Internal Due Diligence Review Important for Physician Practices

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Whether you’re considering selling your practice, growing your practice or maintaining the status quo, it’s important to periodically do a checkup on your internal operations and compliance with the law. It’s always preferable to discover problems within your practice and correct them (if possible) before those issues are discovered by third parties, such as the government or a potential buyer.

A failure to review your internal operations prior to selling your practice could limit the interest of potential buyers, delay the closing of a sale and reduce the economic benefit to you. Increased attention from recovery audit contractors (RACs) and other government agencies that are tasked with finding instances of Medicare and other government expenditure overpayments may also ensue.

This article describes some key areas to address when conducting a checkup of your practice.

Relationships with Referral Sources

Your relationships with referral sources can be a source of potential risk and should be high on your list in an internal review. This may include meeting and interviewing employees in various roles within your organization to best capture an understanding of these relationships.

Consider using the following questions in your review checklist:

• Do you have any business relationships with referral sources or recipients of your referral?
• Do you have any “discount” or other benefits that are provided to referral sources? If yes, these should be vetted by legal counsel to ensure that such arrangements are permissible under fraud and abuse laws.
• Do you have written internal policies and procedures that ensure compliance with all regulatory requirements associated with your referral relationships?

Marketing & Sales Activities

Review all of your marketing and sales materials to determine if there are any circumstances in which your marketing activities may involve potential fraud and abuse law violations (e.g., referrals from physicians with a financial interest in the practice). Do you have written policies and procedures that address appropriate and inappropriate marketing and sales activities? If not, implementing written policies and procedures and conducting training for all personnel that may be involved in such activities should be a priority.

If your employment agreement includes a restrictive covenant, such as a noncompetition clause, it’s possible that state law may have changed regarding the enforceability of such a provision since the contract was signed.

Financial Documentation Review

Do you regularly review the coding and charge information for your office visits and procedures? This information can change often, and there should be mechanisms in place to capture those changes. Also, do your medical records document the medical necessity of the procedures performed? This could prove important in government audits and post-payment reviews.