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Urgent Care Center Compliance

If you own or manage an urgent care center, or if you are thinking about opening an urgent care center as a way to build your own practice, you need to be fully aware of the legal risks involved. Our lawyers and consultants provide comprehensive compliance, transactional, and defense representation for urgent care centers and doctors.

Lynette Byrd

Attorney Lynette S. Byrd
Healthcare Team Lead
Former Federal Prosecutor

Urgent care centers provide patients with easy access to medical care. When a patient does not have time to wait for an appointment with his or her primary care physician and does not need full-blown emergency room care, visiting an urgent care center affords an opportunity to obtain necessary medical treatment without unnecessary delay or expense.

Due to the nature of the services that urgent care centers provide, they are often able to bill at higher reimbursement rates than other providers. This makes the urgent care model attractive for many doctors as well. However, it also makes urgent care centers likely candidates for healthcare fraud audits and investigations. Centers that overbill Medicare, Medicaid, Tricare, and private insurers can face substantial penalties due to intentional and unintentional billing mistakes, and this means that they must make billing compliance a top priority.

Urgent Care Centers Must Manage Their Risk Effectively

But, billing compliance is not the only legal concern for urgent care centers and the doctors who own them. From business and employment issues to licensing action and malpractice litigation, urgent care centers must carefully and strategically address various other legal issues as well. At Oberheiden, P.C., we provide comprehensive compliance consulting and legal representation for urgent care centers and doctors across the country.

Federal Healthcare Compliance and Defense Lawyers for Urgent Care Centers

Our firm is comprised of senior lawyers and expert consultants who offer thorough experience in federal healthcare matters. We have assisted clients in more than 45 states with matters ranging from billing and coding compliance to Drug Enforcement Administration (DEA) investigations, and we have a proven track record at all stages of the federal investigative process. If you are planning to open an urgent care center, we can help you build a compliant practice. If you are unsure of the effectiveness of your urgent care center’s existing compliance program, we can thoroughly assess and address your legal needs. If you are facing a federal investigation or medical malpractice lawsuit, we can fight vigorously to make sure your practice (and your personal finances and freedom) are secure. We also represent urgent care centers and doctors in transactional matters; and, if your medical license is at risk, we can fight to protect your ability to practice as well.

So, how can we help you? Contact us today for a complimentary initial consultation regarding your legal needs in the areas of:

Business Entity Formation and Management

There are various legal and practical considerations that go into choosing the most-appropriate legal entity structure for an urgent care center (or any medical practice). Our lawyers can help you make informed and strategic decisions that allow you to seek outside investment (if necessary) while adequately limiting your personal liability. We can assist you with other business-related legal matters as well, such as franchise and joint venture agreements, partnership disputes, and other similar types of issues.

Employment Relationships

Employment relationships can present unique legal issues in the healthcare context. When negotiating with medical directors, physicians, advanced care providers, nurse practitioners, and other prospective employees, it is imperative to do so with the prohibitions of the Anti-Kickback Statute and Stark Law in mind. There are federal employment tax considerations that must be addressed as well, and all staff members should be appropriately screened in order to mitigate your risk of patient complaints and billing and coding errors.

Third-Party Contracts

Contracts with marketing agencies, lead providers, durable medical equipment (DME) companies, pharmaceutical companies, and other third parties can raise Anti-Kickback Statute and Stark Law implications as well. All third-party contracts should be drafted to avoid statutory violations, and they should provide appropriate protections in the event that your urgent care center faces a lawsuit or federal enforcement action due to a third party’s conduct.

Licensing, Exemptions, and Disciplinary Matters

Our lawyers provide representation for all medical and business licensing matters, including professional license defense, clinic license and exemption applications, and administrative disciplinary proceedings. We can help you if you are struggling to obtain a license or exemption (or if you do not know where to start), and we can help you protect your license and your practice if you are facing allegations of ethics violations, medical malpractice, or other improper conduct.

