Health & Medicine - Healthcare Business Relationships
Claims against physicians and practice groups for alleged overpayment
by Medicare and private insurers are expected to rise dramatically
over the next several years. More and more of these claims will
be brought under the federal False Claims Act. This act allows
both the government and individual citizens to bring a claim against
a medical provider for alleged overpayment for medical services.
In appropriate circumstances the Act allows treble damages - damages
up to three times the amount of the over-billing. Call on Drake,
Narup & Mead P.C. to guide you through these difficult and
often complicated claims.
With the increasing number of regulatory agencies overlooking
medical practices, just meeting the standard of care is no longer
Physicians are subject to scrutiny by Medicare, private insurers,
managed care companies, Medicaid as administered by the Illinois
Department of Public Aid, just to name a few. Understanding compliance
with the Health Insurance Portability and Accountability Act, Medicare
legislation, Stark self-referral prohibitions, anti-kickback laws,
as well as the many state laws is difficult at best. At Drake,
Narup & Mead, P.C., we work with individual physicians and
practice groups to monitor their compliance with the many government
agencies which regulate their practices. When a disagreement arises,
we are available to represent the medical provider and work to
an agreeable solution.
Contracts with new physicians, hospitals and managed care providers
come with their own intricacies. In addition to the level of compensation,
other issues need consideration, such as the manner in which compensation
will be determined, does the manner of compensation violate anti-kickback
or self-referral laws; responsibility for billing compliance; whether
ancillary services, such as physical therapy or laboratory services
meet the requirements of the Stark self-referral laws, is a non-compete
provision necessary, and what terms are appropriate: who pays for
malpractice insurance and tail insurance; ownership of particular
assets; what happens to patient records in the event of a dissolution.
Drake, Narup & Mead, P.C. is able to analyze the issues and
bring the parties to an agreement.