Health Care Compliance
Our lawyers represent clients who have corporate compliance obligations and needs. Much of our compliance work has been in the health care industry, where clients include hospitals, nursing facilities, ambulatory surgical centers and freestanding diagnostic and therapeutic facilities; practitioners of all types and their practice entities; health systems; networks of providers and other joint venture organizations; and payment entities.
We also represent companies that provide various types of management and other administrative services to health care providers. Our services for those clients routinely include the following matters:
- Medicare, Medicaid and private insurance billing and payment issues, including administrative appeals;
- Facility operational issues, such as EMTALA, HIPAA and advance directives;
- Compliance programs consistent with guidance from the HHS Office of Inspector General and other regulatory agencies;
- Counseling and defense related to fraud and abuse, self-referral ("Stark Law"), fee splitting and false claims issues;
- Licensure, accreditation, certification and certificate of need issues;
- Managed care contracting;
- Self-Funded Plans; and
- Physician and ancillary provider credentialing, compensation, discipline and related issues.
We also assist clients in designing systems to ensure that their day-to-day operations comply with legal requirements. These include mechanisms to advise our clients of recent developments. For example, we frequently provide our clients with summaries of recent developments relating to Stark Law developments and changes in Medicare coverage and billing rules. In addition, we regularly meet with a group of our hospital clients to educate them on compliance developments. We also present seminars and prepare training materials for our clients' personnel.
We have designed compliance programs for a wide range of clients, including many hospitals and multi-hospital systems that employ physicians, as well as national provider chains, physician groups and billing companies. Our experience has come from dealing with specific problems under the cloud of governmental investigations. We also represent a large group of unrelated hospitals that have formed a cooperative hospital service organization to allow shared efforts in many areas, including compliance programs for physicians.
We have defended health care providers in connection with government audits and commercial payor audits.
FCPA and Other Compliance Programs
We assist our clients that do business globally with their compliance requirements that arise from the Foreign Corrupt Practices Act, the U.K. Anti-Bribery Act, economic and trade sanctions administered by the Office of Foreign Assets Control and the United States Sentencing Guidelines and from other sources. For those clients, we assist from the ground up with the establishment of compliance programs, including anti-corruption policies and procedures, risk assessment, compliance training, and other elements required by the Department of Justice, Securities and Exchange Commission, Office of Foreign Assets Control and other regulatory agencies.
Our lawyers’ extensive experience in the prosecution and defense of corporate criminal and regulatory matters provides great insight into the kinds of compliance systems that will minimize the potential for enforcement action, and where such action occurs, any sanctions that may be imposed.