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Health Care Billing Agreements & Regulatory Compliance

Texas Health Care Attorneys Serving Providers Nationwide

Today, health care providers have the opportunity to take advantage of thriving industry that allows them to more efficiently manage their practice and provide quality care to patients. This can include third party management services with which providers can contract to handle billing and other administrative tasks. It can also include a range of related medical businesses and services (designated health services) that provide critical support to physicians and which benefit themselves through compensation arrangements.

What’s clear about the health care industry today is that providers can find themselves forming a variety of arrangements and relationships as a part of their day-to-day practice. However, because there are many moving parts when it comes to who providers work with and for, and because there are numerous regulations that apply, ensuring those relationships are compliant with applicable state and federal laws is a critical aspect of success – especially when it comes to billing agreements.

Have questions about billing agreements, regulatory compliance, or another health care matter? Call (713) 909-7323 to speak with an award-winning attorney with our health and medical law team.

Billing Agreements & Exposure to Risks

Medical billing agreements, as well as billing practices, are closely scrutinized by regulators to ensure they do not violate health care fraud and abuse laws, including self-referral laws (such as the Stark Law), the Anti-Kickback Statute, and the False Claims Act. Because violating these and other regulations can subject providers to substantial penalties, ensuring compliance is crucial – during new practice set-ups, mergers and acquisitions, joint ventures, and when structuring any deals and transactions involving health care business for designated health services (DHS).

Our legal team has extensive experience counseling physicians, practices, and other entities involved in all types of health care services as they structure their businesses, medical contracts, billing agreements, billing practices, and other essential components of their practice in a clear, compliant, and enforceable manner. This includes:

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

Compliant Billing Agreements

When it comes to ensuring your business relationships and any billing agreements you create, negotiate, or sign are compliant with the law, experienced insight can make all the difference. This is especially true given the many state and federal regulations that may apply and the many requirements that must be met in order for an arrangement to fall under a “safe harbor” or exception. 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, there are a few essential issues involving billing agreements that can result in potential violations and adverse consequences such as audits, fraud investigations, subpoenas, civil or criminal penalties, or even breaches of contract. Examples may 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 health care 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 health care clients, we can also help address issues moving forward through the creation and implementation of compliance plans, ongoing counsel, and responsive representation when audits or investigations do arise.

Helping Clients Navigate a Complex Regulatory System

Regulatory compliance – whether it involves billing and compensation agreements, transactions, contracts, employment agreements, or other matters – is one of the most important aspects for a successful venture, and a task more easily said than done. By working with our legal team at Hendershot, Cannon & Hisey, 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.

To learn how we may be of assistance in helping you address billing agreements or any other health care compliance matter, call (713) 909-7323 or contact us online today.

Committed To Protecting Your Interests

Lawyer Consulting a Client
  • "Our firm defended a health care client against a fraud and abuse investigation by the Office of Inspector General. The client's response: Trey, On behalf of myself and M., I would like to extend our gratitude and appreciation for an outstanding job in our presentations regarding the OIG matter. Your honest and thorough work and your belief in our honesty and integrity as physicians, which was conveyed to the OIG and resulted in giving us the opportunity to meet with them, was a smart move and is greatly appreciated. We truly appreciate all your hard work and representation. Ben, I would also like to take this opportunity to thank you for finalizing the documents for the purchase of . . . in such a short time."

    - A.
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