A Healthcare Compliance Attorney for Physicians
In a highly regulated, high-risk industry such as the healthcare industry, regulatory compliance is especially important. Noncompliance can lead to fines, license loss, exclusion from federal programs, lawsuits, criminal charges, reputational harm, and operational disruptions. With potentially severe consequences, this is why you need an experienced healthcare compliance attorney on your side.
Healthcare Compliance Attorney Barney Cohen has decades of experience helping physicians develop healthcare compliance programs. Barney Cohen can help you. Call him now for a free consultation at 872-224-2554 or send an email to: barney@conciergehealthcareattorneysllc.com.
About Healthcare Compliance
Healthcare regulatory compliance is the process of following rules, regulations, and laws that relate to healthcare practices. Most healthcare regulatory compliance issues relate to patient safety, the privacy of patient information, and billing practices.
Key Federal Regulations Include:
- Anti-Kickback Statute
- Emergency Medical Treatment and Active Labor Act (EMTALA)
- Health Insurance Portability and Accountability Act (HIPAA)
- Medicare enrollment and reimbursement
- Stark Law
Healthcare providers must also comply with state-specific requirements, including licensure and certification rules, anti-kickback laws, and corporate practice of medicine (CPOM) restrictions.
Compliance issues can arise during day-to-day practice. They can also arise through healthcare transactions, including healthcare mergers, acquisitions, syndications, joint ventures, divestitures, and organizational restructurings.
Every Physician Deals with Confidential Health Information
Consequently, every physician will need to include compliance with the Health Insurance Portability and Accountability Act (HIPAA) as part of its compliance program. The HHS Office of Civil Rights (OCR) is charged with implementing and enforcing the HIPAA privacy and security rules, and it has provided volumes of guidance on compliance with those rules.
Regulatory compliance in healthcare aids physician practices to avoid trouble with government authorities. An effective healthcare compliance program can identify problems and find solutions to those problems before a government agency finds the problem.
An effective healthcare compliance program can also mitigate against the imposition of sanctions, or financial penalties that might otherwise be imposed on physician practices.
The creation of compliance program guidance is a major initiative of the Office of Inspector General (OIG) in its effort to engage the private health care community in preventing the submission of erroneous claims and in combating fraudulent conduct. According to the OIG, a well-designed compliance program can:
- Speed and optimize proper payment of claims
- Minimize billing mistakes
- Reduce the chances that an audit will be conducted by HCFA or the OIG
- Avoid conflicts with the self- referral and anti-kickback statutes
Office of Inspector General (i.e., OIG) Compliance Program for Individual and Small Group Physician Practices
The incorporation of compliance measures into a physician practice should not be at the expense of patient care, but instead should augment the ability of the physician practice to provide quality patient care.
Each physician practice can undertake reasonable steps to implement compliance measures, depending on the size and resources of that practice. Physician practices can rely, at least in part, upon standard protocols and current practice procedures to develop an appropriate compliance program for that practice. Healthcare compliance attorney, Barney Cohen, has developed compliance programs for other physicians and can do the same for you.
Conducting Appropriate Training and Education
Compliance training educates employees on the laws, regulations, policies, and best practices they need to follow to perform their job duties safely, ethically, and legally. It equips employees with the knowledge to perform their roles ethically, report any concerns, and support transparency and trust with patients and regulators. It also benefits employers by reinforcing a top-down culture of compliance which helps to prevent legal issues as well as protect the organization from liability.
Education is an important part of any compliance program and is the logical next step after potential healthcare regulatory issues have been identified in the organization that could lead to noncompliance with rules and regulations. Subsequently, the practice should designate a person to oversee the educational training.
Ideally, education programs will be tailored to the physician practice’s needs, specialty and size and will include both compliance and specific training. A one-size-fits-all approach is rarely effective in healthcare, where different specialties face different regulatory challenges and operational demands. For example, a dermatology clinic may have different compliance concerns than a behavioral health provider. Customized training ensures that staff receive relevant, practical information that directly supports their day-to-day responsibilities and helps the organization meet its regulatory obligations.
Setting Up Educational Objectives for Training
There are three basic steps for setting up educational objectives:
- Determining who needs training (both in coding and billing and in compliance)
- Determining the type of training that best suits the practice’s needs (e.g., seminars, in-service training, self-study or other programs)
- Determining when and how often education is needed and how much each person should receive
What Trainings Consist Of
Training can cover a wide variety of topics and be delivered through a variety of methods to accommodate different learning styles and practical needs:
- In-person sessions can be conducted either onsite at the physician practice or offsite at specialized seminars and workshops
- Educational content can be shared regularly through newsletters that highlight key compliance topics, updates in regulations, or reminders about best practices
- An office bulletin board placed in a common area can serve as a quick-reference resource where important compliance updates, policy changes, and training announcements are visibly posted and easily accessible
Regardless of the training modality used, a physician practice should ensure that the necessary education is communicated effectively and that the practice’s employees come away from the training with a better understanding of the issues covered. Effective communication means presenting information in an accessible way, avoiding jargon when possible, and tailoring content to the audience’s level of knowledge and job responsibilities. The practice should use interactive elements whenever possible to reinforce key concepts.
Additionally, it is important to verify that employees truly understand the material by soliciting feedback, conducting assessments, or following up with practical applications of the training.
