While healthcare providers and suppliers play distinctly different roles in the industry, both are subjected to regulations and laws governing the healthcare arena. This particularly holds true for suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The New York healthcare law firm of Norman Spencer & Associates provides a wide scope of services to DMEPOS suppliers, and we’re well-versed in the unique legal challenges these suppliers face.

Our attorneys regularly counsel DMEPOS clients on a variety of legal issues, with one of the most common being abuse and fraud. Abuse and fraud counseling is the means by which we help DMEPOS clients increase compliance with the Stark law as well as federal and state anti-kickback statutes.

These statutes can be rather complicated, and they also come with severe penalties. Penalties can include denial of payment, or civil fines in the range of thousands of dollars per incident. The lawyers at Norman Spencer & Associates can conduct a careful analysis of your transactions to ensure you remain in compliance, thereby avoiding costly fines or Medicare program exclusion.

Our attorneys can help DMEPOS clients with a number of additional issues, such as:

• Selling and purchasing DME companies
• Payment and coding regulations following Medicaid and Medicare guidelines
• Compliance with FDA regulations, HIPAA and other privacy laws
• DME provider counseling for relations with sleep labs
• Contracts, issues with competitive bidding
• Medicare enrollments and managed care contracting
• Structural issues, operations, compliance policies and corporate governance
• Licensure and registration at the state and local levels
• Audits and appeals relating to MAC, RAC, ZPIC, Medicaid and private payors
• Additional regulatory health care issues

The list is by no means conclusive. If you’re facing other legal issues not noted above, feel free to contact our offices.

The lawyers at Norman Spencer & Associates are able to offer clients the benefit of extensive legal experience in a wide range of areas. It’s one of the things that sets up apart.

We’ve developed numerous compliance plans for healthcare providers and DME suppliers, all built from the ground up to ensure all necessary details were covered. Our compliance programs come with compliance training and self-auditing assistance for streamlined plan implementation.

Never-ending regulations can make the selling or purchasing of a DMEPOS company a challenge. Issues to consider include compliance with regulatory requirements, steps required to transfer Medicare billing privileges, and any warranty and indemnification provisions that apply. Our lawyers work closely with you to ensure nothing is overlooked, including a review for potential Stark law or fraud and abuse statute violations.

DMEPOS companies are huge targets for audits by Medicare and third-party payors. In fact, one in four DME suppliers was penalized by Medicare in 2008. Our attorneys work hard to defend your rights and reduce the risk of penalties, with experience providing Medicaid, Medicare, ZPIC, RAC and third-party payor defense.

OMIG audits are another area where an experienced legal team is crucial. OMIG audits concentrate on major issues that include:

• Lack of written orders, information or signatures on orders
• Lack of documentation of service or documentation confirming receipt or delivery of item
• DME billed in excess of the maximum allowance or allowable number of refills
• Surgical and medical supplies billed in excess of the maximum allowance
• Billed items not matching ordered items
• Billed items in excess of quantity ordered
• Billing items prior to delivery
• Billing items after patient’s death
• Orders filled beyond acceptable timeframe
• Medicare-covered items lacking explanation of benefits
• Failure to bill Medicare first
• Incorrect codes, duplicate payments
• Unqualified ordering practitioner, unqualified dispenser

The process of selling and purchasing medical equipment and devices is also subjected to other rules and regulations. You must adhere to abuse and fraud laws, FDA regulations and HIPAA guidelines. The lawyers at Norman Spencer & Associates are intimately familiar with these laws, and we have extensive experience representing DMEPOS suppliers to ensure compliance.

Our services include reviewing, negotiating and drafting contracts as well as advising clients on matters related to group purchasing organizations and physician-owned distributorships.

Recent focus areas related to DME include:

• Requirements for billing
• Financial relationships with physicians
• Agreements with medical directors
• Challenges with motorized wheelchairs

In the field of prosthetics and orthotics, we’ve recently focused on:

• HIPAA compliance
• Financial relationships with physicians
• Fee schedules
• Prefabricated vs custom items
• Whistleblower cases

If you’d like to learn more about legal topics associated with DMEPOS suppliers, our legal team has written numerous articles. You can review them by clicking here (Need to add link). We’re also available for speaking engagements and, of course, legal counseling for your DMEOPOS business. Call 212-577-6677.

Recent focus areas related to DME include:

• Requirements for billing
• Financial relationships with physicians
• Agreements with medical directors
• Challenges with motorized wheelchairs

In the field of prosthetics and orthotics, we’ve recently focused on:

• HIPAA compliance
• Financial relationships with physicians
• Fee schedules
• Prefabricated vs custom items
• Whistleblower cases

If you’d like to learn more about legal topics associated with DMEPOS suppliers, our legal team has written numerous articles. You can review them by clicking here (Need to add link). We’re also available for speaking engagements and, of course, legal counseling for your DMEOPOS business. Call 212-577-6677.