Houston Health Care Regulatory Compliance
Navigating a Complex Regulatory System in Texas
Health care is arguably the most stringently regulated industry in the United States. Whether you are pursuing a health care business transaction, executing a contract, or establishing a risk-mitigating structure for your practice, you must ensure you meet strict regulations. Regulatory compliance is crucial because failing to do so can create exposure to audits, investigations, and serious penalties that jeopardize the success of your business and professional future.
At Hendershot Cowart P.C., our Houston-based health care regulatory compliance lawyers have decades of experience counseling health care professionals and practices across the country in a range of state and federal regulatory compliance matters, including those related to the False Claims Act, Anti-Kickback Statute, Stark Law, HIPAA, and more.
Schedule a consultation with our Houston health care regulatory compliance attorneys when you call (713) 909-7323.
Comprehensive Regulatory Compliance Services
With more than 100 years of collective experience, our legal team has the insight and resources to help clients in a range of regulatory matters, including:
- Proactive counsel and support
- Drafting and implementing compliance plans
- Health care transactions and start-ups
- Medicare provider enrollment
- Responsive representation for audits, investigations, and alleged violations.
In all of our work, we focus on preparedness – from ensuring that your health care business transaction is structured properly to ensuring that your practice stands up to the increasing scrutiny of state and federal regulators. Our services are utilized by providers throughout the U.S.
Compliance in Health Care Transactions and Startups
Numerous regulatory requirements govern transactions and business dealings involving health care professionals and facilities. The Stark Law, fraud and abuse statutes, False Claims Act, anti-kickback laws, and other regulations all affect which parties can be involved in a transaction and how the transaction should be structured.
We Regularly Handle Transactional Matters Involving:
- Joint ventures
- Establishment, purchase or sale of compounding pharmacies
- Investments by physicians
- Purchase of equipment and lease agreements
- Management agreements
- Billing arrangements
Drafting and Implementing Healthcare Compliance Plans
A sound compliance program is the best preventative medicine for any health care organization. Health care providers are under increased scrutiny from the Texas Attorney General, the Department of Health and Human Services' Office of Inspector General (OIG), Texas Department of Insurance (TDI), and other government agencies. Even if you did not intend to commit a violation, you can face costly and time-consuming investigations, sanctions, penalties, and even criminal prosecution.
A comprehensive properly implemented compliance plan provides clear direction to members at every level of the organization and minimizes the potential for you to be the target of an investigation.
Our health and medical law team develops individualized compliance programs for clients in an array of different health care settings, including medical practices, clinics, suppliers, and hospitals.
Our compliance plan toolkit encompasses eight elements to help your organization consistently meet regulatory requirements:
- Code of Conduct establishes an organization's commitment to regulatory adherence and clearly defines the mission and ethical standards for the entire workforce, from board members to hourly employees.
- Written policies and procedures document your organization's Code of Conduct and policies and procedures related to compliance training, corrective action plans, disaster recovery plans, and internal controls. These written policies and procedures ensure that all employees have access and knowledge of the organization's compliance expectations.
- A designated compliance officer (and/or compliance committee) – A dedicated compliance officer takes a lead role in ensuring that compliance remains an integral part of the organization, staying on top of new and relevant regulations and updating compliance plans and procedures as needed; oftentimes with the support of a committee. Your compliance officer should also oversee new employee compliance training and regularly audit records and review files to ensure that employees are adhering to protocols.
- Training and education programs help ensure that employees are aware of the written policies and procedures and understand how to comply with them. A training program should detail who will receive training, how often, and, most importantly, monitor whether the training is effective.
- Open lines of communication – Experts recommend an “open-door policy” to create a culture in which employees feel encouraged to speak up without fear of retribution or punishment. Written procedures and training should make it clear who employees can go to with compliance-related questions and concerns, and allow anonymous reporting.
- Auditing and monitoring – Healthcare practice compliance plans should outline general audit guidelines and foster collaboration between at least one medically trained individual (i.e. nurse or physician) and administrative personnel. Conduct audits at least once per year, and review at least five or more medical records per federal payer, and five to 10 medical records per physician
- Enforcement of disciplinary standards – Employees should be aware of the consequences for noncompliance with written policies and procedures, including the potential disciplinary actions (i.e. warnings, probation, demotion, suspension, etc.).
- Corrective Action Plan – Building on your enforcement plan, a corrective action plan details a clear line of action from training to violation, from violation to enforcement, from enforcement to internal review. A corrective action plan not only helps identify the violation, but helps provide insights in why the violation occurred.
The Importance of Oversight in an Effective Healthcare Regulatory Plan
There needs to be some form of accountability as well as someone who oversees how records are being processed. Appointing a compliance officer to handle these things is highly recommended.
Your compliance officer should know the system in and out, and be able to effectively train new employees on the subject of how to follow protocols. They should also audit records and hold regular reviews of files to ensure that your employees are adhering to protocols and take measures to help iron out any problems that arise, either through retraining employees, making changes to outdated protocols, etc.
Audit & Monitor your Compliance Plan to Avoid Regulatory Investigations
We strongly encourage clients to actively audit and monitor healthcare compliance plans to ensure compliance on an ongoing basis. A thorough medical practice compliance plan should:
- Outline general audit guidelines, including procedures for reviewing compliance with coding, billing, and documentation requirements, on a concurrent (prior to submission) and / or retrospective (after submission) basis
- Prioritize federal programs when conducting audits and monitoring, and stay up to date with any changes in claims submission, OIG updates, and compliance guidelines.
- Compare audit results with benchmark data
- Establish guidelines to foster collaboration between at least one medically trained individual (i.e. nurse or physician) and administrative personnel
- Conduct audits at least once per year, and review at least five or more medical records per federal payer, and five to 10 medical records per physician
Speak With a Texas Health Care Regulatory Compliance Lawyer Today
As a law firm that has earned national recognition for our work in health care and medical law and the representation of providers facing audits, investigations, and allegations of waste, fraud, and abuse, Hendershot Cowart P.C., has the requisite experience and resources to help all types of medical practices establish the clear and enforceable compliance plans that allow them to effectively operate their practices, ensure compliance, and avoid risks of litigation or penalties that can jeopardize their futures.
From tailoring compliance programs to the unique needs of practices to addressing critical issues and compliance with important federal health care regulations like the Anti-Kickback Statute, Stark Law, and False Claims Act, and other Texas health care fraud laws, our team focuses on a comprehensive approach to compliance, and to the proactive measures that ensure providers establish the policies and best practices for implementing their plans moving forward.
Our Houston-based attorneys at Hendershot Cowart P.C. proudly serve clients throughout Texas and the U.S.
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