Additional Cities will have HEAT Teams in 2011

August 27, 2010 by  
Filed under Featured, HEAT Enforcement

(August 27, 2010): Yesterday, Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius conducted the second of a planned series of “Regional Health Care Fraud Prevention Summits.”  The first summit was recently conducted in Miami, Florida.  This summit was held in Los Angeles, California. 

In addition to these agency heads, summit participants learned of current and additional planned initiatives from a number of Federal and State law enforcement officials. 

Describing the progress made in the last fiscal year, Attorney General Holder noted that:

“In just the last fiscal year, we’ve won or negotiated more than $1.6 billion in judgments and settlements, returned more than $2.5 billion to the Medicare Trust Fund, opened thousands of new criminal and civil health care fraud investigations, reached an all-time high in the number of health care fraud defendants charged, and stopped numerous large-scale fraud schemes in their tracks.”

Notably, Attorney General Holder also made it clear that the government’s joint Health Care Fraud Prevention and Enforcement Action Team (HEAT) program is slated for further expansion over the next year.  As he noted:

HEAT’s impact has been recognized by President Obama, whose FY 2011 budget request includes an additional $60 million to expand our network of Strike Forces to additional cities.   With these new resources, and our continued commitment to collaboration, I have no doubt we’ll be able to extend HEAT’s record of achievement.   And this record is extraordinary.” (emphasis added).

These additional funds will be to supplement, not supplant, existing health care fraud enforcement efforts currently underway around the country.  While the additional cities slated fro HEAT expansion were not announced at this event, all CMHC providers, regardless of location, should be especially vigilant in their efforts to ensure that Medicare coding and billing practices regulating partial hospitalization services must comply with applicable statutory and agency requirements.  We strongly recommend that all CMHC providers examine both basic issues such as the “core elements” required of CMHCs, as well as their operational approach, documentation, coding and billing practices.

 Should you have questions regarding a health care fraud issue, you may call Robert W. Liles or another of our attorneys.  Call 1 (800) 475-1906 for a free consultation.

Medicare Fraud Strike Force Operation Leads to Charges against 94 Defendants, including 4 in South Texas

July 19, 2010 by  
Filed under Featured, HEAT Enforcement

 (July 17, 2010): Yesterday, the Department of Justice (DOJ) announced charges against 94 physicians, medical assistants, and health care company owners and executives in connection with alleged false Medicare claims amounting to more than $251 million.  24 defendants from Miami account for approximately $103 million of that amount.  Four defendants were charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for durable medical equipment (DME).  Other arrests were made in Baton Rouge, Brooklyn, and Detroit.   The offenses charged include conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, and money laundering.  The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home health care schemes, HIV infusion fraud schemes and durable medical equipment (DME) schemes.

Announcing the arrests, Attorney General Eric Holder said, “With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet.  It’s no longer easy money.  If you choose to engage in health care fraud, you will be found; you will be stopped; and you will be brought to justice.”

The operation was conducted by the joint DOJ-HHS Medicare Fraud Strike Force, multi-agency teams of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.  Strike Force teams are operating in seven cities in the United States: the five aforementioned cities, Los Angeles, and Tampa.  AG Holder noted that the ongoing Strike Force initiative in South Florida has resulted in the indictments of 810 organizations and individuals since March 2007 and uncovered $1.85 billion in improperly billed claims.

The Strike Forces are a part of Health Care Fraud Prevention and Enforcement Action Team (HEAT), which is made up of top level law enforcement and professional staff from the DOJ and HHS and their operating divisions.  HEAT is dedicated to joint efforts across government to both prevent fraud and enforce current anti-fraud laws around the country.

Should you have any questions regarding these issues, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.

