As part of the employment process, most healthcare professionals are subjected to a rigorous credentialing process. Providers usually undergo this credentialing process every two or three years. Further, as part of the credentialing process, the employer is required to oversee the practice of the provider and investigate concerns raised about their practice. If the credentialing body determines that the care being provided is substandard, corrective action may be recommended in such a situation, there are policies and procedures which govern the rights and responsibilities of both parties. These guidelines must usually be strictly adhered to.
These policies and procedures are usually referred to as “Peer Review” investigations and are governed by special statutes, regulations and professional staff by laws. Our attorneys have counseled both institutions and providers about the peer review process so that all obligations are met, all rights are protected, and all proceedings are privileged. We have also represented parties in such proceedings. Finally, we have successfully represented parties before the Massachusetts Supreme Court when the confidentiality and conduct of such peer review proceedings were challenged.
Over the past couple of years our firm as noticed an increase in Medicare fraud and abuse matters being brought against physicians. What starts as questions regarding simple billing errors can lead to recoupment letters requesting a large amount of reimbursements returned to Medicare. As Medicare and other private payors have grown more aggressive in pursuing potential fraud and abuse issues, the need for representation among health care professionals has increased. The rebuttal and appeals process can often be a complicated and strenuous undertaking and one of our experienced attorneys can help guide you through the process. Our lawyers have experience representing health care professionals ranging from hospitals, doctors, labratories, long term care facilities, rehab facilities, pharmacies, and other clients. Our firm handles matters in both state and federal trial court, the appellate level, before regulatory agencies, and before professional boards, such as the Board of Registration in Medicine and the Board of Registration in Nursing.
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