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Investigation of Home Health & Hospice by Qlarant

If you’ve been contacted by a company known as Qlarant Integrity Solutions, then your healthcare billing practices may be under review. Qlarant investigates Medicare and Medicaid billing on behalf of the federal government. Qlarant investigations should not be taken lightly; they are authorized to recommend fines and other penalties on companies they determine are violating various provisions of the healthcare laws and regulations. If they find that a healthcare practice may be committing fraud or malpractice, they will refer the matter to the Department of Justice (DOJ) where further penalties, including criminal prosecution, may occur.

If your healthcare practice is facing investigation by Qlarant, you need to retain the services of a seasoned healthcare investigation defense lawyer as soon as possible. You do not want to be caught unawares and unprepared if you become the subject of a formal investigation or enforcement action, whether you are a physician, a pharmacist, a hospital, a hospice, or other healthcare provider. A California home health and hospice investigation attorney at the Law Offices of Art Kalantar can help defend your practice against the actions of Qlarant, ensure that you get a fair and full process, and avoid the consequences of further investigations and enforcement actions.

Who is Qlarant?

Qlarant Integrity Solutions is a private company based out of Maryland that works with federal investigators. Qlarant describes itself as “a non-profit organization whose objective is to fight fraud, wastage of money and improve service delivery in the healthcare sector.” Qlarant is often retained to conduct investigations on behalf of the Centers for Medicare and Medicaid Services (CMS).

Qlarant was chosen as a Unified Program Integrity Contractor (UPIC) along with other private organizations intended to perform fraud, waste, and abuse detection, deterrence, and prevention activities for Medicare and Medicaid claims. Qlarant was named as the UPIC for the Western Jurisdiction in 2017, covering California, Oregon, Arizona, and several other western and southwestern states. They claim to be staffed by former federal law enforcement officers “experienced in investigative techniques that successfully uncover fraud, waste, and abuse for prosecution.”

What to Expect During a Qlarant Audit

Qlarant conducts audits and investigations on behalf of the CMS. They primarily rely on software designed to automatically detect outlier billing practices by scanning through Medicare and Medicaid billing data. Qlarant also boasts that they conduct “boots-on-the-ground” investigations aimed at “the worst potential offenders.” If their initial audits uncover evidence of more pervasive or more severe problems, a fuller investigation can be expected.

“Investigations” and “audits” should be treated as more or less the same from the standpoint of the response. Either process can lead to a DOJ referral and substantial penalties should irregularities be uncovered. They will look for violations of Medicare/Medicaid billing practices such as billing for unnecessary services, unbundling, upcoding, double-billing, coding mistakes, and other intentional or unintentional billing problems. Qlarant also investigates possible violations of the Anti-Kickback Statute and the Stark Law, aiming to uncover unlawful financial relationships among providers participating in the governmental program.

If you are subject to an audit or investigation, get a seasoned healthcare fraud and defense legal team on your side as soon as possible. You’ll need help responding to Qlarant requests, keeping their actions to the proper scope, and identifying potential problem areas before they give rise to federal fines and penalties. The Qlarant investigation defense team at the Law Offices of Art Kalantar will help you protect your practice and your livelihood against overreaching government and contractor investigations.

Trusted, Professional Assistance Responding to Qlarant Investigations

If you or your healthcare practice is facing investigation by Qlarant or another CMS contractor, you need to act fast to protect your practice and, potentially, your freedom. Your business, your finances, your reputation, and your liberty may be at stake. Trust the Law Offices of Art Kalantar and our Qlarant investigation defense lawyer for experienced, thorough, and effective legal assistance and representation with your healthcare law matters in Los Angeles and throughout Southern California.  Call 310-773-0001 at any time to request a free case evaluation with the Law Offices of Art Kalantar in Beverly Hills.

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