertaining to billing, coding, documentation, etc. should be viewed as mandatory, not optional!
2. Compliance Committee: Once your Compliance Officer is appointed, it will be necessary to determine what departments within your practice should be represented on a Compliance Committee to which the Compliance Officer will report. Frequently, providers mistakenly conclude that the practice consists of only one department. Rarely would this be the case.

Most practices will have, if nothing else, the following: (1) record keeping; (2) billing; (3) collections; and (4) production. Although one individual may wear hats for each department, it is best to consider these departments as discrete entities. This permits more effective management and analysis of your overall practice.

Compliance Manual: The Compliance Manual we have prepared addresses areas of exposure to which attention must be directed to attenuate (i.e., lessen) the exposure arising in each area. This is one of the most critical areas of any compliance program, and should not be given short-shrift.

Employee Manual: We have also provided an Employee Manual in which examples of employees’ duties and responsibilities are provided. It is recommended that the manual be tailored to the individual practice. While the duties and responsibilities included pertain to the principal areas of most healthcare practices, undoubtedly your practice has one or more unique areas that would benefit from slight modification of this manual.

Vendor/Agent Contracts: We have also included sample contracts to be used when working with vendors, independent agents, and licensed providers who are not employees of your organization.

Hotline: We have provided Hotline protocol, intended to provide a viable reporting mechanism for concerns/complaints concerning the organization’s practices. This protocol is effective in providing a reporting mechanism for concerns/complaints arising either internally (i.e., employees) or externally (e.g., patients, insurance adjusters et al.).

Education: The policies/procedures contained in the manual serve as an excellent educational tool for all employees, agents et al. However, to be effective, as is true for all education, it is necessary for those policies and procedures to animate those with whom they are shared. Merely having a dormant document in which such policies/ procedures are contained will not accomplish your intended goal of developing a vibrant bona fide healthcare compliance program.

Disciplinary Procedures: We have provided a guide to Disciplinary Procedures, applicable to both licensed and unlicensed employees. It is important to bifurcate these disciplinary procedures to ensure licensed providers that they are the individuals to whom boards of examiners will look for accountability, to whom law enforcement will look as the instigator of abusive and unnecessary procedures, and to whom governmental agencies will address inquiries into questionable/unusual practices. Unlicensed individuals must realize that their activities may also result in the accrual of personal criminal liability. Neither licensed nor unlicensed individuals are immune from prosecution. I was involved in one investigation in which a provider whose name was affixed to billing statements had been dead for more than six months, and the office manager’s sentence was actually longer than the doctors’.


Exit Interview: We have provided an Exit Interview form, as well as procedures to follow when employees sever their employment relationship, whether it be voluntary or otherwise. Failure to perform this procedure may result in many unnecessary claims (e.g., wrongful termination, “whistle-blower” actions, etc.) and prove extremely costly.

About the Author:

Dr. Tom Rhudy is licensed as both an Attorney and Doctor of Chiropractic in the states of Texas and Missouri. While serving as both an Attorney and Doctor of Chiropractic, he has worked closely with law enforcement, insurance carriers, administrative agencies, the FBI, US Attorney's Office, the US Postal Inspector's Office, and healthcare providers in the prevention, investigation, and prosecution of healthcare fraud.

For the past 20+ years he has devoted most of his efforts toward educating and assisting providers in the development of healthcare treatment and compliance programs and prevention of healthcare fraud and abuse, making every effort to improve the quality of care and representation provided to patients.

To obtain assistance in developing an efective healthcare compliance program, you may check us out here:
http://www.HealthCareComplianceTraining.net

Can an Effective Healthcare Compliance Program Prevent Healthcare Fraud and Reduce Healthcare Costs?

If you realize that you need a healthcare compliance program, but feel apprehensive about what seems to be such a daunting task, this Guide will assist you in gaining the confidence that you need to proceed step-by-step in creating a healthcare compliance program that will make you proud to be a healthcare provider once again. This Guide will show you the most important elements to consider in the development of a compliance program, irrespective of the size of your practice.

