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What To Do If You Think You Have a Health Care Business Compliance Problem

Posted by Tracy Green | May 31, 2018

If you are engaged in a business relationship you think is problematic or have been following business or billing practices you now realize were wrong, what do you do?  Every case is different but here are some starting points:
Immediately cease the conduct (for example, cease submitting the problematic bills, unlawful marketing arrangement, etc).
Seek knowledgeable legal counsel.
Determine what money you collected in error from your clients, patients or from federal health care programs or private insurers.  Consider whether to submit corrected billing, self-report and return overpayments or some form of fixing the problem.
Unwind the problematic investment or business venture. Disentangle yourself from the suspicious relationship.
Consider a compliance plan and training employees on the new procedures.
In health care where there has been billing to Medicare or other government health care programs, with legal counsel consider using OIG's or CMS's self-disclosure protocols. The OIG Provider Self-Disclosure Protocol is a vehicle for physicians to voluntarily disclose self-discovered evidence of potential fraud. The protocol allows providers to work with the Government to avoid the costs and disruptions entailed in a Government-directed investigation. For more information on the OIG Provider Self-Disclosure Protocol, see

About the Author

Tracy Green

Past recipient of the Public Counsel Law Center's "Outstanding Advocate" Award, Tracy Green is a founding partner of Green & Associates. She combines more than 25 years of experience with a strategic...

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