No industry is subject to greater regulatory oversight than the healthcare industry. In no other industry do so many factors – including complex reimbursement processes and government contracting – expose companies to civil and criminal investigations and enforcement actions by both federal and state officials.

Our Healthcare Fraud Task Force provides healthcare clients with multidisciplinary counsel and support for every sort of civil and criminal exposure, including matters relating to the Stark Law and Anti-Kickback Statute, the False Claims Act, various criminal statutes, and Medicare and Medicaid audits by Recovery Audit Contractors (RACs), Program Safeguard Contractors n/k/a Zone Integrity Contractors (ZPICs), Medicare Administrative Contractors (MACs), and Medicaid Integrity Contractors (MICs) and other government and third party payor overpayment disputes with the government. We have successfully represented clients throughout the United States in virtually every type of investigation and enforcement litigation that healthcare companies face today.

Clients come to us when they are under investigation for violating fraud and abuse laws because they need counselors who are experienced in dealing with federal and state authorities, including the U.S. Department of Justice and the United States Attorneys’ Offices, the Federal Bureau of Investigation, various states’ Attorney’s General offices and investigators, and the Office of Inspector General of the U.S. Department of Health and Human Services.

We routinely advise clients in making voluntary disclosures to governmental authorities and assist clients in responding to governmental inquiries. We conduct effective internal investigations and to manage client exposure before, during, and after governmental inquiries. And, whether the matters involve actions brought by federal or state governmental agencies or regulators or by private relators, we have litigated fraud and abuse matters vigorously and successfully on our clients’ behalf. We guide clients through all aspects of their dealings with government agencies and regulators and proactively advise clients on what to expect when facing these challenges. We recognize the importance of avoiding or minimizing corporate criminal and civil liability and understand the relevant governmental policies and priorities that bear on these issues, drawn from our firm’s experience in in governmental policymaking.

While the stakes for such engagements are undoubtedly high, we also understand the importance of minimizing the disruption these issues can cause to our clients’ business. Simply stated, we stand with our clients before, during and after their dealings with healthcare fraud and abuse matters to ensure the best possible outcomes.

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Compliance Task Force

Healthcare providers face ever-changing complex federal and state regulations. Annual changes in reimbursement and modifications in the interpretation of regulatory guidance require providers to continually update internal systems and processes. Recently, Congress has dramatically increased financial resources available to combat both Medicare and Medicaid fraud, waste, and abuse, leading to a significant increase in government audits and investigations. Additionally, compliance programs are now mandatory for all Medicare and Medicaid providers as set forth by the Patient Protection and Affordable Care Act. Because of these challenges, health care providers, now more than ever, need strong compliance programs.

To better assist clients in this area, our firm has established a Compliance Task Force, a multidisciplinary group of attorneys and other professionals with significant experience in all aspects of healthcare compliance. Our Compliance Task Force works with a broad range of healthcare providers in developing, implementing and improving their compliance programs. These providers include individual physicians, physician practices, hospitals and hospital health systems, ambulatory surgery centers, hospices, home health agencies, laboratory providers, behavioral health systems, ambulance providers, and durable medical equipment suppliers.

Our Compliance Task Force counsels clients in each of the elements considered necessary for a comprehensive compliance program by the Federal Sentencing Guidelines and Office of Inspector General's Compliance Program Guidance. We have extensive experience in the following areas:

• Drafting and revising compliance program documents, including but not limited to, Codes of Conduct, policies and procedures, forms, and job descriptions;
• Developing and presenting compliance training programs to Board of Directors, officers, and clinical and administrative staff;
• Developing and reviewing audit checklists for specific risk areas;
• Conducting internal investigations, including coordinating the hiring of outside coding or billing experts, and providing advice on how to handle reporting and repayment of overpayments, as appropriate;
• Representing providers involved in claims audits, including RACs, MICs, ZPICs and MACs, and in any necessary appeals;
• Representing clients in responding to governmental inquiries, and defending whistleblower lawsuits, including, but not limited to, matters brought by the Department of Justice, the Office of Inspector General of the Department of Health and Human Services, various United States Attorneys’ Offices, and state Attorney Generals' offices.

