Healthcare Billing Agreements & Regulatory Compliance

Nationwide Legal Support for Healthcare Billing and Compliance Matters 

Healthcare providers often partner with third-party contractors to handle medical billing and administrative tasks more efficiently. These outsourced management services can also include designated health services, which provide critical support to physicians and their patients.

Ensuring that your relationships and agreements with these service providers – such as medical billing companies and other third-party contractors – comply with applicable state and federal healthcare laws is critical to a thriving, enduring practice.

Need assistance with billing agreements, regulatory compliance, or other healthcare-related issues? Call Hendershot Cowart P.C. today at (713) 783-3110 or contact us online to consult with one of our award-winning attorneys with our health and medical law team.

Navigating Healthcare Billing Compliance and Avoiding Fraud Penalties

Regulators scrutinize medical billing agreements and practices to ensure they do not violate healthcare fraud and abuse laws, including self-referral laws (such as the Stark Law), the Anti-Kickback Statute, and the False Claims Act. 

Violating these and other regulations can subject providers to substantial penalties. Check that your agreements are in compliance during new practice set-ups, mergers, and acquisitions, joint ventures, and when structuring any deals and transactions involving designated health services (DHS).

Read our blog: Healthcare Providers Liable For Billing Company Fraud, Negligence

Comprehensive Legal Guidance for Healthcare Providers and Entities

Our legal team has extensive experience counseling physicians, practices, and other healthcare entities as they structure their businesses, medical contracts, billing agreements, billing practices, and other essential components of their practice in a transparent, compliant, and enforceable manner. 

Healthcare entities and third-party services we routinely advise include:

• Physicians and medical groups
• Clinical laboratory services
• Physical and occupational therapy
• Radiology and imaging
• Home health services
• Radiation therapy
• Prosthetics and orthotics
• Medical equipment
• Personal and management services
• Outpatient prescription drugs / compounding pharmacies

Avoiding Risks in Billing Agreements: Compliance with State and Federal Regulations

Numerous state and federal regulations may apply to your business relationships and billing agreements, and specific requirements must be met for an arrangement to fall under a “safe harbor” or exception. The omission of even a single element required for an exception – even accidentally in some cases – can result in serious repercussions, just as erroneous entries or unusual patterns can lead to audits and recoupment.

While every case is fact-specific and demands a personalized assessment from experienced attorneys, a few essential issues involving billing agreements can result in potential violations and adverse consequences, such as audits, fraud investigations, subpoenas, civil or criminal penalties, or even breaches of contract. 

Common Examples of Unlawful Billing Agreements

Examples of unlawful billing arrangements can include:

• Alternative payment models that may factor volume or value of referrals into account (such as pay-for-performance or gainsharing)
• Untracked billing/compensation arrangements involving any form of remuneration (monetary or non-monetary)
• Poorly structured deals and agreements with other healthcare businesses
• Verbal agreements or any non-written agreement
• Not having billing agreements signed by all parties
• Not setting compensation in advance based on fair market value
• Failures to conduct business according to the written agreement
• Not ensuring agreements are commercially reasonable
• Billing agreements that are insufficient in duration (i.e. a minimum of one year)

Compliance in any practice and agreement begins with personalized evaluations and careful preparation that can ensure the facts of the situation, services, and parties involved are tailored in a manner that fits within a statutory exception. 

Because our firm provides comprehensive counsel and representation to healthcare clients, we can also help address issues moving forward by creating and implementing compliance plans, ongoing counsel, and responsive representation when audits or investigations do arise.

Complete Legal Guidance for Healthcare Regulatory Compliance

Regulatory compliance – whether it involves billing and compensation agreements, transactions, contracts, employment agreements, or other matters – is one of the most critical aspects of a successful venture, and a task is more easily said than done. By working with our legal team at Hendershot Cowart P.C., you can benefit from the insight and resources of a firm known for our work in this field and for providing the comprehensive, proactive, and responsive legal services required of these high-stakes issues.

Contact Hendershot Cowart P.C. today to learn how we can assist you with billing agreements and other healthcare compliance matters!