Trainings Should Not Be a One-Time Only Affair
It is also important to note that compliance training is not something that is done once. Compliance training should occur during the onboarding process and then repeated annually throughout an employee’s tenure. These ongoing training help keep compliance top-of-mind for staff, reinforce key policies, and support an organizational culture that prioritizes ethical and lawful operations.
The Goals of Healthcare Compliance Training
Healthcare compliance training is both proactive and reactive. Proactively, it equips staff, providers, and leadership with the knowledge needed to understand and follow federal and state regulations, including HIPAA, the False Claims Act, the Anti-Kickback Statute, and billing and coding standards. Regular, proactive training helps prevent violations before they occur by promoting awareness, consistency, and ethical decision-making across the organization. It also fosters a culture of compliance, where employees feel empowered to identify and report potential issues.
Reactively, compliance training is a valuable corrective tool after a compliance lapse, audit finding, or enforcement action. When gaps are identified, whether through internal audits or external investigations, targeted training can address the root causes of noncompliance and prevent recurrence. For example, if a Medicare billing error is discovered, retraining on documentation standards or coding requirements can quickly correct the issue and demonstrate good-faith efforts to regulators.
When conducting healthcare industry compliance training, there are two goals a practice should strive for:
1. All employees will receive training on how to perform their jobs in compliance with the standards of the practice and any applicable regulations.
- All new employees will receive compliance training during orientation to ensure they understand the practice’s ethical standards, operational procedures, and regulatory requirements from the start
- Training will be tailored to the employee’s specific duties, addressing the particular laws, policies, and risks relevant to their position
- Employees will be instructed on how to maintain accurate and complete records, and how to report concerns or suspected violations internally
- Staff will be trained to respond appropriately in the event of audits or investigations, including cooperation protocols and communication guidelines
2. Each employee will understand that compliance is a condition of continued employment.
- Each employee will be required to review and sign an acknowledgment form confirming their understanding that compliance is a job requirement
- Compliance responsibilities will be incorporated into job descriptions and performance evaluations to reinforce their importance
- Regular training, internal communications, and leadership messaging will continually reinforce that compliance is not optional
- Violations of compliance policies, whether intentional or due to negligence, may result in disciplinary action up to and including termination
In the Event of Investigations/Audits
Sometimes, despite best efforts, regulatory issues can still arise. Some of the main reasons that investigations and audits occur are:
- Compliance Monitoring: ensuring that healthcare providers follow federal and state laws, including billing practices, licensure, and patient care standards
- Overpayment Detection: identifying and recovering improper Medicare or Medicaid payments due to coding errors, lack of documentation, or ineligible services
- Patient Safety Concerns: investigations may arise from complaints or adverse events affecting patient safety or quality of care
- Random or Routine Checks: some audits are random or part of a regular cycle to assess general compliance across provider
- Suspected Fraud or Abuse: triggered by red flags such as unusual billing patterns, whistleblower complaints, or data analytics indicating potential fraud, waste, or abuse
- Whistleblower Claims: allegations made under the False Claims Act can prompt DOJ or OIG investigations into billing fraud or kickback schemes
Regulatory audits and investigations are often very stressful for healthcare practitioners and organizations. Concierge Healthcare Attorneys LLC can:
- Assist healthcare clients facing government investigations, overpayment claims, and False Claims Act allegations
- Conduct regulatory audits, investigations, and appeals related to Medicare reimbursement
- Defend against overpayment allegations by:
- Medicare Administrative Contractors (MACs)
- Medicare payment suspensions
- Office of Inspector General (OIG) audits
- Recovery Audit Contractors (RACs)
- Unified Program Integrity Contractors (UPICs)
- Zone Program Integrity Contractors (ZPICs)
- Represent healthcare clients in enforcement actions by the U.S. Department of Justice, HHS-OIG, and Medicaid Fraud Control Units
A robust regulatory compliance program demonstrates the organization’s commitment to lawful and ethical behavior, which can mitigate penalties or enforcement actions. These programs ensure that documentation is accurate and readily available. It will show that the organization is cooperative and transparent, which can potentially lead to more favorable outcomes.
Healthcare Compliance Attorney Barney Cohen Has the Experience You Need
Healthcare clients work in a space unlike any other professionals. Concierge Healthcare Attorneys LLC speak their language. They understand the healthcare law landscape, regulations they face, and the ins and outs of their day-to-day professional lives. This allows us to offer personalized, concierge-level legal support.
With a proactive, compliance-focused approach and a strong commitment to client service, we aim to ensure that practices avoid audits and investigations, and all associated negative consequences. Healthcare clients know that we prioritize protecting their practice, reputation, and livelihood.
Barney Cohen is intent on helping physicians and group practices avoid the maze of regulatory compliance issues in healthcare. Mr. Cohen has served as a compliance officer, developed compliance programs, conducted in-service training, and written educational documents for physicians on Fraud and Abuse and HIPAA. Using in-depth knowledge of the governing laws, our concierge healthcare law firm can help with policy development and healthcare transaction matters, as well as the addressing of potential infractions of the law. Whatever your circumstances require, we’re here to be your healthcare compliance attorney.
For additional guidance see: Office of Inspector General: Compliance