It is dangerous to assume that because your practice is small (e.g., 1 doctor and 1-2
staff members), that you do not need to have such a program. Any healthcare practice can become the target of a fraud investigation!

The following steps, if followed closely, will get you well on your way to a bona fide compliance program:

Practice Analysis: First, and foremost, it will be necessary to assess the areas of your practice that pose the greatest liabilities. To determine this, you will need to consider the following:

1. Do you provide healthcare to patients who are either employees of the Federal Government who will be filing claims against/with their employers’ carrier, or who will be filing claims under a government contract (e.g., Medicare/ Medicaid)?
2. Do you accept Letters of Protection on 3rd-party liability claims?
3. Do you have high employee turnover?
4. Do you file your billing electronically?
5. Do you out-source your collections?
6. Do you contract with independent practitioners?
7. Do you contract with outside vendors?
8. Have any of your providers been sued for malpractice?
9. What percentage of your billings are denied/reduced?
10. Do you have a mechanism for responding to either denials or reductions in reimbursement?
11. Do you provide ongoing training to billing and collections employees regarding CPT coding and ICD-9 coding?
12. Do you perform background investigations on all employees prior to hire?
13. Do you provide a mechanism for reporting complaints for internal resolution?

Once this assessment is competed, it will be necessary to develop policies and procedures to allow management of each potential liability. The Compliance Manual that we have created addresses those areas that pose the greatest liabilities for the largest number of providers. It is inadvisable to merely implement these policies prior to performing a thorough analysis of your individual practice needs.

For more tips on developing your Healthcare Compliance program to prevent healthcare fraud and reduce healthcare costs, visit us at:
http://HealthCareComplianceTraining.net/

Not Enough Lawyers! Are You Kidding Me????

Not enough lawyers?

Staff shortages hit local federal prosecutors' offices; vacancies affecting cases
BY ANTHONY M. DESTEFANO | anthony.destefano@newsday.com
5:05 PM EST, February 15, 2009
Overworked and understaffed.

That sounds like many workplaces, and it includes the offices of local federal prosecutors.

At a time when Wall Street wrongdoing is a major national concern, recent Department of Justice statistics show local federal prosecutions of white-collar crime and securities fraud have dropped off from higher levels earlier in the decade.

One reason for the drop, although prosecutions have picked up in recent months, may be staffing shortages and unfilled lawyer jobs in the U.S. Attorney's offices based in Brooklyn and Manhattan, according to a recent Department of Justice Office of Inspector General report. Another reason may be a drop in recent years in referrals for white-collar crime prosecution from federal agencies.

Severe in Eastern District


The staffing impact has been most severe in the Eastern District, which covers Long Island, Queens, Brooklyn and Staten Island. But even the Southern District, which covers Manhattan, the Bronx and six nearby upstate counties, appears to have shifted staff from priorities like counterterrorism and firearms to health care fraud and drug cases, according to the study.

The audit, which was released late last year and covered all 94 federal districts, showed unfilled staff positions in local federal prosecutors' offices between fiscal years 2002 and 2007. The report also signaled that federal prosecutors nationwide have been lax or uneven in the way they comply with Justice Department record-keeping requirements.

A spokeswoman for the U.S. Attorney's office in Manhattan acknowledged that the office underreported attorney work hours before 2007, not reflecting the effort in various investigative areas. The office has been working to rectify it, she said. A spokesman for the Eastern District declined to comment about the office's record keeping and deployment.

Budget problems blamed


According to Justice Department officials, the reduction in filled attorney jobs is rooted in federal budget problems.

"This underutilization occurred primarily because (prosecutors) had limited budgets to address annual rising costs, such as cost-of-living adjustments and increases in rent," said the report. "As a result, (federal) officials said (prosecutors) did not have adequate funds remaining to fill vacant positions."

"At some point they just stopped hiring," said one former Eastern District prosecutor, who asked not to be identified.

