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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 enough. 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.