Health Care Compliance & Regulation

Details

Our attorneys analyze and advise on compliance with fraud and abuse including the Anti-Kickback Statute, False Claims Act, and Stark statutes and regulations, cybersecurity, Medicare and Medicaid reimbursement, development and implementation of vertically integrated delivery systems, CON and licensure compliance, provider consolidation, mergers, acquisitions, and joint ventures.

Additionally, our team has significant experience with regulatory aspects of health care mergers and acquisitions, syndications, private equity ventures, divestitures, and restructuring, as well as handling regulatory investigations and audits. Clients rely on our expertise to ensure compliance with federal and state regulations, while private equity firms and healthcare specialty lenders utilize our extensive knowledge of the regulatory environment in investments and commercial finance transactions.

Experience

• Hospital-physician structures and ventures including integration strategies, ambulatory surgery centers, diagnostic imaging centers, and medical office buildings
• Strategic and regulatory counseling, fair market value assessments, managed care contracting and strategy, and negotiation and implementation of contractual and employment arrangements with physicians and other health care providers
• Analysis and advice concerning compliance with Anti-Kickback Statute, Stark, False Claims Act, qui tam/whistleblower investigations, and Medicare and Medicaid reimbursement
• Executive compensation and deferred compensation plans (qualified and non-qualified) including ERISA and IRC Section 409A compliance
• Tax-exempt bond financing and compliance assessments and programs
• Successfully negotiating a waiver agreement with the bond insurer for a major hospital system that was in technical default of its tax-exempt bond covenants
• $300M electronic medical record (EMR) technology agreement for health care system.
• Recovery Audit Contractor (RAC) audits and development of tool kits for internal staff use
• Bond transaction: $29,785,000 Hospital Authority of Effingham County (Georgia) Refunding & Improvement Revenue Anticipation Certificate
• Represented several clinical and genetic testing laboratories in DOJ fraud investigations.
• Represented pharmacies, pharmacists, and other providers/registrants in DEA and state investigations involving dispensing, storage, and violations of the Controlled Substances Act.
• Represented several behavioral health providers in state and federal investigations involving allegations of improper billing, inadequate documentation, and resident misconduct.
• Represented several hospitals before state surveyors and the OIG for alleged EMTALA violations. The engagements included reviews and revisions to policies and procedures.

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