Specializing in Chiropractic & Physical Medicine, CCC has the knowledge, experience and expertise demanded for assistance on increasing practice certainty and to bolster healthcare fraud-fighting success, from more than twenty years working in the trenches:
- Training health care professionals on risk reduction strategies for staying or
getting out of the fraud target danger-zone
- Conducting practice audits for health care professionals to facilitate
proactive detection/correction of practice problems
- Aiding health care professionals on implementing/administering ‘effective’
health care compliance programs
- Assisting health care professionals on responding to allegations of
misconduct
- Training health care fraud investigators on proven methods of detecting and
establishing evidence of health care fraud
- Conducting health care fraud investigations and establishing the evidence
to support prosecutions
- Assisting prosecutions of individuals and/or corporations committing health
care fraud
- Expert witness in administrative, civil & criminal health care fraud matters
CCC affords Health Care Professionals, Regulators, Insurers & Law Enforcers timely, insightful and diverse Education & Training Programs (1 to 12 hour blocks, on-site, tele-seminars, webinars...CEUs) to:
- Enhance awareness of health care fraud/abuse issues and developing
schemes
- Raise sophistication level on the laws & rules that govern health care
- Understand common practice mistakes resulting in investigations
- Promote complete documentation and correct coding
- Facilitate timely & accurate reimbursement
- Expand understanding of ‘effective’ healthcare compliance programs with
steps-for-success
- Meet governmental standards for general and specialty compliance
program training
- Advance recognition & detection of health care fraud / abuse
- Foster appropriate actions to address violations
- Encourage use of records (clinical / billing) to isolate violations
- Establish evidence to support (administrative, civil &/or criminal)
prosecutions
CCC affords Health Care Professionals audit services to facilitate the
proactive detection & correction of practice problems and advance
compliance:
- Audits Performed by a seasoned auditor under direction / supervision of client’s legal counsel — ensuring legal guidance available and protection from unwanted disclosures of audit findings
- Executed on-site while practice is open & seeing patients — allows for complete picture of practice activity to offer a comprehensive evaluation & thorough report
- Conducted to detect time-bombs and violations of law — digging deep on behalf of provider as if we were a regulator, insurer &/or law enforcer looking for violations to prosecute; however, what we find is not used against the provider but is used to empower provider with a confidential written report of findings with recommendations for corrective actions to resolve / mitigate existing administrative, civil &/or criminal exposure
- Completed to set (or enhance) the foundation for development (or administration) of an ‘effective’ compliance program — Empower Health Care
Practices & Increase Practice Certainty; meeting audit component of governmental standards for an ‘effective’ compliance program
CCC affords Health Care Professionals (telephonic, on-site & off-site) services for the who, what, when, where, why & how for putting together an ‘effective’ Health Care Compliance Program:
- Auditing, Monitoring & Reporting — baseline audit to set program foundation, ongoing systems to proactively
discover violations of law;
- Overall Compliance Program Oversight — train internal staff on compliance officer (CO) duties. In some cases
we serve as C.O.;
- Compliance Policies & Procedures — specific to practice (based on audit findings) with compliance program forms;
- Education & Training — general and specialty compliance program training, meet government standards on
compliance education & training;
- Due Care in Delegation Authority — employ ‘trust but verify’ system to ensure discretionary authority is not
inappropriately delegated;
- Enforcement & Discipline — launch system to hold representatives accountable for following organizational
compliance standards, and laws & rules governing healthcare;
- Response & Corrective Action — institute mechanisms to ensure timely & appropriate remediation of identified
problems and/or violations.
CCC affords Health Care Professionals, Regulators, Insurers, Law Enforcers & Others (on-site, off-site and telephonic) Investigative Services:
- Respond to Payor Denials & Audits: Review documents, ascertain if denial / audit findings factually based,
direction offered on response.
- Respond to Allegations of Misconduct: Review pending administrative, civil and/or criminal issues, working
closely with provider’s legal counsel, direction offered on response.
- Internal Investigations: Inquiries into potential employee and/or agent misconduct, including interviews of
witnesses and other investigative activity with recommendations.
- Clinic Inspections: Minimal evaluation to identify potential risk areas, including staff activity, patient flow,
service administration, PHI issues, etc., with recommendations.
- Expert Witness Testimony: Fact witness for provider, regulator, insurer and/or law enforcer when dealing
with administrative, civil and/or criminal issues.
- Forensic File Reviews: Review documentation and billing practices—including forms, completeness of notes,
and if billing codes are supported by notes.
- Health Care Fraud Investigations: Detect developing schemes, complete leads, uncover and establish evidence
of fraud to support and further prosecutions.
Contact us for more information about how we can help you. We offer Free Confidential Consultations. |
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