Hospitals and the Decision to Retain an Independent Investigator

August 30, 2021 0 Comments

If healthcare is the most regulated industry in the United States, then hospitals are surely the most regulated entity. As if operating on razor-thin margins was not difficult enough, hospitals are forced to comply with an array of federal and state laws that pervade every area of its business. To make matters even worse, many of the laws do not even require a showing of malicious intent – strict liability can even attach to some actions a hospital thinks are innocent. In light of the passage of the new health care reform earlier this year, these trends only will strengthen in the long run as regulations roll out F95zone .

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So what can a hospital do to ensure it is not stumbling onto any regulatory landmines? Many retain in house legal counsel to ensure compliance, and some even retain outside law firms to do the job. However, both have their drawbacks. In house attorneys typically excel at handling more pressing legal matters (i.e. immediate lawsuits), but their reactionary skills sometimes come at the expense of performing more precautionary investigations. On the other hand, hired hands from outside law firms tend to do stellar work but at a price many non-profit hospitals can ill afford.

Fortunately, hospitals have an alternative option in an independent investigator. Independent investigators, especially those experienced in health law issues, know exactly what to look for when on assignment and provide a fresh set of eyes to catch potential problems that may have gone unnoticed. Moreover, their independence adds more credence to a report in the eyes of regulators. Finally, an independent investigator adds to a hospital’s bottom line both through its discounted services and accrued savings from avoiding future lawsuits.

A Special Skill Set for a Special Occasion

Efficient, thorough, and experienced. While a skilled investigator worth its weight in gold will have all three of these qualities, the best ones will stand out with the last one. Hospital administrators and in house counsel will already have an abundance of combined healthcare experience. However, what they lack in investigation-specific experience is best supplemented with an independent investigator.

Independents are best equipped for this job because they use their past experiences from previous hospital visits to determine a baseline from which complying hospitals must build. A tenured general counsel attorney, though excelling at responding to lawsuits and drafting employment agreements, may not have same experience investigating regulatory shortfalls at a variety of hospitals. Administrators may know how to run their hospital better than anyone, but they too may lack in this legal-specific type of investigation. An independent investigator, however, picks up where these two leave off. They understand how to identify coding inconsistencies and point out reimbursement overpayment issues.

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