Under interim U.S. Attorney Benton Campbell, appointed in October 2007, the Eastern District has since gone on a feverish hiring binge, employing 60 new prosecutors as 29 left, for a net gain of 31, said spokesman Robert Nardoza. The office has five vacancies out of 178 attorney spots, he added. A spokeswoman for the Southern District said the office had 219 attorneys.

But even with more prosecutors, overall indictments in the Eastern District fell 33 percent from fiscal year 2003 to 2008, according to government data compiled and released by the nonprofit Transactional Records Access Clearinghouse, affiliated with Syracuse University. The Southern District's drop was 17.8 percent.

Securities fraud cases up 200%


White-collar crime and securities fraud prosecutions in both districts also fell in that period, though they recovered substantially in 2008 in the Eastern District, with securities fraud cases jumping 200 percent in a year, TRAC data showed. Among those cases were the pending indictments against former Bear Stearns hedge fund managers Ralph Cioffi and Matthew Tannin. (The arrest of Nicholas Cosmo in the suspected Ponzi scheme at Agape World Inc. occurred in fiscal year 2009 and won't show up in federal data until later this year.)

But in Manhattan, the drop in Wall Street securities fraud cases has been marked, with a 71 percent decline from 2003 to 2008, although all white-collar cases are off only an average of 17 percent, according to TRAC.

"I am not surprised at all," prominent defense attorney Gerald Lefcourt said of the Manhattan trends. He said that prosecutors used massive resources in one tax fraud case surrounding accounting giant KPMG, which he was involved in. The case against many of the 19 defendants was dismissed before the October 2008 trial, in which three defendants were convicted and one acquitted. With so much effort on one case, combined with the need for federal agents to work on terrorism, Lefcourt said the drop is understandable.

Others agreed. "Most of them (securities cases) are very difficult cases," said Fordham University Law School professor James Cohen.

"Many of the white-collar prosecutions have come from internal investigations that private law firms do," said defense attorney and white-collar crime specialist Elkan Abramovitz. TRAC data showed that white-collar crime prosecution referrals from the FBI and other agencies to the Southern and Eastern Districts dropped by more than 50 percent from fiscal year 2002 to fiscal year 2008.

Federal prosecutors in the Eastern and Southern Districts declined to comment on the TRAC data.

Where Judges Can Be Bought and Sold

Where Judges Can Be Bought and Sold

Sandra Day O'Connor: Where Judges Can Be Bought and Sold

Published: January 28, 2009 in Knowledge@W.P. Carey

The story sounds just like a John Grisham novel: The CEO of a West Virginia energy company spent more than $3 million to help a relative unknown unseat the incumbent and become a judge on the state's Supreme Court.

Later, that same judge, after refusing to recuse himself, cast the deciding vote on two decisions overruling verdicts against the energy company -- verdicts now worth $82 million.

Retired Supreme Court Justice Sandra Day O'Connor isn't shy about her opinion on the matter -- states should do away with judicial elections in order to restore independence to their courts, she said recently at an Economic Club of Phoenix luncheon, co-sponsored by the W. P. Carey School of Business and the Sandra Day O'Connor College of Law at ASU.

The plaintiffs in the West Virginia case -- who were awarded the $82 million verdicts in West Virginia's lower courts and then denied the verdicts by the state's Supreme Court -- are asking the U.S. Supreme Court to make it illegal for a state justice to vote on decisions involving people or groups that made significant contributions to the justice's election campaign.

What surprises O'Connor about the case, she said, is that the state allowed such bias into the courtroom in the first place. The argument shouldn't be about whether a judge should be forced to recuse himself from cases with litigants who financed his election campaign. Instead, O'Connor said, it should center on whether judges should be elected at all.

"I don't know what the constitution has to say about this or what the Supreme Court will do, but it strikes me as a sad state of affairs when a case like this becomes a question of constitutionality when it's clearly bad policy for the state to allow that environment to exist in the first place," she said.

