Webinar: How to Avoid Getting Wiped Out by the Wave of Commercial Payor Behavioral Health Audits
- Date Recorded: October 4, 2018
- Presenters: Paul Gilbert and John Mills
- Length: about an hour
- Price: free
- Questions/Concerns: [email protected] | 888-958-2282
There is a confluence of national and local public policy developments regarding mental health, substance use disorders, and treatment. The federal government, working in partnership with states, addresses behavioral health issues and establishes and enforces minimum standards. States, however, have significant power in making decisions—mental health regulations and available services can look very different from state to state, and even from county to county.
This was part of a partnership between Behavioral Health Association of Providers, Epstein Becker Green, and Nelson Hardiman: offering a winter / spring webinar series that addressed topics highlighting the accelerating legal and policy issues for the behavioral health industry.
The number of commercial payor audits of behavioral health facilities has been steadily rising, forcing closures of multiple treatment facilities, straining resources, and setting up an increasingly contentious conflict between treatment providers and payors.
This webinar examines the most common issues arising in payor audits (including medical necessity; patient financial responsibility; and other issues asserted to constitute fraud, waste, or abuse) and the common arguments used as grounds for the nonpayment or recoupment of fees by insurers. The presenters also review responsive strategies in commercial payor audits and examine defensive strategies and best practices to avoid fraud, waste, and abuse.
Paul Gilbert is in the Health Care & Life Sciences and Corporate Services division of Epstein Becker Green.
Paul regularly represents a broad range of health care provider and private equity clients in transactional, corporate, governance, compliance oversight, strategic, and change and crises management matters. He also counsels health care boards of directors on corporate governance, strategic alternative considerations, compliance oversight, and fiduciary duty matters.
Navigating between regulatory compliance and litigation, the versatility of John A. Mills' healthcare practice and the diversity of his clients provide him with a keen understanding of the unique business objectives and risks facing different segments of the healthcare provider community.
His regulatory compliance work focuses on key issues facing providers that could potentially impede their business operations. He advises clients on managed care and ERISA compliance, voluntary disclosures of possible Medicare over-payments, medical staff and peer review, analysis of business arrangements to ensure compliance with the anti-kickback and Stark laws and provides regulatory guidance to covered entities and contract pharmacies in connection with the federal 340B program.