Owning and operating a professional medical practice is no easy task. From complex transactions and business relationships to various day-to-day tasks and the duty to provide sound treatment, there are many issues practices must address. Those issues are given even greater importance in terms of the dense and complex health care regulations with which practices must comply in nearly every facet of their operation – regulations that can subject providers to significant consequences for violations.
In today’s health care regulatory landscape, practices can feel the impact of regulations concerning waste, fraud, and abuse through the intense scrutiny and aggressive enforcement of regulatory agencies, auditors, and authorities. For some, this may involve the tasks required of a self-constructed compliance program or third-party audits and recoupment when billing irregularities or errors are identified. For others, it may involve more drastic measures taken by authorities, including a Civil Investigative Demand or (CID).
At Hendershot, Cannon & Hisey, P.C., our Houston health care and medical law attorneys have earned national recognition for our work handling matters involving health care fraud – from proactive compliance to responsive defense following notices of pending investigations and legal action. Having handled many cases involving clients who received civil investigative demands, we know that such notices can create significant concerns for practices – not only when it comes to the long-term risks for substantial penalties, civil or criminal liability, and provider exclusion, but also the disruption, costs, and time that come with complying with those demands.
While every health care fraud investigation and case is unique, there are a few general ways practices should be addressing a civil investigative demand. These include
- Immediate response – By responding immediately to practices that reach out for assistance upon receiving civil investigative demands, we’re able to assess those demands and initiate a course of action to deal with them effectively. Not only does an immediate response provide greater opportunity for in-depth evaluations that provide insight into the scope of a demand, why authorities took action, and how to seek the most appropriate resolution, it can also allow for a targeted approach in helping practices comply with the CID, communicate and negotiate with authorities, create manageable terms and timelines for compliance and production of things they want to see, and generally help practices better deal with demands while continuing their operations.
- Preparation – Preparation is critical to effectively dealing with a civil investigative demand, and is best approached with the help of experienced representation. When handling CIDs, our attorneys work closely with practices to help them understand what to expect, both in the immediate future and long-term, which is often invaluable to practices navigating unfamiliar territory. Effective preparation should also consist of gathering the resources to produce documents and information sought in the demand, creation of actionable steps to ensure cooperation, and ensuring professionals and employees are available and prepared for any interviews conducted by regulators and needed changes.
- Communication– Communication should always be a top priority when dealing with CIDs, internally and with authorities. Within a practice itself, communication can keep staff apprised of the current climate, and ensure they take steps to facilitate compliance with the demand and respond appropriately to changes or requests. In terms of communication with regulators, developing a dialogue is essential to creating informed decisions when responding and protecting rights and interests as the process unfolds. An open line of communication can also help open the door to good faith negotiations that ensure the government gets what it needs without undue costs and setbacks for the practice.
- Regulatory compliance – Aside from working with authorities to define the scope of a demand and facilitate communication, practices must address the focal point of regulatory compliance. This includes addressing the underlying issue for why the CID was issued, as well as the creation and implementation of comprehensive compliance plans that address all facets of a practice in terms of compliance, including proactive measures to prevent, identify, and address other occurrences or issues in the future.
- Resolution strategies – Dealing with a civil investigative demand can feel like an immediate and overwhelming threat, but practices should remember to establish their objectives. While every case is different, practices will largely structure their goals and game plans around avoiding criminal liability and keeping demands and investigations within the civil realm. Of course, objectives should also include strategies for avoiding or reducing penalties or setbacks that can threaten the future of a practice through the most appropriate means possible. Ensuring goals are within reason and creating sound strategies is a matter that requires extensive insight into the CID process, health care regulations, and the law.
Civil investigative demands are serious and high stakes matters, which is why practices are warranted in the concerns they have regarding demands made by authorities, complying with those demands, and the ultimate outcome of an investigation. For practices that want to take the rights steps from the very beginning, working immediately with proven attorneys who have experience in this area of law and with representing practices on a proactive and responsive basis can make all the difference – both in terms of dealing with the CID itself and pursuing the most positive outcome possible.
Hendershot, Cannon & Hisey, P.C. is a Houston-based law firm regarded for our depth of experience and comprehensive representation of practices and medical providers facing all types of matters involving health care regulations, fraud investigations, demands, and allegations. Over the years, we’ve been trusted by medical clients throughout Texas and beyond when it mattered most – and are prepared to immediately help your practice deal with the civil investigative demand process and the resulting chain of events.
To learn more about our award-winning health care lawyers and the services we provide, call (713) 909-7323 or contact us to request a no-obligation, confidential consultation.