Keeping the field level

"The basic precept of equal justice under the law requires that neither side of the dispute has an unfair advantage," Justice O'Connor said. "I think you might be concerned if you were in court litigating some issue in front of a judge who had been given a bunch of money by your opponent."

Alan Page, a National Football League Hall of Famer and Minnesota State Supreme Court Justice, compared a lack of judicial independence to how football fans would feel if, before their favorite team took the field, they learned that the officials for the game had a stated preference for seeing one side or the other win. "Or if the referees had to campaign for their jobs while being funded by the opposing team -- that's what we're facing today," said O'Connor.

Arizona does a good job of maintaining judicial independence through a system that selects most judges based on merit, O'Connor said. Yet a majority of states still elect state judges in partisan elections -- a fact that O'Connor said is "shocking."

The United States is the only country in the world that elects judges.

"People around the world are shocked that is our system," O'Connor said. But judicial election was never the intention of the country's founders. "Originally states' governors selected judges with confirmation by the states' senates," she said. "But then the great populist President Andrew Jackson persuaded Georgia to begin electing its judges -- and many states, including Arizona, followed suit."

In 1974 -- when Justice O'Connor was herself serving in the Arizona State Senate -- legislators amended the state's constitution to mandate a judicial selection system for most judges. Today, the governor appoints appellate court judges statewide and superior court judges in Maricopa and Pima Counties from a list of nominees submitted by judicial nominating commissions. Once appointed, the judges are retained or rejected by the voters every four years for superior court and six years for the appellate courts.

Arizona's current merit selection system is one of the best in the nation, O'Connor said. Nevertheless, she said, some of Arizona's legislators continue to fight to go back to the old election system, "with all the money changing hands and the problems that produces."
"Don't let that happen," she cautioned.

"If I could do one thing to protect judicial independence in this country," O'Connor said, "it would be to convince those states that still elect their judges to adopt a merit selection system and -- short of that -- at least do something to remove the vast sums of money being collected by judicial candidates, usually from litigants who appear before them in the courtroom."

The importance of judicial independence

Justice O'Connor said that the threat posed by the "flood of money into courtrooms by way of increasingly expensive and volatile judicial elections" is huge. The issue extends far beyond the courts, as decisions that judges make influence government, businesses and individuals. If those decisions are swayed by money, O'Connor said, everyone loses. "

A fair and impartial judiciary is absolutely fundamental to a properly functioning business and economic climate," she said.

Speaking after Justice O'Connor, W. P. Carey School of Business Dean Robert Mittelstaedt echoed the importance of judicial independence for business. "Economics always works," he said, "but it works best with the rule of law."

Some of the country's largest businesses seem to agree.

A "friends of the court" brief filed with the U.S. Supreme Court by Wal-Mart, Lockheed Martin, Intel Corp. and PepsiCo in advance of oral arguments in the West Virginia case says that "There is a need to signal to businesses and the general public that judicial decisions cannot be bought and sold."

Impartiality among justices is also important, O'Connor said, because the country needs the two other branches of government -- the executive and legislative branches -- to follow judicial orders. "To achieve that, they need to have confidence in a fair and impartial judiciary." Which, ostensibly, is hard to ask for when judgeships can be bought.

Furthermore, the judicial system, O'Connor said, needs judges with the courage to decide against the majority. Whether it's going against popular opinion, or the political leanings of a prominent politician, or a particular business interest, judges that are appointed for their merit are more likely to have that courage, she suggested.

When asked about whether merit-based judicial selection circumvents the will of the people, O'Connor said that she advocates a merit-based selection system with periodic retention elections -- like Arizona's -- where voters can vote "Yes" or "No" to retain a sitting judge. "That ought to be plenty of power for the electorate," she said.

To find out what happened when judicial independence was brought into question by corporate money in John Grisham's latest novel, read "The Appeal." To find out how the oddly similar real-life story ends, stay tuned for the U.S. Supreme Court's ruling; the Court is scheduled to hear the case beginning on March 3.

