Healthcare Regulatory Risk Solutions, LLC, Offers Physicians and Other Providers a Strong, Affordable Line of Defense Against Allegations of Medicare/Medicaid Fraud

“The government is campaigning to recoup lost healthcare dollars, and is doing so by targeting physicians for regulatory infractions,” explains Prestera. “Not a week goes by where a regulatory agency does not announce another indictment or settlement. Unfortunately, conscientious, hardworking physicians will be unexpectedly caught up in this and may become embroiled in a dispute with the government for allegations of overpayments, HIPAA violations, identity theft and other enforcement actions. The legal fees will be very costly, as can be the penalties and fines.”

 

Pursuing healthcare providers for Medicare and Medicaid fraud has become a new profit center for the government, according to Prestera and Bagan. In 2009, the government recovered over $2.5 billion in Medicare money and $440 million in Medicaid money paid due to fraud. It is expected that they will recover $3 billion during the first half of this fiscal year alone. Just recently, HHS announced additional funding to specifically target the state of Florida. With a tightening of HIPAA rules and an increase in penalties, a solo practice can now be exposed to penalties of $50,000 for one violation or $1,500,000 a year. Providers need to take strategic action to protect themselves and their practices from the activity of untrained staff which can lead to unexpected prosecution.

 

This is where HRRS enters the picture. By providing convenient, affordable, and user-friendly web-based training and support services, HRRS offers providers a formidable first line of defense. HRRS provides the proper training for staff that is required annually by law: 1) HIPAA training; 2) Fraud, Waste and Abuse training; 3) OSHA training; and 4) the new Red Flags – Identity Theft training promulgated by the Federal Trade Commission. The primary goal of the program, says Prestera, is to help providers train their staffs to prevent the mistakes that can lead to prosecution and penalties.

 

“Our program is designed to help providers and their staff, so that they know exactly what they should and should not be doing in each of these areas,” says Prestera. “The program is web-based and has been structured to be convenient and easy to implement. In a busy physician office, it’s nearly impossible to get the entire staff together for “live” training; it disrupts operations and is costly. With our program, it can be done by each staff member on an individual basis. HRRS makes it simple for physicians (as well as providers of all types) and their practice administrators to ensure that each person gets the required training, so that they are in compliance with regulations. We give the administrators a ‘dashboard’ with which they can monitor the employee’s progress and, if necessary, step on toes to get the training completed.”

 

Christopher Prestera is President of The Physicians Advocate, a firm that specializes in serving physicians in medical professional liability insurance and other healthcare providers in the Medical, Life Sciences and Managed Care industries. Prestera has worked in all aspects of the insurance industry, beginning his career as an underwriter in New York to senior management with medical malpractice insurers and medical professional liability insurance brokers over the past 28 years. Along the way, he was also able to collect his CPCU designation, secure his law degree from Seton Hall University School of Law and has passed the bar exam in two states. Earl Bagan has over 15 years of professional experience in healthcare compliance. He has served as a Director of Regulatory Affairs and Director of Corporate Compliance for several healthcare facilities and has extensive experience in conducting live training in these topics in South Florida and elsewhere. He is a graduate of the Law School at Oklahoma City University.

 

“The HRRS training program was reviewed by certified healthcare attorneys from the prestigious law firm of Broad and Cassel and will be available to provider practices across the nation,” says Prestera. “It’s a response to an emerging and increasingly critical need for physicians, dentists, hospitals, clinics and other providers who need to understand that these training requirements are a serious matter, and are not to be ignored. We offer them an economic solution that gets the job done without interrupting their clinical operations or burdening them with trying to provide the training themselves. We are very excited about the HRRS program and are eager to help providers achieve compliance without a lot of time, cost and effort.”