Hospitals and the Decision to Retain an Independent Investigator

In the event that healthcare is the most regulated industry in the United States, then clinics are surely the most regulated entity. As if operating on razor-thin margins was not difficult enough, hospitals are forced to comply with an series of federal and local regulations that pervade every area of its business. To make matters even worse, many of the laws do not even require a showing of malicious intent – stringent liability can even add to some actions a hospital thinks are blameless. In light of the passage of the new health care reform tracking, these trends only will strengthen in the long run as regulations rotate out. Private detectives

So what can a hospital do to ensure it is not stumbling onto any regulating landmines? Many retain internal legal counsel to ensure compliance, and some even retain outside law businesses to get the job done. However, both have their drawbacks. In house attorneys typically get better at handling more pressing legal matters (i. e. immediate lawsuits), but their reactionary skills sometimes come at the price of performing more precautionary investigations. On the other hand, hired hands from outside law businesses are likely to do stellar work but at a price many non-profit hospitals can not well afford. 

Fortunately, hospitals have an alternative option in an independent investigator. Impartial investigators, especially those experienced in health law issues, know just what to look for when on project and provide a new collection of eyes to capture potential problems that may have hot unnoticed. Moreover, their independence adds more credit to a report in the eyes of government bodies. Finally, a completely independent investigator brings to a hospital’s bottom level line both through it is discounted services and built up savings from avoiding future lawsuits.

A Special Skill Set for an Unique Occasion

Efficient, thorough, and experienced. While a skilled investigator worth its weight in gold will have all three of those features, the best ones will stand out with the last one. Hospital facilitators and in house lawyer will already have an abundance of combined health-related experience. However, what they lack in investigation-specific experience is better supplemented with an independent investigator.

Independents are best equipped in this job because they use their past activities from past hospital visits to determine set up a primary from which complying clinics must build. A tenured general counsel attorney, though excelling at responding to lawsuits and drafting job agreements, might not exactly have same experience investigating regulatory shortfalls at many different hospitals. Facilitators may learn how to run their hospital greater than anyone, nevertheless they too may lack in this legal-specific type of investigation. An independent detective, however, picks up where both of these leave off. They will realize how to identify coding disparity and point out refund overpayment issues.

Skilled in such areas as Kampfstark self-referral protocol and the Anti-kickback statute, investigators can also sniff out doctor recruitment issues and probably over-compensated vendors. Finally, experienced investigators know when scholarhip money issues may climb to the level of federal scrutiny from earlier investigations and will take the necessary procedure for correct deficiencies beforehand.

A completely independent investigator with an instinctive feel and fresh collection of eyes will point out structural compliance issues that will help a hospital avoid regulatory issues down the road. A hospital selecting an investigator gets it is biggest investment return when it taps into the auditor’s inherent feel for compliance.

Impartiality With the Eye of the Textbox

Picture the following situation. You are the CEO of a rural medical center and you get a dreaded yet inevitable notice on your desk of the RAC audit. Questions start whirring in your brain: Is my compliance program up to date? Specifically what is the position of our appeals process? Is our coding education system sufficient for the audit?

To the officer that has a complete independent investigator workup from months ago, these questions are quickly assuaged. Certainly not only did the survey preemptively point out all the compliance shortfalls after which you subsequently served, it provided you with exhibit A to provide to the RAC as proof of your careful efforts to curb any illicit practices in your hospital.