Health Care Law

Health care providers are facing more and more challenges from the insurance industry. Typical challenges for health care providers include compliance, retrospective reviews/audits, recoupment, fraud claims and denials. The Martin Law Firm takes a strong initiative in helping health care providers successfully overcome these obstacles so that the provider can focus his or her energies on quality patient care and maximizing profits.

Post Payment Reviews and Post Payment Audits

Recently, health care providers, especially chiropractors, are experiencing an increase in retrospective reviews and audits, leading to significant overpayment demands from the insurance industry. Proper handling of these matters takes a thorough understanding of federal and state insurance laws, coding guidelines, documentation and attention to detail. Achieving the desired result also takes experience and professionalism in communicating the position of the provider to the insurance or Medicare representatives. The Matin Law Firm has saved health care providers hundreds of thousands of dollars in overpayment demands.

Health Care Reimbursement Compliance Program

The Department of Health and Human Services' Office of Inspector General (OIG) has provided Compliance Program guidance to assist health care providers in adhering to applicable statutes, regulations and program requirements. It is well established that health care practices implement and maintain a Compliance Program in an effort to identify and correct risk areas regarding billing, coding and documentation. In addition, the Compliance Program will serve as an educational tool for the provider and his or her employees with regard to fraud and abuse laws.

An effective Compliance Program will mitigate risk exposure and serve as protection for the provider against the insurance industry and federal programs such as Medicare.

Other Areas of Representation

Other key ares of representation for health care providers include:

- Development of and assistance with implementation of corporate compliance programs for small group physician practices and billing companies consistent with Medicare rules and guidelines
- Representation of clients in enforcement and related proceedings regarding Medicare issues
- Representation of clients involving disclosure of billing errors involving Medicare and private payers
- Advising clients for issues involving Anti-Kickback, Stark, fee-splitting and False Claims Acts
- Review and analysis of contracts, transactions and joint ventures for fraud and abuse, Stark and False Claims Act compliance
- Representation of clients and resolution of audits and post-payment reviews from Medicare and private payers
- Representing clients in licensing, credentialing and disciplinary actions
- Obtaining formal Advisory Opinions regarding fraud and abuse, Stark and CMP compliance and sanctions
- Assisting physician practices with general corporate matters and contracts