HPRP

I have been pretty busy lately with what appears to be a new, more aggressive, unreasonable HPRP Program.  A number of clients have come to me for help and protection from HPRP.   HPRP seems to be demanding extensions of existing contracts several months before they are due to expire.  The demands often are instigated by the slightest causation.  The worse part of it is, in my opinion HPRP is a very dictatorial, aggressive and unreasonable toward its own patients. 

What a lot of health professionals don’t know is that HPRP is a for-profit corporation and I would emphasize the for-profit aspect.  There seems to be some misinformation extant that HPRP services are provided free or that it is some sort of benevolent, charitable organization.  That’s far from the truth.  Participation in the HPRP program is quite expensive and demanding.  If the health professional is unable to pay for services they are deemed to be in breach of contract and they are then threatened that they will be turned over to the State and lose their license to practice.

The threat of taking away a professional’s license because they don’t have money to pay for services is a heavy and frightening hammer indeed.  When an organization has that kind of power, it is up to the State of Michigan, health professionals and lawyers to stand up to the organization to ensure that such power is not abused.  No truer words were spoken when it was said that “power corrupts and absolute power corrupts absolutely”.

Kickbacks

Another very active area in healthcare law is criminal and civil cases involving kickbacks.  With the announcement of scores of kickback indictments in the Eastern District Federal Courts in Michigan it appears there will be a shortage of qualified attorneys to represent them!  The wave of kickbacks in the Eastern District I predict is crested and the Federal authorities will transfer interest to the Western side of Michigan.   And the difference will be that instead of indicting pharmacies, pharmacists, doctors, physical therapists, home healthcare providers, etc. located in urban areas, the focus in the Western half of the state will be on rural providers.

If you are a healthcare provider and are involved in a kickback situation it might be in your interest to contact me rather than wait for the hammer to descend.  Things can be done to mitigate situations.

Additionally, if you are approached by healthcare providers offering disguised kickbacks, please call me.  There are some healthcare providers that might be licensed to be a physical therapist or own a home healthcare agency, etc. but in reality they are criminals who just happen to be operating in the healthcare field. 

Some of these criminals are extremely effective in persuading physician’s assistants, nurse practitioners and doctors that their payment for being a “consultant” or “board of director” in an ACO is not a kickback but a lawful way of getting around anti-kickback statutes.  Don’t think they are so clever, or worse delude yourself into believing that this seemingly free money is a loophole that this genius has been the only one to figure out.

The truth is, if this healthcare provider is kicking back money to you and claiming that this is payment for “mileage reimbursement” or for your purported work as a consultant or board of director, there will come a time when federal law enforcement will challenge you to prove that you put the hours in, did the work and drove the miles.  Don’t think the feds are foolish.  They have vast computer surveillance “data mining” and they are very sophisticated and have seen and heard about every bogus scheme that the local genius can come up with.

If you are running an honest healthcare practice, then you should be concerned about the criminals paying kickbacks.  How can you compete and keep your professional practice thriving when someone else is cheating by paying kickbacks to doctors or other prescribers, etc.?  You will lose income to the cheating criminal every time.  In fact, one tip-off that kickbacks are occurring is when you see a too rapid rise of a particular chain of pharmacies, radiologists, doctor groups, etc.

Who are some new healthcare providers that are in the federal cross hairs now?  Cardiologists doing unnecessary surgical interventions, psychotherapist, and physician’s assistants.  Physician’s assistants unfortunately are easy to rope in to disguised kickback schemes because they often don’t have an attorney who could steer them away from criminal schemes.

In conclusion, when you are approached by somebody claiming that they have a new loophole to avoid income taxes or to pay you for referring healthcare business to them, be realistic.  Give me a call and let’s talk about their proposal.  The odds are the bonus payment or scheme is likely just another disguised kickback that will ruin your life and practice.  You may prosper for a while but in the end a big hammer is coming and you will regret any involvement.