We counsel healthcare providers, physicians, and suppliers regarding regulatory and operational issues. 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
  • 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

CONSULTATIONĀ 

  • 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