Billing and Coding Compliance

Billing and coding compliance is one of the areas where most private practitioners first run into trouble. Medicare, Medicaid, Tricare, the U.S. Department of Labor (DOL), and private insurers all have their own unique billing regulations and requirements, and coding errors and other mistakes can lead to denial of payment, pre-payment review, recoupments, fines, exclusion, and other penalties. If your urgent care center is accused of intentionally overbilling a federal healthcare benefit program, you could be charged with a criminal violation of the False Claims Act (and potentially other federal laws as well).

DEA Compliance

All prescribing physicians are subject to registration with, and oversight by, the Drug Enforcement Administration (DEA). If your urgent care center has a pharmacy component that dispenses prescription medications, this raises a number of potential issues that require careful planning and management as well. Violations of the Controlled Substances Act (CSA) carry severe penalties, and losing your DEA registration could be devastating for your urgent care practice. Our lawyers and DEA consultants know what you need to do to avoid these consequences, and we can help you develop and implement an effective DEA compliance program.

Patient Privacy and Recordkeeping Compliance

When you own an urgent care center, Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Act compliance are your responsibility. Our lawyers have worked with numerous doctors in urgent care and other settings to implement patient privacy and recordkeeping policies and procedures that are federally compliant.

Federal Audits and Investigations

When mistakes happen in the healthcare setting, the repercussions can be swift and severe. “Fee-for-service” audit contractors (such as MACs, RACs, and ZPICs) working with the Centers for Medicare and Medicaid Services (CMS) aggressively pursue recoupments from healthcare providers that overbill Medicare, and CMS, the DEA, and other federal agencies are constantly targeting providers in civil and criminal investigations. Our lawyers have extensive experience on both sides of these audits and investigations (several of our lawyers previously prosecuted healthcare fraud cases for the U.S. Department of Justice (DOJ)), and we can promptly intervene to help you avoid unnecessary consequences.

Federal Civil and Criminal Prosecutions

In addition to representing urgent care centers, doctors, and other providers in audits and investigations, we also handle federal prosecutions under the False Claims Act, Anti-Kickback Statute, Stark Law, federal healthcare fraud statute (18 U.S.C. § 1347), and other civil and criminal laws. If your urgent care center gets raided or you are arrested on federal charges, our lawyers can use their experience to defend you.

Medical Malpractice Claims and Litigation

Our lawyers also have a proven track record in private medical malpractice claims and litigation. If you (or any of your physicians, advanced care providers, nurse practitioners, or other employees) are accused of misdiagnosing, failing to treat, or improperly treating a patient’s condition, we can work with you and your malpractice insurer to defend the claim to the fullest extent possible.

4 Key Legal Aspects of Urgent Care Center Operation and Compliance

With these specific types of issues in mind, urgent care centers’ legal needs can be condensed into four key aspects: (i) business and licensing, (ii) documentation, (iii) ongoing compliance, and (iv) proactive defense.

  • Business and Licensing – Business and licensing matters are at the core of any legally-sound healthcare practice. This includes business entity formation and governance, professional licensing, clinical licensing, and employment matters.
  • Documentation – Virtually all aspects of operating an urgent care center require through documentation. This includes compliance policies and procedures, third-party contracts, patient records, and substantiation for reimbursement billings.
  • Ongoing Compliance – For healthcare providers, compliance is an ongoing process. This includes billing and coding compliance, DEA compliance, and patient recordkeeping compliance.
  • Proactive Defense – When an issue arises, reacting swiftly can be crucial to mitigating any potential negative consequences. This includes proactively defending your urgent care center against allegations of billing fraud, Anti-Kickback Statute and Stark Law violations, and medical malpractice.

Contact the Federal Healthcare Compliance Consultants and Defense Lawyers at Oberheiden, P.C.

Are you preparing to open an urgent care center? Do you need help updating or managing your urgent care center’s compliance program? Are you at risk for losing your license (or your freedom) as the result of a lawsuit, audit, or investigation? To learn more about how our federal healthcare compliance consultants and defense lawyers can help, call us at 888-680-1745 or contact us online today.

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