Texas Psychiatrist Indicted and Arrested

July 9, 2010 by  
Filed under Featured, HEAT Enforcement

(July 9, 2010):  On June 14, 2010 the U.S. Attorney’s Office for the Western District of Texas announced that a Federal Grand Jury had returned a 99-count indictment against a pain management physician who operated clinics in San Antonio and El Paso.  The physician was charged with 21 counts of health care fraud, 20 counts of false statements relating to health care fraud matters, 21 counts of mail fraud, 16 counts of wire fraud, 4 counts of unlawful distribution of a controlled substances and 16 counts of money laundering.  The indictment alleges that the physician “caused to be submitted claims for reimbursement of peripheral nerve injections, facet injection procedures and Level Four office visits–typically involving 25 minutes of face-to-face time between patient and physician–which never were performed.”  Instead, the U.S. Attorney’s Office alleges that the physician performed “prolotherapy” on his patients — a procedure that Federal health care benefit programs do not reimburse. 

Notably, an indictment is merely a charge and is not considered to be evidence of guilt. In issuing this indictment, the Texas HEAT task force, comprised of Federal prosecutors and investigative agencies,  have continued to ramp up efforts to investigate and prosecute allegations of health care fraud.  Notably, the use of “prolotherapy,” a relatively new therapeutic approach, has been supported by some of the best known clinics and physicians in the country. 

While this case has yet to fully develop, it again points out that health care providers must take care when utilizing new approaches, despite the fact the therapeutic technique may be considered to be state-of-the-art.  Unfortunately, Medicare may take years to recognize and cover some techniques.  In the mean time, it is essential that providers take care when coding and billing for procedures that may not clearly qualify for coverage under applicable Medicare and / or contractor guidance.

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.

Owner of Texas Behavioral Health Counseling Clinic Pleads Guilty to Medicare Fraud

June 5, 2010 by  
Filed under Featured, HEAT Enforcement

(June 5, 2010):  Early last week, the U.S. Attorney’s Office in Houston, Texas announced that a plea agreement had been reached with the owner of a behavioral counseling center in Houston.  The owner pled guilty to (1) conspiracy to commit health care fraud, (2) health care fraud and (3) aggravated identity theft, all arising out of the defendant’s alleged role in a health care fraud scheme in which Medicare and Medicaid were fraudulently billed for psychiatric counseling services.

According to the government, the owner of the behavioral counseling company misrepresented himself as a doctor in psychology (Ph.D.) when, in fact, he had merely purchased a doctoral degree online and then supposedly awarded himself several bogus professional certifications in counseling.

The government further alleged that the defendant unlawfully acquired Medicaid beneficiaries’ information, including names, addresses and Medicaid numbers which were then used to file false claims for reimbursement by Medicare and / or Medicaid for group therapy sessions and psychiatric counseling sessions that were not provided to the beneficiaries.  

The defendant also allegedly billed for services that were supposedly provided by qualified, licensed professionals, when in fact the provider of the services was not licensed or qualified to bill for the mental illness services provided.

While the defendant pled guilty to the charges, he has not yet been sentenced.  The case was investigated by agents working for HHS-OIG and the Texas MFCU.

What should CMHCs learn from this case?

First and foremost, both Federal and State investigative agencies are actively reviewing clinics and other organizations involved in the provision of behavioral health and counseling services. CMHCs must be vigilant in their efforts to ensure that services billed fully comply with applicable statutory and regulatory services governing the coverage, coding and billing of partial hospitalization program claims and other services provided to Medicare and Medicaid beneficiaries.

Second, as part of your compliance efforts, it is important that you regularly review and verify the credentials and licensure status of your physicians, counselors and therapists. While none of you may intend to engage in the type of conduct described above, you may nevertheless find that your clinic has improperly billed for services due to the actions of one or more of you treating personnel.  Professional licenses may have lapsed, been placed on suspension or even revoked without your knowledge.  It isn’t enough to merely check a physician’s or professional therapist’s licensure status when they are hired.  Licensure checks should be routinely conducted as a part of your compliance efforts.   

Responding to a Search Warrant of Your CMHC.

June 1, 2010 by  
Filed under Featured, HEAT Enforcement

(June 1, 2010)  I.   Introduction:   Like most honest health care providers, the CMHCs that we work with believe that “search warrants” are only executed by the government in connection with the investigation of nefarious characters and criminals.  Unfortunately, that just isn’t the case.  The Federal government has increasingly utilized search warrants as a first-strike investigative tool.  In fact, the execution of a search warrant may very well be the first notice a CMHC has that their practice or clinic is under investigation.

