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 added, “Failure to formalize these processes and stay away from illegal inducements may result in conflict a with payers.”
At this seminar, industry experts will walk through an audit from start to finish and discuss possible outcomes. They will also address the most frequent issues raised by payers, and how to limit the chances of your practice being audited. You will learn actionable techniques to implement at your facility, and have the opportunity to get your questions answered!
The seminar will be held in Fort Lauderdale at the Infinity Offices on November 8, 2017 from 10:30 AM – 2:00 PM (lunch is included) and seats are limited.
The seminar is part of an ongoing AATA educational series, which offers regulatory compliance resources for eleven states: California, Arizona, Texas, Florida, New York, Illinois, Michigan, Pennsylvania, Washington, Tennessee, and Georgia. AATA plans to make content available to its addiction treatment industry members for all 50 states over the next 12 to 18 months.
AATA membership provides a variety of benefits and helps recovery industry professionals, owners, and operators navigate the evolving clinical and regulatory landscapes. For more information, visit http://www.addiction-tx.com or call (888) 958-2282.