Each member of our Compliance Task Force stays abreast of all current laws and regulations that may impact healthcare providers and their compliance efforts. We also frequently speak to local and national groups, publish articles regarding compliance issues and network with other compliance professionals through our membership in the Health Care Compliance Association and the American Health Lawyers Association. By bringing this sophisticated expertise to the multitude of issues that face the highly regulated healthcare services provider, we produce cost-effective and practical solutions for clients interested in improving their compliance programs.

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Presentations

Date	Topic	Event
August 19-21, 2012	Responding to Government Investigations	THCA/TNCAL Annual Convention
July 30, 2012	Aggressive False Claims Actions, Medical Necessity Determinations and Individual Liability Charges	ACI Advanced Forum on Healthcare Provider Disputes and Litigation
May 24, 2012	When a Contractor Audit Turns into Criminal Prosecution: Learn How to Keep from Being Targeted	RAC University Webcast
May 8, 2012	Medico-Legal Ethics of Off-Label Use of Pharmaceuticals and Devices	Nashville Council of Health Care Attorneys meeting
April 30, 2012	Federal Sanctions and Individual Liability for Non-Compliant Organizations	2012 HCCA Compliance Institute
April 30, 2012	Defending Against Statistical Sampling and Extrapolation	2012 HCCA Compliance Institute
April 17, 2012	Health Care Fraud and Abuse: Preparing for an Investigation and Financial Ramifications	9th Annual World Health Care Congress
March 27, 2012	Claims Audits and Appeals	2012 Compliance 360 Customer Conference
February 22, 2012	What's Ahead for 2012: The OIG Work Plan and Health Care Enforcement Trends	DC Bar Association
February 8, 2012	Medicare Audit and Appeals Workshop: Practical Advice on Preparing for and Responding to RAC, ZPIC and MAC Audits	AHLA Physicians and Physician Organizations Law Institute
December 9, 2011	Off Label Promotion: Recent Enforcement Actions	Q1 Productions Medical Device Regulatory Clearance & Approval Conference
December 9, 2011	The Latest In Healthcare Fraud Prosecutions and False Claims Litigation	Tennessee Bar Association CLE Program
December 2, 2011	When the Whistle Blows: Proactive and Reactive Responses to Whistleblowing	HCCA South Central Regional Annual Conference
November 10, 2011	"Pay and Chase" No More: The Government's Proactive Initiatives to Combat Healthcare Fraud	Western District of Tennessee U.S. Attorney's Healthcare Fraud Task Force Group Meeting
October 17, 2011	Corporate and Individual Risk Mitigation when Responding to a Government Inquiry/Investigation	CBI 13th Annual Guidelines for Disseminating Off-Label Information
October 16, 2011	Beyond the RACs: MACs and ZPICs Coming to a Practice Near You	HCCA Physician Practice/Clinic Compliance Conference
October 13-14, 2011	Recent Topics in Healthcare Oversight and Enforcement	TBA 23rd Annual Health Law Forum
September 27, 2011	Ethical Considerations in a Healthcare Investigation - Protecting the Company's Interests	Nashville Council of Health Care Attorneys Meeting
September 8, 2011	Accountable Care Organizations	Healthstream Webinar
June 1-2, 2011	Beyond the RACs: Medicare Administrative Contractors (MACs) and Zone Program Integrity Contractors (ZPICs) Audits	American Conference Institute's Government Program Integrity Audits
April 7, 2011	Perspectives on Recent Trends in Healthcare Fraud and Abuse Litigation	Tennessee Bar Association CLE program
April 5, 2011	The Future of HIT Today	Nashville Technology Council event
March 8, 2011	Liquidity and Growth Capital Options for Growing Healthcare Companies	Bass, Berry & Sims panel discussion
February 2011	Fraud and Abuse Enforcement Trends in Health Care	Health Law Symposium
November 11, 2010	Pointers and Pitfalls in Gaining Physician Buy-in to a Compliance Program	HCCA South Central Regional Annual Conference
November 11, 2010	Medicare and Medicaid Managed Care and the Provider's Role in Compliance	HCCA South Central Regional Annual Conference
September 2010	Developing a Critical Action Plan	Government Investigations for Life Sciences, American Conference Institute
August 3, 2010	A Conversation on Healthcare Reform with Congressman Jim Cooper	Bass, Berry & Sims event
April 2010	Health Care Reform Fraud and Abuse and Enforcement Initiatives	National Web Seminar
April 2010	Insights on Recent Government Investigative and Enforcement Initiatives in the Medical Device Industry	American Conference Institute
November 12, 2009	Federal Laws that Keep In-House Counsel Awake at Night	Current Issues in Pharmaceutical and Medical Device Litigation Conference, ABA Section of Litigation
September 2009	2009 Health Law Educational Program: The Government Strikes: Responding to Searches and Investigations	National Web Seminar
September 2009	Crisis Management in the Healthcare Setting: A Case Study	National Web Seminar
April 2009	Fraud and Abuse the Sale and Marketing of Drugs	American Conference Institute
January 2009	Fraud and Compliance in the Hospital / Physician Setting	Health Care Financial Management Association

