As the health-care industry grows and splinters into sub-specialties, and as the regulatory environment becomes increasingly complex, challenges for health-care companies and their counsel will only increase. Understandably, companies often turn to consultants for expert help in dealing with these issues. While that is a laudable goal, those very consultants pose potential landmines of their own with respect to government enforcement.
Consider the recent announcement by the Department of Justice of the $26 million settlement with Florida-based Shands Healthcare. The allegations were fairly ordinary: The government claimed that several of Shands’s facilities submitted false claims by virtue of billing for inpatient services that should have billed as outpatient services. But the way the case came about was not so ordinary: In 2006, Shands engaged a consulting firm to review various billing issues at its facilities. The consultant later found what it believed to be were billing errors and other compliance issues, such as lack of documentation for medical necessity, excessive billing for observation and inadequate case management.