Represented medical imaging company in successful defense of federal False Claims Act investigation arising from the alleged failure to deliver refunds to patients.
Represented hospital in connection with Justice Department inquiry under the False Claims Act into licensing of sleep lab technician compliance with state licensing regulations.
Represented providers and management company to satisfactorily resolve allegations in civil False Claims Act liability and claimed damages of $180 million related to Medicare upcoding, supervision and “incident to” billing noncompliance.
Represented physician and related companies owned by physician in obtaining decision by the U.S. Department of Justice not to indict on allegations of lack of medical necessity as a false claim.
Successfully negotiated a settlement, prior to prosecution, for the administrator of a skilled nursing facility in claims against him brought by federal and state governments under their respective False Claims Act statutes.
Served as counsel to clients in connection with defense of federal false claims allegations, including qui tam whistleblower cases.
Handled regulatory portion of defense of qui tam claim against chain of providers located throughout the southeast.
Represented a health system and an individual hospital in an unsealed qui tam action under the False Claims Act in which the government intervened, alleging a kickback scheme for referrals of obstetric services.
Served as co-counsel with criminal defense attorney on post-trial hearing to successfully overturn convictions for upcoding based on perjury by Illinois Medicaid auditor.
Represented physician-principal investigator at a major academic medical center in investigation and qui tam allegations of improper off-label promotions as a false claim.
Represented nationwide provider of therapy services at skilled nursing facilities in a Justice Department investigation into the medical necessity of services.
Represented hospital and hospital system in conducting internal investigation and responded to Justice Department inquiry regarding the relationship with independent diagnostic laboratories.
Stark Law, Anti-Kickback, Fraud and Abuse Issues
Advised clients on Stark, fraud and abuse and tax exemption issues associated with joint venture arrangements, including compliance issues raised by arrangements with physician investors.
Represented health systems, including academic medical center, and physicians on federal and state regulatory issues and in connection with federal and state investigations of alleged improper billing activities and operations.
Assisted with preparation of disclosure materials under the Office of Inspector General’s provider self-disclosure protocol and CMS’s Stark Self-Disclosure Protocol.
Analyzed various states’ self-referral, anti-kickback, fee-splitting and corporate practice of medicine laws in connection with the syndication of numerous hospitals to physician investors.
Represented hospital clients in connection with restructuring and unwinding of “under arrangements” transactions to comply with changes to Stark regulations.
Successfully represented providers in pre-indictment illegal remuneration (anti-kickback) criminal investigations by the OIG.
Prepared corporate integrity agreement for a home health agency as part of a settlement of False Claims Act case.
Advised clients with respect to self-disclosure and civil money penalty liability for employing excluded individuals.
Advised academic medical center on proposed corporate restructuring, including analysis of Stark implications and other regulatory issues.
Internal Investigations
Conducted internal investigations in responding to allegations from employee whistleblowers relating to billing fraud.
Represented hospital and hospital system in internal investigation in response to anonymous complaint letter regarding alleged test manipulation and Stark Law concerns with hospital employees’ outside work for local provider of durable medical equipment.
Conducted internal investigation and liability exposure analysis for coding compliance issue at contract hospital coding company.
Compliance Reviews and Development
Represented hospitals and physician groups in development and implementation of compliance plans and counseling on compliance issues.
Conducted internal compliance investigations on behalf of health system clients.
Crafted compliant compensation arrangements for various physician services, including employment agreements, recruitment agreements, call coverage arrangements, exclusive hospital-based physician agreements, personal service agreements, and clinical co-management arrangements.
Negotiated corporate-level service agreements with vendors, on behalf of hospital chains.
Analyzed various states’ self-referral, anti-kickback, fee-splitting and corporate practice of medicine laws in connection with the syndication of numerous hospitals to physician investors.
Represented hospice provider in the appeal of improper calculation of hospice cap limitations, which resulted in the recoupment of Medicare reimbursement from the client. Case involved the challenge of the hospice cap methodology.
Licensure, CON and Regulatory Issues
Provided counsel regarding licensing and Medicare/Medicaid certification and enrollment issues in connection with numerous facility acquisitions, which included a merger involving facilities in 17 states for a major public hospital company, and also included the restructuring of home health and hospice operations in 22 states for a large hospital system.
Assisted health system clients with Medicare provider-based issues and related state licensing issues and navigating physician supervision requirements applicable to hospital outpatient departments.
Assisted hospital clients in connection with licensing and regulatory filing requirements in connection with public company mergers and major internal restructuring transactions.
Advised academic medical center on proposed corporate restructuring, including analysis of Stark implications and other regulatory issues.
Represented hospital clients in connection with the acquisition of freestanding outpatient facilities in numerous states, and with the regulatory issues related to conversion of such facilities to hospital outpatient departments.
Represented nurses employed by national dialysis provider in Board of Nursing investigation and physician in Board of Medical Licensure investigation.
Defended facilities, physicians, and other providers in license revocation proceedings.
Represented dozens of providers in responding to routine audits, appeals, fair hearings, and administrative law judge hearings on Medicare and Medicaid audits and overpayment demands, payment suspensions, and loss of provider numbers.
Assisted multiple health system clients in connection with participation in Medicare bundled payment program.
Conducted investigations of billing errors for hospitals, physician practices and billing companies.
Represented providers in numerous Medicare coverage and payment appeals before hearing officers and administrative law judges.
Represented hospice provider in the appeal of improper calculation of hospice cap limitations, which resulted in the recoupment of Medicare reimbursement from the client. Case involved the challenge of the hospice cap methodology.
Represented hospitals, physician practices and national radiation therapy company on Certificate of Need issues.
Successfully represented long term care provider in obtaining the introduction and passage of special purpose legislation that permitted the skilled nursing facility to partition its existing large facility into components, allowing the client to execute their strategic business plans.
HIPAA Compliance
Created and helped implement corporate and HIPAA compliance plans and provided counsel regarding HIPAA compliance matters as well as conducted internal compliance investigations and assisted with preparation of disclosure materials under the Office of Inspector General's provider self-disclosure protocol, and served as counsel to the health information and privacy and security committee of a large health system in Tennessee.
Counseled clients on transactional, regulatory and operational matters related to health information privacy and security.
Analyzed legal and regulatory issues associated with uses and disclosures of health information for hospitals and health systems.
Represented hospital, conducted internal investigation to determine root cause, and coordinated contact with law enforcement following the criminal theft of patient data and related identity theft issues.
Represented hospital and coordinated contact with law enforcement following the criminal theft of hospital’s patient data and fraudulent submission by perpetrator of tax returns.
