Failure to formalize these processes with diligence may result in conflict with payers if patients are not required to pay their portion; or even worse, conflict with the law if a provider is engaged in illegal forms of patient inducement.
Los Angeles, CA (PRWEB)
September 21, 2017
The American Addiction Treatment Association (AATA) is co-hosting a lunch and learn with Infinity Behavioral Health Services for professionals in the addiction treatment industry entitled: Special Investigations Unit (SIU) – What to Know in a Commercial Payer Audit.
Insurance companies and state and federal governments are increasingly scrutinizing the addiction treatment industry for fraudulent and abusive practices.
“Increased attention on fraud within the addiction treatment industry puts a spotlight on all providers. Audits are now commonplace. And the complexity of addiction treatment regulations can lead even the most well-intentioned professionals to unwittingly fall short of meeting compliance standards. It is imperative that providers fully understand how to comply with regulations,” said Lisa Montague, a regulatory/compliance attorney at Nelson Hardiman.
Professionals need to be prepared when a Special Investigation Unit (SIU) walks through the door. The consequences of noncompliance are significant and include insurance companies refusal to reimburse for services, civil litigation leading to money damages and penalties, and criminal investigations and potential jail time. Many investigations fall under state and federal “false claims” statues, which prohibit the preparation and/or submission of false claims for payment to private insurers or to state and federal programs like Medicaid and Medicare. These statutes impose serious penalties, including triple damages on violators, and give whistleblowers a financial incentive to report fraud.
Compliance with Current Regulations is Critical
“To ensure compliance with the law and meet the expectations of commercial health insurers, it is important to implement sound policies and procedures which govern the financial arrangements made between providers and patients,” according to Max Sirianni General Counsel and Chief Compliance Officer for Infinity Behavioral Health Services. He…