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Publications

Date	Topic	Publication
May 1, 2012	CMS issues hospital outpatient and ASC payment final rule for 2012	Compliance Today, May 2012 issue
February 13, 2012	Smith & Nephew's $22 Million Settlement Highlights Medical Device Industry's FCPA Risk	AHLA Fraud & Abuse Email Alert
December 19, 2011	KV Pharmaceutical Reaches $17 Million False Claims Act Settlement	AHLA Fraud & Abuse Email Alert
October 24, 2011	Incoming! Medicaid RACs Enter the Claims Auditing Arena	Health Reform Impact Alert
September 1, 2011	Budget Control Act Foreshadows Medicare Cuts	Health Law Alert
August 30, 2011	340B Doesn't Get An "A"	Health Law Alert
August 22, 2011	More Efforts To Stop "Pay and Chase:" CMS Launches Predictive Modeling Technology	Health Reform Impact Alert
August 19, 2011	Providers Can Look Forward to MooreCare in Audits	Health Law Alert
August 11, 2011	Breathing Room For Now: CMS Defers Implementation of Final SNF and NF Ownership Disclosures	Health Law Alert
August 1, 2011	Top Compliance and Legal Risks for Healthcare in 2011, Part 1	Compliance Today, August 2011 issue
May 1, 2011	CMS Shifts from 'Pay and Chase' to Proactive Fraud Prevention	Compliance Today, May 2011 issue
November 18, 2010	Maintaining the Attorney-Client Privilege in Change-in-Control Transactions	Health Law Reporter
August 30, 2010	Suit Over Hospital's Closure Could Be a Harbinger	The National Law Journal
June 3, 2010	Kyphoplasty False Claims Settlements Should Prompt Renewed Self-Audits	HealthLeaders Media
May 7, 2010	Electronic Hospitals Face Major New Enforcement Challenges as ZPICs Gear Up Nationally	Report on Medicare Compliance
April 13, 2010	Get Your Compliance Program in Shape to Avoid, Defend Against Auditors	HealthLeaders Media
March 1, 2010	Readying for Another Round of Audits - Medicaid Integrity Program Audits Coming Soon to Tennessee	Nashville Medical News, March 2010 issue
March 1, 2010	Medicaid Integrity Contractors: The Next Audit Initiative	Compliance Today, March 2010 issue
February 24, 2010	ZPICs: Medicare and Medicaid Billing Practices Under the Microscope	Health Care Fraud Report
February 1, 2010	Katrina Settlement Leaves Questions About Disaster Prep	HealthLeaders Media
January 25, 2010	Weighing the Cost of Disaster; Trial Could Raise Stakes for Emergency Planning	Modern Healthcare
January 4, 2010	Eight Healthcare HR Trends for 2010	HealthLeaders Media
January 1, 2010	Avoid Being Drawn Into Billing Fraud	Healthcare Risk Management

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