How to Defend Against Recoupments, Repayment Demands and SIU Audits

We will provide strategies to defend demands by insurers and health plans who seek refunds due to retroactive denials based upon a variety of reasons including medical necessity and fee forgiveness. We will discuss audits and refund demands grounded in state as well as federal law. Appeal drafting will also be discussed.

Objectives:

Audience will learn how to object and appeal refund demands, audits and recoupment demands from health plans and insurers which can save the healthcare practitioner hundreds of thousands of dollars in potential repayments.

Agenda:

• What is a recoupment and reason it is usually commenced by an insurer Special Investigative Unit (“SIU” Unit).
• Explain how a defund demand is nothing more than a retroactive denial and reasons that is important.
• The specific information that an auditor is required to include in a refund demand or rercoupment request.
• Discuss Cross-Plan offsetting and how to stop health plans and auditors from using this tactic.
• Provide summary of state and federal law governing refund demands and overpayment request by insurers and health plans.
• Appeals drafting techniques will be discussed.
• The difference between commercial insurer versus Medicare refund requests will be explained.
• Basic ERISA Health Plan obligations will be discussed and explained reasons this is important with respect to refund demands by health plans and insurers.

Who Should Attend:

Healthcare providers and their revenue cycle staff, medical practices office managers and billing staff, healthcare compliance attorneys and consultants

Waiving Patients Cost Share Responsibility: What Every Healthcare Professional Needs to Know

Objectives:

Waiving patient cost share responsibility such as deductible coinsurance and co-payments, can result in commercial and federal healthcare programs and plans, Thus, it is important for healthcare professionals to understand the law, its rules and potential penalties governing waiver of patient cost share responsibility.

Agenda:

• Why is waiving patients cost share responsibility so important.
• Federal False Claims Act’s Liabilities & Penalties.
• Anti-Kickback Liabilities & Penalties.
• Financial Hardship, what you need to know.
• Impact of Medicare & other federal Healthcare Programs versus commercial health plans.
• Health Plan sample language.
• Analysis Of Legal Cases.
• Professional Courtesy, Financial Hardship & Prompt Patient Discounts.
• Exceptions – Where OMS can Waive or Discount Patient Balances

Who Should Attend:

Physicians, Assistant and Office Managers, Revenue Cycle Managers Hospitalists, Nurses, Billing staff, Third Part Billing company, Ambulatory Surgery & Hospitals revenue cycle staff.

Materials & Reference provided:

• Powerpoint
• Discussion on Relevant legal cases
• Danger of payer doubts on whistleblowers
• The reason why the routine waiver of patient cost share is dangerous.

The 2024 Healthcare Provider Legal Toolkit: Strategies For Protecting Practice and Reputation

STARK, False Claims Act, Anti-Kickback Statute and HIPAA

Are you a healthcare provider looking to fortify your practice against legal challenges and protect your hard-earned reputation? Join us for a groundbreaking webinar that will empower you with the knowledge to navigate the complex landscape of healthcare law and safeguard your practice.

Webinar Overview:

In our exclusive presentation, “The Healthcare Provider Legal Toolkit: Strategies for Protecting Practice and Reputation,” we will dive deep into the critical legal aspects that every healthcare professional should understand. We’ll decode the intricacies of STARK, False Claims Act (FCA), Anti-Kickback Statute (AKS), and HIPAA regulations, all while discussing real lawsuits that have been brought against healthcare practices by government entities and whistleblowers.

What You’ll Learn:

1. STARK Unveiled: Understand the implications and nuances of STARK regulations.
2. Demystifying the FCA: Explore the False Claims Act and its potential impact on your practice.
3. Navigating AKS: Discover the ins and outs of the Anti-Kickback Statute.
4. HIPAA Decoded: Master the essentials of HIPAA compliance to safeguard patient data and privacy.
5. Liability Avoidance: Learn strategies to proactively avoid liability as a responsible healthcare provider.
6. Nuances and Practical Insights: Delve into each statute’s intricacies and gain actionable insights on avoiding liability.

Who Should Attend:

This webinar is tailored for healthcare providers, revenue cycle and compliance personnel at healthcare practices and facilities, healthcare compliance experts, and healthcare attorneys. Whether you’re a practitioner, administrator, or legal professional, this event is designed to equip you with the legal insights necessary to navigate your role effectively and ethically.

Benefits for Attendees:

Walk away armed with the knowledge to shield your practice from potential liabilities, ensuring that you can avoid both compensatory damages and criminal penalties. By attending, you’ll gain the confidence to make informed decisions that protect your practice and reputation in an ever-evolving legal landscape.

Concrete Results at Work:

Following this webinar, you’ll be empowered to implement actionable strategies that mitigate risks associated with STARK, FCA, AKS, and HIPAA violations. By integrating these insights into your daily operations, you’ll actively safeguard your practice against legal challenges and maintain your commitment to patient care.