Description:
Waiving patient cost share responsibilities, including deductibles, coinsurance, and co-payments, carries significant legal risks for healthcare professionals. Both Federal and commercial healthcare programs and plans impose civil and criminal liability in cases of non-compliance. It is essential for healthcare professionals to grasp the intricate legal framework, rules, and potential penalties associated with the waiver of patient cost share responsibilities.
In today’s healthcare landscape, understanding these complex regulations is imperative to protect both patients and medical practices. Failure to comply can lead to severe consequences, including legal actions, fines, and damage to professional reputation. Healthcare professionals must navigate the fine line between providing financial assistance to patients in need and adhering to strict legal requirements.
This session by Thomas J. Force, Esq. aims to shed light on these critical aspects. Thomas will delve into the nuances of the Federal False Claims Act and Anti-Kickback statutes, exploring their defined penalties and implications for healthcare providers. Additionally, he will discuss practical strategies for drafting policies that align with financial hardship, professional courtesy, and prompt payment, while staying within the bounds of the law.
Session Highlights:
- Why is waiving patient cost show responsibility so important.
- Federal False Claims Act liability & penalties
- Anti kick back liabilities
- Impact of Federal health programs versus commercial health plans
- Health Plan sample language
- Analysis of legal cases
- Professional courtesy, financial hardships, and prompt payment discounts
- The reasons why the routine waiving patient cost share is dangerous
- Federal False Claims Act defined with penalties
- The Anti Kick Back statutes defined with penalties
- How to draft a complaint financial hardship, professional courtesy and prompt payment policy
- Analyze typical health plan documents relative to the prohibits of waiving patient cost share basis
Who Should Attend:
- Physicians
- Revenue Cycle Managers
- Physicians Assistants
- Nurses
- Physician/Hospitalist
- Physician office managed by Biling Staff
- healthcare attorneys
- third party billing companies
- Ambulatory Surgery centers & hospital revenue cycle staff
Thomas J. Force
Thomas J. Force is a state and federally licensed attorney with over 34 years of experience in the healthcare and insurance industries. As a former U.S. Marine and a successful Wall Street insurance litigator, Mr. Force served as General Counsel for a New York-based Accident and Health Insurance Company, where he also served as Chief Compliance Officer. These experiences led to the founding of The Patriot Group. Mr. Force is a nationally recognized expert in revenue collection techniques, appeal strategies, and healthcare compliance. He is on the Advisory Board at Hunter Business School, a New York-based school for medical billing and coding students. Mr. Force is an active member and frequent speaker on managed care and collection techniques for the Health Finance Management Association, several state medical associations, and other healthcare organizations. On March 29th, 2022, Thomas J. Force, J.D, Esq, President of The Patriot Group, served as moderator for the forum on Clinical Denial Management at Hofstra University, organized by the Health Finance Management Association – Metropolitan Section. For more information on this forum, please email Mr. Force.