Allegations of wrongdoing may arise from a wide variety of sources. CMHCs may have been reported by disgruntled current or former employees, dissatisfied patients, or others familiar with the practice’s operations.  Notably, recent criticism aimed at RACs for their failure to identify and refer possible criminal wrongdoing to the government for further investigation may have generated a new period of significant enforcement.  It appears that Zone Protection Integrity Contractors (ZPICs) around the country have recently intensified their activities, going well beyond the typical overpayment audits normally seen.  We have seen a marked increase in the number of unannounced site visits, Medicare suspension actions and Medicare number revocation cases.  We fully anticipate the number of criminal referrals to DOJ to increase as well.

In assessing this issue, it is important to remember that prior to obtaining a search warrant, an Assistant U.S. Attorney has gone before a Federal Magistrate and has shown “probable cause” that a crime has been committed or is being committed.  Once issued, the search warrant may greatly help DOJ build its case.  Search warrants are preferable to subpoenas and other investigative tools because:

CMHCs will likely be caught completely off-guard, thereby reducing the possibility that documents may be lost, destroyed or otherwise be missing before it can be secured as part of the investigation.  In executing a search warrant, the government can preserve the documentation and electronic evidence to the greatest extent possible.

The government may use the execution of a search warrant as an opportunity to segregate possible witnesses and see if they can interview the employees and obtain statements before the clinic and its employees have an opportunity to obtain counsel.

The combination of force and surprise will have an enormous psychological effect on your employees.  There will be absolutely no question about the seriousness and gravity of the government’s investigation.  This is often very intimidating, often resulting in significant damage to the practice, ranging from employee resignations to adverse publicity and media attention.

Finally, the scope of the search warrant will likely be sufficiently broad that the CMHC will have a difficult time determining the focus of the government’s investigation.

Once a search warrant is executed, the issue becomes how to best respond.  The purpose of this advisory is to provide an overview of the Federal search warrant process so that your interests can be protected.

II.   Responding to a Federal Search Warrant:

   A.         Before the search.

If the government were to execute a search warrant on your practice today, would you be ready?  Have your employees been briefed on how to respond if Federal agents show up at your clinic?  If your answer to either of these questions is “no,” you should take immediate steps to better ensure that you are ready if this event were to occur.  Understandably, no CMHC likes to think that they would learn of an investigation in such a fashion.  Nevertheless, it occurs practically every day.  You should work with your attorney to draft procedures for responding to a search warrant that are tailored for your clinic. 

   B.         At the time of a search.

Please remember that these steps are not all inclusive.  Upon the execution of a Federal search warrant, you should immediately contact your attorney so that the specific facts and circumstances of your situation can be fully assessed and taken into consideration.  In responding to a search warrant, you should:

Avoid taking any actions that could be misconstrued by the government as an obstruction to their search.  That does not mean that you cannot ask questions – merely that you should not obstruct their search.

 Try and ensure that patient care activities are not jeopardized. Typically, law enforcement will be sensitive to these issues and will try to avoid direct patient care areas.  Nevertheless, you may need to bring this issue to their attention.  You may find that legal counsel can often work with law enforcement to resolve an unreasonable intrusion in this regard.

 Ask for a copy of the search warrant and give it to your lawyer.  Your lawyer will try and prevent them from seizing any documents or items that appear to be outside of the scope of their warrant.  Importantly, search warrants are supposed to provide a specific description of the information or items to be search.  If a search warrant is ambiguous overly broad, your counsel may choose to seek to quash to the search.

 Regarding the search warrant itself, your lawyer will try and note the issuance date of the warrant and the date it was executed. Additionally, counsel will ask to check the identification of the leading agent handling the search, along with the identification of any other participating agencies (e.g. IRS, HHS-OIG).

