Healthcare Audits Investigations Lawyers

An audit or investigation for a medical practice can mean serious business. Depending on the circumstances surrounding the audit or investigation, there could be severe consequences if fraud or other illegal activity is discovered.

But in order to get through an audit or investigation and come out with your practice and reputation in tact, you need to understand and follow the correct practices. In many cases, that means working with a New Jersey Healthcare Audit Investigations Lawyer.

What are Healthcare Audits and Investigations?

If your practice has never had an audit or investigation before, you may be confused about what the terms mean and what the processes that follow those terms may look like. In many situations, individuals will use the terms audit and investigation interchangeably. Unfortunately, this can be misleading because they are actually quite different.

What is a Healthcare Audit?

Like with any other business, an audit serves the purpose of looking a little more deeply into the purchases and behaviors of the company. Audits will take a look at the way money is being spent, what is being charged, and whether or not those numbers make sense.

A healthcare audit can begin for a number of different reasons. One of the most common reasons an audit may start is if an insurance provider believes that the practice is overcharging for their care and services. An assumption that the practice is overcharging does not necessarily mean fraud is being committed, just that the insurance provider would like additional information to support the price charged.

This same idea applies to audits looking at equipment, services, or products purchased for the medical practice. If an audit on purchases is held, the organization or company requesting the audit simply wants to know if those purchases are legitimate and that they are needed.

But someone else does not always need to spark an audit in the healthcare industry. In an effort to reduce the amount that medical practices are spending, random audits can be performed. These audits aim to take a look at what purchases are being made, what prices are being charged, and if the medical practice can do anything to reduce the amount of money they are spending.

Using an Attorney During a Healthcare Audit

While an audit does not automatically mean serious consequences are around the corner, you may still want to consider hiring a New Jersey Healthcare Audit Investigations Lawyer. Having an attorney on your side can ensure you comply with the audit, you’re presenting all useful and necessary information, and that the auditing process runs smoothly and efficiently.

What is a Healthcare Investigation?

Like a healthcare audit, an investigation looks into the way your medical practice is spending money or charging patients and insurance providers. But unlike an audit, an investigation assumes that fraud or illegal activity has taken place.

An investigation may begin if a insurance company or patient believes that the amount they were purposefully charged too much or that the medical practice has suspicious billing patterns. Investigations can also stem from audits if something was discovered during an audit that could potentially contain fraud. Investigations may also begin if an employee or other individual at the medical practice alerts law enforcement agencies that they may not be following the best billing practices.

Using an Attorney During a Healthcare Investigation

Because an investigation assumes that illegal activity has occurred, it is always advised to use a New Jersey Healthcare Audit Investigations Lawyer. Your lawyer can help protect you by educating you on what you should do or say during your investigation and prevent you from making comments that may get you into trouble later down the road.

A New Jersey Healthcare Audit Investigations Lawyer can also help you develop a defense if your investigation should take you to court. Depending on what is found during the investigation, responsible parties may be facing additional court time, including professional sanctions, civil litigation, or even criminal prosecution. If any of these additional actions occur, you will need an attorney.

You should contact a New Jersey Healthcare Audit Investigations Lawyer as soon as you are aware of an audit or investigation.

baltimore dental license defense lawyers

Baltimore law requires all dental professionals to obtain a state license prior to beginning work in the dental field. This includes everyone from the dental assistant to the dental hygienist to the dentist in the office. Each person is required to uphold medical laws, ethical laws, and a certain level of behavior when working with patients, the healthcare industry, and in their offices. The laws are numerous and complex, and they are designed for the safety both patients and professionals. When a dental professional is accused of misconduct or any form of inappropriateness, the complaint is investigated by the Baltimore Dental Board, and appropriate action is taken.

In Baltimore, dental investigations are broken down into two separate types of accusations. The first type of accusation a patient, a family member, or employee might make regards the overall quality of the facility used. If someone suspects a dental office is using outdated equipment or not adhering to basic hygiene practices, inspectors are sent to the office to perform an in-depth inspection of the facilities. Anything found to be against health codes, state violations, or basic legal laws is subject to a fine. This type of accusation doesn’t mean a Baltimore dentist or professional will lose his or her license. It merely means fines are issued and an overhaul of the issues at hand becomes mandatory.

A dental professional or office might see the suspension of a license if an inspector finds the facility is not where it should be, but all offices and professionals are given an opportunity to fix what’s incorrect. Additional complaints at a later date might result in a more serious misconduct inspection, and failing to pass basic inspections repeatedly might result in more serious punishment.

When a complaint is filed against a Baltimore dental professional that encompasses criminal activity, the game is changed. This type of investigation is not one anyone wants to be accused of. It requires immediate suspension of a professional license with the investigation is ongoing. Dental professionals are required to hand over sensitive medical records, but only for the person who has accused the office of working in an illegal manner. Coworkers, employees, suppliers, and even other patients might be questioned if there is any hint of misconduct in the office, and it can turn into a major situation as soon as the investigation is opened against a dental professional in Baltimore. Criminal misconduct is not taken lightly in Baltimore. These cases usually involve accusations such as:

Healthcare fraud
Sexual misconduct
Substance abuse
– Alcohol or drug use
– Financial misconduct

A guilty party is immediately at risk of losing his or her dental professional license. All guilty parties are referred to the local courthouse, and further investigation becomes necessary. If found guilty of any of the above-referenced issues, the professional immediately loses his or her license and ability to obtain a similar license within the state. Furthermore, anyone accused and found guilty of any of the above-mentioned crimes faces fines and criminal punishment, which could include a prison sentence. Dental professionals are required to work with a sense of ethical importance, which cannot be ignored at any point throughout a dental professional’s career. Criminal misconduct by one person in an office can affect everyone in the office if it’s suspected they have knowledge of the misconduct and/or if patients begin to leave the practice for one not in legal trouble.

When a dental professional is accused of any type of misconduct within the State of Baltimore, he or she is issued a statement from the Dental Board outlining the complaint and the inspection or investigation process. The professional is required to hand over any information found pertinent in the investigation, and her or she must comply with the investigation to the fullest extent. Hiring a Baltimore Dental License Attorney is highly recommended in a case such as this one.

Many people assume they’ll get through the complaint process on their own, but the sheer complexity of the legal issues at hand makes it difficult. It takes time, it takes knowledge, and it affects a professional’s entire future. Anyone accused of misconduct working as dental professional risks losing his or her professional license forever, which means their future is in question.