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

• 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

• Medicare, Medicaid, and private payer denials and overpayment determinations

• Medicare and Medicaid cost report reimbursement issues

• 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