 While your lawyer may request to see the affidavit upon which the search warrant is based, you should not be surprised if it was sealed by the Court and cannot be obtained. If counsel has not yet arrived, call your lawyer to discuss whether there may be any grounds to object to the search.  Should you object, inform the lead agent of your objection. Should the search continue, record the date and time of their arrival and departure.

 If they will allow it, try and accompany agents on the search.  Try to note which areas were searched and which documents or items were seized.  

 You may have documents that qualify as attorney-client privileged materials.  Should agents try to take documents that may be considered privileged, you should immediately object and notify the agents that the documents they are seizing are privileged.

 Try and obtain a receipt from the agents for any items or documents that are seized. When possible, get copies of original documents before they are removed.

C.  Handling employee issues.

The execution of a search warrant is an extremely stressful situation and can create confusion and stress on a practice’s employees. You should quickly move to restore order and re-assure employees that the situation is under control.

While a search warrant can be used to seize documents or other items, it cannot be used to force employees to participate in an interrogation.  Due to the many sensitivities in this area, it is strongly recommended that you have counsel advise employees of the situation.  While the government cannot force employees to answer questions, you must take care when you are briefing employees on the situation. While you must not tell employees that they are not allowed to talk with an agent, it is appropriate to tell employees that they have no obligation to answer any questions.  While individuals have a Fifth Amendment privilege against self-incrimination, your practice or clinic does not enjoy such a privilege.

When possible, send employees home for the day or have them work in another part of the facility.  Finally, you should notify employees that any questions regarding the location of certain records should be directed to a specific management official so that any inquiries can be properly and consistently handled.

  D.  After the search.

Document retention issues should be carefully handled. It is our view that all document destruction should immediately stop, even if the activity would be consistent with pre-search document retention policies used by the CMHC.  Once an investigation is initiated, you should diligently work to avoid even an appearance that obstruction of justice may be occurring. 

Questions?  Call Robert W. Liles, Esq. at (202) 298-8750 for additional information.

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.

HEAT Enforcement Update — Health Care Fraud Investigations and Prosecutions in Texas Increased in March 2010

April 3, 2010 by  
Filed under Featured, HEAT Enforcement

(April 3, 2010): Notably, the number of publicly-disclosed investigations and prosecutions in Texas significantly increased last month.  Two of the cases disclosed involved mental health professionals.    

  • A Psychologist was convicted of health care fraud and money laundering, in connection with various claims fraudulently billed to Medicare.  Instances of improper conduct included billing for more than twenty-four hours of services in a single day; billing for services in a single day which amounted to more than double the normal business hours of the Psychologist’s practice; billing for services allegedly rendered during weekends, holidays, and times that the Psychologist was known to be out of town and away from the practice; and, submitting claims for services and evaluations not actually performed by the Psychologist, as required by law.  
  • An unlicensed Behavioral Health Counselor was charged with Medicaid fraud for allegedly engaging in aggravated identity theft.  The defendant allegedly improperly acquired Medicaid beneficiaries’ information, including names, addresses and Medicaid numbers, then used the information to file false claims through a behavioral counseling service the defendant owned.  These behavioral counseling services were billed to Medicaid but allegedly not provided to the beneficiaries for which they were billed.

Since being established approximately a year, Texas HEAT team investigations and prosecutions have significantly increased throughout the State.  Both enforcement efforts and the frequency of Medicare audits are anticipated to increase throughout 2010.  In addition to the increasing number of civil and criminal cases brought by the Texas HEAT Strike Forces, the number of administrative overpayment cases is anticipated to grow as well.  It is essential that CMHCs continue in their efforts to ensure that both business operations and billing practices fully comply with applicable statutory and regulatory requirements. 

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.

Hold on Tight – 2010 Could be Rough. . .

February 27, 2010 by  
Filed under Featured, HEAT Enforcement

(February 27, 2010): The number of auditors, reviewers, investigators and prosecutors going after CMHCs is increasing and signals an alarming, unprecedented effort by the government to uncover and recover alleged overpayments for partial hospitalization claims.

