Martin Merritt, PLLC - The Physicians
If You Are a Physician
Martin Merritt is one of the nation’s leading Health Lawyers, focusing his practice upon the representation of physicians in Medicare Fraud and Abuse litigation and compliance at the lowest possible cost. He is a member of the Health Law Section of the Dallas Bar Association and the State Bar of Texas Health Law Section. Martin Merritt is a regular lecturer and contributor to national health magazines, and writes a weekly blog for Physicians Practice. He is regularly called upon to consult with professionals from across the country on Fraud and Abuse regulations, as well as federal civil procedure techniques in defense of qui tam actions.
At the heart of the problem is the Civil Monetary Penalties (CMP) Statute, which was written especially by the OIG and enacted by Congress to permit the OIG to bypass protection of the federal courts. The OIG takes the position that you must be in “compliance” with Stark Law and the Anti-Kickback Statute as a prerequisite to the submission of a bill to the government for payment. Otherwise, the bill can be deemed a “False Claim” under the CMP as well as the False Claims Act, 31 U.S.C.§§ 3729–3733, or under the Texas False Claims Act, Texas Human Resources Code §§ 36.001, et seq.
False Claims Act cases are usually filed by Whistleblowers under the qui tam provisions of the FCA. Whistleblowers may be a disgruntled employee, a competitor, a RAC auditor, or virtually anyone else. Penalties add up fast, as each bill for treatment is considered a separate violation and subject to a penalty of $11,000 per claim. The lookback period is six years.
Civil Monetary Penalties actions are even more dangerous because they are instituted by the OIG and are handled administratively by judges hired by HHS, whose findings are conclusive as to facts in most cases. Appeals are limited primarily to questions of law. Thus, in Civil Monetary Penalties cases, the organization which wrote the rules, is also the plaintiff, and hired the judge. Further, AKS violations carry as much as a $50,000 fine per claim. Thus, “compliance” is mandatory, if you wish to accept Medicare or Medicaid patients.
Physicians must consult a health lawyer
prior to entering into, or renewing office space agreements, joint
ventures, investments in medical businesses, employment agreements,
medical director agreements, equipment leases, and many others.
Martin is available for a free initial consultation, and can get
started with your compliance issues right away.
Many of the same rules apply to
pharmacists, sellers of durable medical equipment, home health care,
operators of advanced imaging centers, and anyone who provides
services for which Medicare or Medicaid may be liable to pay. While
Stark Law Martin regularly assists these providers on the same terms
as his physician patients.
draft agreements on behalf of medical providers, you may benefit
from bringing Martin Merritt on board for a consult in which you
draft the main document. Martin Merritt will review and draft the
Fraud and Abuse- compliant language. You keep the client.
reads and reports in his newsletter, Merritt’s Health Law Reporter,
each and every federal False Claims Act Opinion of note from across
the country. These opinions reveal why a defendant has been sued,
how the defense under the “First to File” and the “Public
Disclosure” bar to litigation, as well as the results of Iqbal/Twombly
Rule 12 b. 6 and Rule 9.b Motions. Specifically, because fraud and
abuse is subject to Rule 9.b’s heightened pleading requirement, and
the elements of a False Claims Act claim are very specific and
detailed, many plaintiffs fail to properly plead all of the
essential elements. Martin is available for consult and assistance
in these cases.
Martin Merritt, PLLC - Dallas Physician Law. Copyright 2012. All Rights Reserved.