We counsel healthcare providers, physicians and suppliers regarding operational issues, and represent them in administrative proceedings and state and federal court litigation. We also regularly consult with counsel in other firms and in-house legal departments on transactions and litigation.

ADVICE

  • Medicare and Medicaid payment and reimbursement
  • Billing, coding and medical record documentation for health care claims
  • Coverage, medical necessity, quality and appropriateness issues
  • Licensing, certification, and accreditation requirements
  • Clinical trials and research, and special issues for academic medicine
  • Fraud and abuse
    • Anti-kickback statutes
    • Physician self-referral prohibitions
    • Patient inducement prohibition
    • Civil money penalties issues, such as gainsharing and excluded parties
    • Quality of care issues
  • HIPAA privacy
  • Developing, implementing and evaluating health care compliance programs

REPRESENTATION

  • Appeals from Medicare, Medicaid, and private payer denials and overpayment determinations
  • Medicare and Medicaid cost report reimbursement appeals
  • Provider enrollment and billing privileges disputes
  • Administrative audits and investigations (OIG, PSC, RAC, MAC, Medicaid agencies, etc.)
  • False Claims Act investigations (OIG, FBI, DoJ, Medicaid fraud units)
  • Internal audits and investigations (coordination of consultants and internal staff)
  • Voluntary refunds and self-disclosures
  • Medicare and Medicaid survey and certification actions (decertification, plans of correction)
  • Utilization review and peer review
  • Quality reporting matters

CONSULTATION 

  • Regulatory aspects of healthcare transactions
  • Fraud and abuse analysis
  • Change of ownership
  • Structuring joint ventures, professional services arrangements and management contracts
  • Data arrangements
  • Due diligence review
  • Regulatory and fraud and abuse issues in litigation
    • Health care fraud and criminal false claims prosecutions
    • Civil False Claims Act litigation
    • Private litigation involving regulatory, reimbursement or fraud and abuse issues
  • Second opinions regarding auditor and consultant findings and recommendations