 CMHCs now face not only simple repayment demands, but also civil False Claims Act cases and criminal Medicare / Medicaid fraud claims identified by various new government contractors. Regrettably, we have seen unintentional mistakes, incomplete documentation and technical errors cited as the basis for seeking the repayment of millions of dollars, representing Medicare services rendered long ago, in some cases as many years before the demand letter was sent.  Perhaps most troubling is the fact that no one, including the ZPIC and / or PSC conducting the medical review, doubts that the medical services were rendered and in most cases, the Medicare beneficiary benefited from the partial hospitalization care and treatment provided.  Today, every health care provider, including CMHCs, must beware of:

  •  “RACs” or Recovery Audit Contractors.
  • “ZPICs” or Zone Program Integrity Contractors.
  • “MICs” Medicaid Integrity Contractors.
  • “MCFU” Medicaid Fraud Control Unit.
  • “HHS-OIG” Department of Health and Human Services, Office of Inspector General.
  • “DOJ” U.S. Department of Justice, and
  • “HEAT” Healthcare Fraud Prevention & Enforcement Task Force (in a number of U.S. Attorney’s Offices around the country).

 RACs and the havoc they are expected to wreak is old news, quite frankly.  Thankfully, they appear to be focused on the larger players at this point.  The newest players in town, ZPICs, MICs and HEAT Teams should be at the top of your current list of concerns.  As you will recall,   CMS consolidated functions of all Program Safeguard Contractors (PSCs) and Medicare Prescription Drug Integrity Control (MEDIC) contracts into ZPIC contracts.  ZPICs are designed to combine claims data (FIs, Regional Home Health Intermediary, Carrier, DMERC) and other data to create a platform for documenting complex data analysis.  While RACs (until recently) have focused solely on recovering money, ZIPCs also look for fraud.

MICs are just now revving up around the country.  Unburdened by many of the restrictions placed on RACs, CMHCs with a heavy Medicaid beneficiary base should diligently review their Medicaid coding and billing efforts to better ensure compliance with applicable statutory and regulatory requirements. 

 HEAT Teams are made up of top level law enforcement and professional staff from DOJ and HHS.  HEAT was implemented to prevent fraud and enforce current anti-fraud laws and prevent waste that focuses on improving data and information sharing between the Center for Medicare & Medicaid Services and law enforcement agencies.  HEAT is working to strengthen program integrity activities to monitor and ensure compliance and enforcement.  HEAT’s tools to identify fraud include hotlines and web sites for healthcare workers and ordinary citizens.  Furthermore, HEAT officials are helping state Medicaid officials conduct better audits and provide better monitoring to detect fraudulent activities.

How should you respond?  The best response is to follow the rules.  If you don’t already have an effective Compliance Plan in place, we recommend you take steps to immediately implement one. 

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.

Expansion of Medicare’s “HEAT” Strike Force

February 1, 2010 by  
Filed under HEAT Enforcement, Medicare Audits

(February 1, 2010):  On December 15, 2009 Assistant Attorney General Lanny A. Breuer of the Criminal Division of the Department of Justice (DOJ) and United States Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the expansion of Medicare Fraud Strike Force teams to Baton Rouge, Brooklyn and Tampa in a effort to target individuals and health care companies that fraudulently bill the Medicare program.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.  After expanding to Baton Rouge, Tampa and Brooklyn, Strike Force Fraud Strike Force will be operating in a total of seven cities in the United States: Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa and Baton Rouge.

The Strike Force started in March 2007 in Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three), Houston (Phase Four), and Brooklyn (Phase Five).  Since that time, the Strike Force has obtained indictments of more than 460 individuals and organizations that collectively have falsely billed the Medicare program for more than one billion dollars.

During the press conference related to the expansion to the three cities, DOJ also publicized five indictments that were unsealed on December 15, 2009 in Miami, Detroit and Brooklyn, following the arrests of twenty-five individuals in Miami, four individuals in Detroit and one in Brooklyn. In addition, Strike Force agents also executed four search warrants at businesses and homes in Coconut Creek, Fla.; Miami and Brooklyn.

The DOJ press announcement also noted that individuals charged in the indictments that were unsealed were accused of various Medicare fraud crimes, including conspiracy to defraud the Medicare program, conspiracy to launder money, money laundering, criminal false claims, making false statements and receiving kickbacks.

