Industries & Practices
Compliance, Fraud & Abuse
We protect clients from fraud and abuse violations and stand by them should an investigation occur.
Many of our attorneys focus specifically on fraud and abuse laws, including the Stark Law, the Anti-Kickback Statute, the Overpayment Statute, the Civil Monetary Penalties Law and the False Claims Act. We are skilled at structuring and implementing contracts, transactions and relationships, including hospital-physician relationships, to both comply with these laws and meet the business goals of the organization. Our team is known for identifying potential problem areas proactively and finding solutions that reduce risk.
Additionally, we help clients resolve potential fraud and abuse compliance concerns. We investigate potential violations, develop corrective action/remediation plans and resolve problems effectively.
Our attorneys also have significant experience handling litigation related to fraud and abuse law. We have successfully worked with the Department of Justice (DOJ), the United States Attorneys’ Office, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS), and state attorney generals’ offices to resolve high stakes cases.
Our experience includes:
- Structuring complex health care transactions, including hospital-physician joint ventures, physician recruitment contracts, professional services contracts and other contractual arrangements
- Developing alternative structures and solutions to achieve client goals while reducing the risk of violating fraud and abuse laws
- Restructuring existing contracts and arrangements due to regulatory changes
- Leading or assisting clients with conducting internal compliance investigations of potential violations of law/compliance concerns
- Guiding voluntary self-disclosures of noncompliance and overpayments
- Managing government-initiated matters (audits, investigations, and civil and administrative actions)
- Defending clients in whistleblower (qui tam) actions
- Handling Medicare/Medicaid and commercial payor reimbursement issues
- Providing compliance training to board members, executives and employees
Clinical research budgeting
Advise health system on fraud and abuse considerations in developing a budget for clinical trials.
MoreClinical research fraud and abuse
Advise a health system on fraud and abuse considerations related to a non-employed physician as the principal investigator.
MoreHospital qui tam defense
Defended a hospital and health system in a qui tam lawsuit filed by an employed physician. The lawsuit involved claims that the system submitted false claims to Medicare and Medicaid by bi...
MoreBehavioral health provider counseling
Represent a variety of behavioral health providers in state licensure matters as well as general operational and compliance matters.
MoreStark Law violation defense
Successfully overturned a $10 million overpayment determination in favor of a physician-owned specialty hospital over alleged violations of the Stark Law.
MoreFavorable OIG advisory opinion
Assisted a client in obtaining a favorable Office of Inspector General advisory opinion.
MoreClinical research contracting and compliance
Review clinical trial agreements and related documents, including non-disclosure agreements and informed consent forms, for hospitals engaged in the conduct of clinical research. Advises ...
MoreFalse Claims Act Supreme Court amicus brief
Drafted and filed an amicus brief on behalf of a managed care organization in an important False Claims Act case pending before the U.S. Supreme Court. The issues before the Court were whether and ...
MoreCompliance program assessment, implementation and ...
Conduct annual assessments of health care organization compliance programs and assist in the development and implementation of compliance programs for hospitals and managed care organizat...
MoreProper payment claim methodology
Worked with an operator of long-term acute care hospitals to resolve a dispute with an insurance carrier regarding Medicare and Medicaid plan payments. We identified the source of payment discrepan...
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