Yet no matter what her former colleagues decide, Justice O'Connor, for one, would like states to adopt their own merit-based selection systems, so cases like the West Virginia one don't happen in the first place.

Bottom Line:

Retired Supreme Court Justice Sandra Day O'Connor said that states should do away with judicial elections in order to restore independence to their courts.

Arizona does a good job of maintaining judicial independence through a system that selects most judges based on merit. But a majority of states still elect state judges in partisan elections.

"A fair and impartial judiciary is absolutely fundamental to a properly functioning business and economic climate," according to Justice O'Connor.

The judicial system needs judges with the courage to decide against the majority; judges that are appointed for their merit are more likely to have that courage.

Healthcare Compliance Training (A-Z)

What is the True Cost of Healthcare Fraud - Part IV

The True Cost of HealthCare Fraud - Part IV
By Dr. Tom Rhudy

When assessing the true cost of healthcare fraud, one must fairly assess efforts expended to breach a fiduciary duty incumbent upon any entity upon which the State bestows its imprimatur, granting a "quasi-governmental" status (e.g., Allstate Insurance, National Insurance Crime Bureau, etc.).

Were competent Healthcare Compliance training to be implemented for all Allstate employees, and a bona fide Healthcare Compliance Officer given authority to enact applicable policies and procedures, one cannot help but wonder, "How much fraud is transacted each and every day, and neither recognized nor reported?" As Goethe said, "The eye only sees what the mind knows."

The "Good Hands People"

Date: 12-11-2008
Case Style: Fred Klecka v. Allstate Insurance Company
Case Number:
Judge:
Court: 150th District Court, Bexar County, Texas
Plaintiff's Attorney: Gravely & Pearson LLP, San Antonio, Texas
Defendant's Attorney:

Description: A San Antonio jury awarded almost a $1 million verdict against Allstate Insurance Company in what attorney Matthew Pearson termed a case where his client was forced to choose between his freedom or his job.


Fred Klecka, a former Allstate special investigation unit (SIU) adjuster uncovered fraudulent claims handling by a co-worker that occurred over six years and involved more than $1.3 million. The fraudulent activities led to a criminal investigation conducted by the FBI."


Our client was told not to cooperate with the FBI or he could lose his job. He chose to disregard the illegal instruction and continued to assist the FBI," Attorney Marc Gravely, Pearson's partner, said after Monday's verdict in the 150th District Court of Bexar County.


Klecka helped the FBI with their investigations of Roland Villarreal, an Allstate contractor, and Chandler Bruton, a claims adjuster. Both were convicted two years ago in federal courts for insurance fraud."


I appreciate the fact that the jury recognized that our client was wrongfully terminated. However, I am especially gratified that the jury decided to punish Allstate for their conduct," Pearson said. " Hopefully, this will prevent another Allstate employee from being placed in the same dilemma."


The jury awarded Klecka $373 thousand in compensatory damages and another $500 thousand in punitive damages.


SOURCE: Gravely & Pearson LLPfor Gravely & Pearson LLP Matt Scherer, 210-325-4130 mattscherer@gmail.com



Outcome: Plaintiff's verdict for $1 million.

Sadly, $1 million is chump-change to Allstate. After spending three more years to have the Appeal heard, and spending hundreds of thousands of dollars on additional legal-fees, the Decsion loses its luster. Nevertheless, Fred Klecka is an individual worthy of our respect and admiration if, as is suggested by this Decsion, he refused to bow to Allstate's efforts to interfere with a lawful investigation into Allstate's activities.

There can be little doubt that the "Good Hands People" will crush any individual who interferes with its bottom-line. Congratulations, Mr. Klecka!