According to the DOJ indictments, the defendants participated in schemes to submit claims to Medicare for products and services that were in fact medically unnecessary and oftentimes, never provided. In the Detroit cases, DOJ alleged that the defendants participated in a scheme whereby they paid pay kickbacks to patients who received instructions from the clinic owners and patient recruiters to feign symptoms to justify expensive testing, including nerve conduction studies. In Brooklyn, the two defendants are alleged to have billed Medicare for durable medical equipment, including expensive shoe inserts reserved for diabetes patients, when in fact much cheaper and over-the-counter shoe inserts were provided to beneficiaries who often didn’t need them. In Miami, 15 individuals, including doctors and nurses, are charged in connection with fraudulent claims to Medicare for home health services. In another case in Miami, individuals are charged for their various roles in running a medical clinic that purported to provide injection and infusion treatments to HIV/AIDS patients and submitted fraudulent claims Medicare for such services, which were often medically unnecessary and/or never provided.

Collectively, the DOJ announced that the physicians, company owners, executives and others charged in the indictments are accused of conspiring to submit approximately $61 million in false claims to the Medicare program.

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.


Health Care Providers in Brooklyn NY, Tampa FL and Baton Rouge LA, Find Themselves in DOJ’s Cross-Hairs

January 22, 2010 by  
Filed under Featured, HEAT Enforcement

(January 22, 2010):  Late last May, Attorney General Eric Holder (U.S. Department of Justice) and Secretary Kathleen Sebelius (Department of Health and Human Services) announced the establishment of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT).  This new initiative is intended to further supplement existing DOJ / HHS-OIG efforts to identify, investigate and prosecute health care fraud violations.  At this time DOJ announced that Strike Force team operations would be expanded from South Florida to include operations in Houston and Detroit.

Over the next six months, multiple indictments and arrests were made by HEAT teams in these cities. Following these successes, the government has now expanded the HEAT program, setting up units in Brooklyn NY, Tampa FL and Baton Rouge LA. As HHS Secretary stated when announcing this expansion:

“When President Obama took office, he promised a new commitment to cracking down on the criminals who steal billions of dollars from Medicare each year through fraudulent claims. . .  ”Today, HHS and DOJ are following through on that commitment with the announcement of three new Medicare Fraud Strike Force teams in Baton Rouge, Tampa, and in Brooklyn. Along with teams already operating in Miami, Los Angeles, Houston and Detroit, these Strike Force operations will allow us to concentrate our agents and resources on the criminal hubs where we know a significant share of fraud occurs.  Medicare is a sacred promise to America’s seniors and we will do everything we can to protect it.  The announcement we’re making today is a significant step towards securing Medicare for seniors today and generations to come.”

HEAT teams typically employ a “data-driven” approach to “identify unexplainable billing patterns and investigating these providers for possible fraudulent activity.” Notably, the Medicare Fraud Strike Force team operating in South Florida has already convicted 146 defendants and secured $186 million in criminal fines and civil recoveries.  As Attorney General Holder stated last May:

“We know these strike forces work. I believe a targeted civil and criminal enforcement strategy in these locations will have a substantial impact on deterring fraud and abuse, protecting patients and the elderly from scams, and ensuring that taxpayer funds are not stolen.”

As always, health care providers must remain vigilant in their efforts to ensure that Medicare coding, billing and operational practices fully comply with applicable statutory and regulatory requirements.

As a final point, it is essential to remember that HEAT teams are only one of the many enforcement entities reviewing the coding, billing and business practices of Medicare providers. A number of CMHCs around the country have been subjected to Medicare audits by Program SafeGuard Contractors (PSCs) and / or Zone Program Integrity Contractors (ZPICs). If you have not already done so, we strongly encourage CMHCs to implement and adhere to an effective Compliance Plan. Far too often, we have found that CMHCs have implemented a general Compliance Plan which does not address the unique risks faced by CMHCs when providing partial hospitalization care and treatment services.

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.