July 1997 Bulletin

Self-audit will prevent future problems

by Sandra E.D. McGraw, JD

Would your orthopaedics practice withstand a Medicare investigation or a lawsuit by a former employee? Are you certain or are you betting the odds that your practice is clean because you hired good people and you certainly are not deliberately doing anything wrong?

People make mistakes and medical practices are comprised of people. However, if you have and you use a routine self-audit plan, you can be more confident you are safe. You also can establish that you have no intent to commit any wrongful act.

Review your practice, not only in terms of possible Medicare-permitted relationships and billing and compensation practices, but also in terms of all of the legal relationships that impact your practice, from laws governing hiring and firing obligations to those dictating how physicians deliver care. Develop and use a corporate compliance checklist to make sure your practice is doing all it can and must do to:

  • Also, consider revisions of materials given to patients to explain procedures and the billing process and avoid problems later.
  • Make sure that you or someone in your practice, perhaps your office manager, practice administrator or practice attorney, understands all the necessary pitfalls and how to avoid them. Retain an outside firm to perform your initial audit and establish your plan. An attorney is best, if you think you may need to develop attorney-client confidentiality.

    Undertake a comprehensive compliance review, or "legal audit." Focus upon detecting any potential violations of the Medicare/Medicaid anti-kickback law, 42 U.S.C. Section 1320a-7b(b), and the Civil False Claims Act, 31 U.S.C. Sections 3729-33. Other elements may include:

    © 1997 The Health Care Group®

    Sandra E.D. McGraw, JD, is a principal attorney and consultant with The Health Care Group® and Health Care Law Associates P.C., based in Plymouth Meeting, Pa.

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