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
CMS and OIG propose three new value-based care exceptions to remove value-based payment barriersMore
Proposed Changes to the Stark Law and Anti-Kickback Statute Regulations
On October 9, 2019, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services Office of Inspector General issued long-awaited proposed changes “to modernize and clarify the regulations that interpret” the Physician Self-Referral Law (Stark Law) and the federal Anti-Kickback Statute.More
Stark 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.More
Favorable OIG advisory opinion
Assisted a client in obtaining a favorable Office of Inspector General advisory opinion.More
Clinical 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 ...More
False 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 ...More
Compliance 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...More
Proper 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...More
Low income house tax credit valuation
On behalf of one of the largest owner/operators of low-income tax credit properties in the country, successfully litigated the valuation of real property with low-income housing credits in which a ...More
False Claims Act
Advised hospitals on potential False Claims Act exposure; also represented the Ohio Hospital Association and the American Hospital Association in successfully challenging the government's use o...More