New York based healthcare attorneys of Joseph Potashnik & Associates provide a wide range of services to Durable Medical Equipment and Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. This group has their own unique legal challenges, all of which our experienced team of attorneys are very familiar with.

Fraud and Abuse Counseling

The attorneys of  Joseph Potashnik & Associates regularly counsel DMEPOS clients on a number of important issues, with one of the most common being fraud and abuse counseling. Fraud and abuse counseling is performed in an effort to increase compliance with the Stark Law and a variety of state and federal anti-kickback statutes. These statutes can be quite complicated to understand, yet come with severe penalties that could result in a denial of payment or civil fines amounting to several thousand dollars per incident. Our goal is to carefully analyze your transactions to determine you remain in compliance, avoiding costly fines or being excluded from the Medicare program altogether.

Other Common Issues

In addition to fraud and abuse counseling, there are numerous other areas we regularly deal with, such as:

• Buying and selling of DME companies
• Coding and payment regulations pursuant to Medicare and Medicaid guidelines
• Compliance with FDA regulations
• Compliance with HIPAA and other privacy laws
• Contracts
• Durable Medical Equipment (DME) provider counseling for those having relationships with sleep labs
• Issues related to competitive bidding
• Managed care contracting
• Medicare enrollments
• Operations, structural issues, corporate governance and compliance policies
• State and local registration and licensure
• ZPIC, MAC, RAC, Medicaid, or private pay audits and/or appeals
• Miscellaneous regulatory health care matters
• Of course, these issues are not all inclusive. If you are a DMEPOS client and have any other legal concerns, please feel free to contact our office.

Our Legal Experience

One of the things that sets us apart from our competition is the fact that we can offer our clients the benefit of our extensive legal experience in a number of areas. Below are just a few of the areas our team has extended experience in.

Compliance Plans

One of the things Joseph Potashnik & Associates is best known for it provided top-quality compliance plans to health care providers and suppliers of DME. We have developed numerous compliance programs from the ground up, and have been meticulous in ensuring all the necessary details were covered. The programs we have provided have also included compliance training and assistance with self-auditing to make implementing a plan as effective as possible.

Purchase and Sale of DMEPOS Companies

Buying and selling a DMEPOS company comes with its own unique challenges, thanks to the never-ending regulations associated with this industry. Each detail must be carefully attended to in order to ensure compliance with all the necessary regulatory requirements. Buyers must also be aware of the steps that are needed to transfer Medicare billing privileges, in addition to any warranty and indemnification provisions that may apply. Our attorneys will work closely with you to see that nothing is overlooked, to include reviewing the Stark Law and fraud and abuse statutes for potential violations.

Audits

DMEs are one of the most frequently-targeted businesses by Medicare and third party payors when it comes to audits. In fact, one in every four DME supplies was penalized by Medicare during 2008. One of the things we specialize in is Medicare, Medicaid, RAC, ZPIC, and third-party payor defense. Should you encounter an audit, we will work hard to defend your rights and reduce the odds of a very costly, unnecessary penalty.

New York OMIG DME Audits

At Joseph Potashnik and Associates we defended numerous DME entities in OMIG audits. OMIG (the New York Office of Medicaid Inspector General) has been targeting DME companies for potential Medicaid fraud and abuse for years.  Here are the major issue OMIG audits concentrate on:

• No written orders
• No documentation of service
• Durable Medical Equipment billed in excess of the maximum allowance or in excess of the allowable number of refills
• Medical, Surgical supplies billed in excess of the maximum allowance
• Items Billed in Excess of Quantity Ordered
• Items Billed Does Not Match Ordered Item
• No Signature or Written Order
• Missing Information  on written order
• Original order filled beyond acceptable timeframe
• Order filled more than 180 days after it has been initiated by the prescriber
• Unqualified ordering practitioner
• Missing Documentation confirming receipt or delivery of item
• Billing of item prior to delivery
• No explanation of benefits for medicare covered items
• Failing to bill Medicare first
• Other Insurance payments not applied
• Using incorrect codes
• Duplicate Payments
• Unqualified Dispenser
• Billing for service date after patient’s death

Purchasing and Supply Chain Agreements

The process of buying and selling medical equipment and devices also comes with a variety of legal ramifications through violations of fraud and abuse laws, HIPAA guidelines, and FDA regulations. The attorneys here at Potashnik & Associates all have extensive knowledge of these laws, and come with years of experiencing representing suppliers to ensure their compliance. We have extensive experience with drafting, negotiating, and reviewing contracts, in addition to advising clients on matters pertaining to physician-owned distributorships and group purchasing organizations.

Recent Areas of Focus

Our law firm has recently been involved in a number of focus areas. With regards to DME, these focus areas include:

• Billing requirements
• Financial relationships with doctors
• Medical director agreements
• Motorized wheelchair challenges

Some of the areas we have recently focused on concerning prosthetics and orthotics are:

• Compliance with HIPPA
• Custom or prefabricated items
• Fee schedules
• Financial relationships with physicians
• Whistleblower cases

In addition to our extensive experience, our attorneys have also written numerous articles on a variety of legal topics pertaining to DMEPOS suppliers. These articles can be accessed by clicking here. We are also available for speaking engagements by calling 212-577-6677. Please feel free to contact us if you have any other questions or concerns, or have other legal questions related to health care.