If you offer health services under the Medicare and Medicaid schemes, you must agree with me how disturbing it is to be visited by Qlarant Integrity solutions (“Qlarant”) auditors or investigators. If you are found with faults, you could suffer the loss of Medicare, recoupments, loss of Medicaid eligibility, or a pre-payment reassessment of subsequent claims. In such a case, you need not worry; our defense lawyers have extensive experience in handling such matters; they’ll come to your aid to prove your innocence.
Qlarant Integrity Solutions (“Qlarant”) is an independent institution tasked by the Center for Medicare and medicaid Services (CMS) with carrying out Medicare and Medicaid audits & investigations. Although this body isn’t under the Federal governments, it’s mandated by them to execute penalties on their behalf. Besides, if Qlarant identifies any form of fraud concerning Medicare or Medicaid, they refer this case to the U.S Department of Justice (DOJ). Such recommendations initiate intensive federal investigations that might result in civil or criminal charges.
If you’re a healthcare provider undergoing Qlarant audits and investigations, it’s vital to seek topnotch defense counsel to avoid harsh penalties. At Spodek Law Group, we have proficient federal defense attorneys with extensive experience in representing health care providers participating in Medicare and Medicaid schemes Nationwide. They have broad knowledge and skills in dealing with Qlarant and CMS contractors. We have registered incredible success in representing our clients and guarding them against tough penalties and recoupments that may come with the audits and investigations. Our defense counsel comprises former federal agents, internal auditors, and other non-legal professionals. This enables us to provide timely, detailed, and well-calculated interventions to bring fast and desired outcomes regarding the Qlarant audits and investigations.
Qlarant Integrity Solutions is an independent contractor that won two contracts in the recent past to undertake investigations on Medicare and Medicaid fraud. This organization has its main offices in Easton, Maryland. Initially, it was referred to as the Delmarva Foundation for Medical Care, Inc. and Health Integrity, LLC. CMS appointed Qlarant in 2018 as its Medicare Drug Integrity Contractor (I-MEDIC). In this task, Qlarant is responsible for handling fraud audits and investigations linked to Medicare parts C& D. In the same year, Qlarant was chosen as the Unified Program Integrity Contractors (UPICs). This contract enables Qlarant to carry out other Medicare and Medicaid fraud audits and investigations in the following territories.
To accomplish this task, Qlarant has hired individuals who have worked previously as federal law enforcement officers in locating dishonesty, misuse, and abuse in Medicare and Medicaid programs. As highlighted in Qlarants website,
“Qlarant investigates potential fraud, abuse, and waste from pharmacies, prescribers, and recipients …..[With a] prime focus ….. on data analysis, complaint intake & response, program integrity and administrative actions…..
“ Qlarant is a nationwide front-runner in fighting [ waste, fraud, and abuse] and has offices and domestic acquaintances all over the country….[It] employs a mixture of data analytics, professional evaluation, and modern technology to offer competent process in line with CMS’s objectives and expectations to benefit Medicare recipients.
You should not harbor false hopes if you’re under Qlarants investigations considering the company isn’t a government organization. Your practice isn’t off the government’s watch because Qlarant is a private contractor. As highlighted before, these audits and investigations may lead to investigations by the federal government. In this respect, face Qlarant audits with a high-level defense strategy and caution as they would do in the case of a federal care fraud investigation.
Qlarants main task as an I-MEDIC &A UPIC is to locate and prevent fraud, misuse, and abuse regarding the Medicare and Medicaid programs. In executing this mandate, it gathers provider’s billing information and scrutinizes their compensation requests via different approaches. In a typical audit or investigation, Qlarant looks for proof of:
Billing made for supplies, services, or equipment that are medically irrelevant. All Medicare and Medicaid reimbursements must meet the set requirements for medical relevance. If a provider doesn’t offer sufficient documentation to prove the medical necessity of the services, equipment, or medical goods they’ve billed to Medicare or Medicaid, the Qlarant auditor or investigator can inflict a considerable recoupment liability on the provider.
Accidental coding and billing errors: Irrespective of the intention, if a provider receives payment from Medicare or Medicaid, as a result of incorrect billing, they must reimburse these funds to the federal government. Billing and coding errors are a key focus in Qlarant audits and investigations. They include upcoding, double-billing, billing for services not offered, unbundling, and presenting incorrect billing code. Such errors can land the provider into recoupments or penalties.
Deliberate billing and coding fraud: The Qlarant auditors and investigators also scout for purposeful billing and coding fraud. If they discover any evidence of intent, the provider may be subjected to immediate liability. This evidence may also be used to initiate criminal prosecution.
Illegal financial arrangements among healthcare providers: Besides scrutinizing the provider’s Medicare and Medicaid billings, the investigators will also seek to uncover any illegitimate financial arrangements between the providers or even medical facilities. Stark law and anti-kickback violations are prevalent and can land such parties in major troubles.
Qlarant has direct access to the provider’s billing information as a CMS contractor. While conducting their investigation, Qlarant is mandated to access healthcare providers and patient’s data. Although most of these audits and investigations are done remotely, Qlarant auditors and investigators also conduct routine visits to clinics, hospitals, and other places where the providers offer their services.
While Qlarant has the right to access the provider’s records for inspection, this authority isn’t outright. For instance, these auditors and investigators can’t ask a provider to allow them to access medical records that lie outside the specific review period. Still, this doesn’t deter them from asking for these records. Healthcare providers must be cautious in such cases to avoid disclosing data that can subject them to liability.
The possible results of Qlarant audits and investigations include no liability to accusations of deliberate Medicare or Medicaid fraud that may result in criminal investigations by DOJ. The outcome for a majority of unrepresented providers lies in between the two extremes. The case is different for those who choose to go with our legal defense experience in resolving federal healthcare fraud issues. In most cases, we ensure these audits and investigations end without recoupments or related penalties.
At Spodek Law Group, we employ various defense strategies to safeguard healthcare providers when faced with Qlarant audits and investigations. Although our representation is to ensure justice for all parties, our ultimate objective is to guarantee the inquiry ends without any penalties or criminal liability for our client.
Some of the defense strategies we apply to protect providers in times of Qlarant audits and investigations include:
Swift and aggressive intervention is critical during Qlarant’s inquiry. It helps to avert overreaching and limits the scope of the audit.
When defending our client, we lookout for any mistakes in the methodologies Qlarants uses in the audits and investigations to challenge the legality of their determinations. For example, if they used any obsolete Medicare or Medicaid billing guidelines, the validity of tier determination is questionable.
While providers should be cautious while disclosing their records to Qlarant, we use the existing documentation to prove there is a lack of sufficient evidence to back claims of Medicare or Medicaid fraud.
Our lawyers and other professionals in the defense counsel can also use your Medicare and Medicaid compliance policies to show you are ready to comply with the law.
If Qlarant is accusing you of overbilling Medicare or Medicaid, our attorney will do their best to refute the allegations and avert the imposition of unfair penalties. They will also defend you against any possible federal civil or criminal investigations.
Todd is a miracle worker who will work tirelessly for you and your family. He is one of the few attorneys i've met - who I earnestly trust to protect me, and who I am happy to refer to our friends and fellow family members. The Spodek Law Group is someone you want on your side, because they will treat you just like family. Todd and his team are available 24/7, and they always answered our calls. Even when we were being irrational, and crazy - they were calm and super helpful. Just call Todd. He gives you a free consultation and is very understanding.- Donna & Robert
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