About the Author:Dr. Tom Rhudy is licensed as both an Attorney and Doctor of Chiropractic in the states of Texas and Missouri. While serving as both an Attorney and Doctor of Chiropractic, he has worked closely with law enforcement, insurance carriers, administrative agencies, the FBI, US Attorney's Office, the US Postal Inspector's Office, and healthcare providers in the prevention, investigation, and prosecution of healthcare fraud. For the past 20+ years he has devoted most of his efforts toward educating and assisting providers in the development of healthcare treatment and compliance programs and prevention of healthcare fraud and abuse, making every effort to improve the quality of care and representation provided to patients.

Now you may receive his FREE 10-STEP QUICK-START COMPLIANCE GUIDE created to minimize healthcare fraud and abuse my completing the form below:

What is the true cost of healthcare fraud?

Are there any secrets remaining regarding the True Cost of Healthcare? It is currently estimated that healthcare fraud accounts for an estimated 100 billion dollars per year in the United States alone!

Healthcare fraud is putatively increasingly a reason that health care costs continue to rise. Unnecessary and fraudulent treatments are being submitted to payer organizations daily, if not hourly. Healthcare fraud has become a huge business in North America today.

Increasingly, health insurance organizations, as well as consumers, are looking at new ways to detect, investigate and prosecute anyone submitting fraudulent health care claims.

In 2000, Americans were spending a staggering 1.3 trillion dollars per year on healthcare! As inexorably as night follows day, when that much money is at stake, the unethical among us seek their personal benefit at the cost of those around them.

What percentage of the $1.3 trillion is spent on fraudulent billing? The truth is, nobody truly knows!

The IRS estimates that between 3 and 10% of healthcare dollars (i.e., $39 billion) may be fraudulent. Independent review organizations, if truly independent, play an important role in helping healthcare fraud special investigative units ("SIU") investigate and determine whether claims are legitimate, whether chart notes support a legitimate case and whether medical necessity is associated with a case.

However, with Billions of dollars at stake for SIU employers (i.e., insurance companies), is it safe to conclude that so-called "independent review organizations" have clean hands? Not very likely!

The same human nature that leads to healthcare fraud permeates the SIU investigator and the "independent review organization." In displays of prosecutorial bravado, too frequently, the innocent are greatly inconvenienced, falsely accused, or even wrongfully convicted.

We all agree, something should be done. The question is, "What should be done?"

Frequently, federal investigators and prosecutors typically rely on a heavy and injudicious hand. The strategy appears to be to make examples of individuals, rather than bring about systemic change, which would be inconvenient and difficult.

What are the types of fraudulent activities that the dishonest Physicians and healthcare providers are known to engage in? The activities include,

• Up-coding/Upgrading (billing for more than actual service provided)
• Providing and subsequently billing for treatments that are not medically ecessary
• Scheduling extra visits for patients
• Referring patients to another physician unnecessarily
• Billing for services to accompanying family members
• Ordering unnecessary tests

Providers often engage in such practices, ignorant of the fact that such activities may trigger fraud investigations. What can providers do when they become the target of a healthcare fraud investigation?


There are several steps providers should take when they become the target of a healthcare fraud investigation. There are 10 steps providers should take:

1. Determine whether the action is civil or criminal. There is a huge distinction. In a civil action, if you lose, you may have to pay monetarily. In a criminal action, if you lose, you may go to prison.


2. Do not shred documents that you now suspect are incriminating.
Although it seems counterintuitive, do not commence a shredding-campaign. Providers frequently fail to realize that patients’ files are often the “crime scene”. By the time you either are made aware of or suspect that you are a target, the incriminating documents are in the investigators’ hands.


3. Determine whether you are a “target” or a “subject” of an investigation.
Frequently, investigators are working closely with prosecutors months, if not years, prior to identifying the “target” of an investigation. If you are a “subject” of such an investigation, this suggests either that the investigation is in an early stage, i.e., information-gathering, or you are a conduit to the “target”. If you are a “target,” seek consultation with someone knowledgeable in health care law without delay.

To see steps 4-10, complete the form below and receive your FREE 10-Step Quick-Start Guide to an effective HealthCare Compliance program.