Compliance Today Publishes Article from Stinson Attorneys on Proactive Approach to Healthcare Billing Audits

01.06.2021

Following a year of uncertainty and numerous new federal rulings, Stinson attorneys Sheva Sanders, Habib Ilahi and Jessica Wheeler published in Compliance Today on the importance of a proactive and strategic approach to billing audits for healthcare companies.

"Appropriate use of billing audits can help you avoid the submission—or allow the timely correction—of incorrect and, at least potentially, false claims. However, in our experience, many companies conduct billing audits only as a response to a crisis," the authors write. "A more proactive approach would be beneficial, allowing healthcare companies to identify and correct errors prior to being called to task."

Included in their guidance is a tailored approach for health care providers and suppliers who submit claims with a focus on billing practices that are likely to affect the government's payment decision and are unlikely to create False Claims Act liability. The authors also recommend self-disclosing possible discrepancies and refunding any overpayments.

Known as a thought leader in the health care and life sciences industries, Sheva is deeply committed to providing timely, comprehensive advice to her clients. She counsels health care, managed care, medical device, pharmaceutical, life sciences and PBM clients on regulatory matters, including fraud and abuse, compliance and reimbursement, and helps her clients bring innovative offerings to market.

As a former federal prosecutor with the Fraud Section of the U.S. Department of Justice, Civil Division, Habib worked exclusively on matters involving the False Claims Act, Anti-Kickback Statute and the Stark Law. He has experience advising and representing pharmaceutical and life sciences companies, hospital systems, national nursing home and long term care facility chains, large and small businesses, and a variety of other types of health care providers in high-stakes investigations and litigation involving Medicare, Medicaid, TRICARE, and other health care programs.

Jessica assists a wide variety of health care clients, including medical device companies, life sciences companies, managed care organizations, and hospitals and providers. With a bachelor's degree in medical biochemistry, Jessica brings a unique perspective on health care law issues.